Foot, Ankle & Lower Leg Center

Thursday, November 8, 2012

Diabetic Foot Care Guidelines

Published by the American College of Foot and Ankle Surgeons
Diabetes can be dangerous to your feet – even a small cut can produce serious consequences. Diabetes may cause nerve damage that takes away the feeling in your feet. Diabetes may also reduce blood flow to the feet, making it harder to heal an injury or resist infection. Because of these problems, you may not notice a foreign object in your shoe. As a result you could develop a blister or a sore. This could lead to an infection or a non-healing wound that could put you at risk for an amputation.

To avoid serious foot problems that could result in losing a toe, foot, or leg, follow these guidelines.

Inspect your feet daily. Check for cuts, blisters, redness, swelling, or nail problems. Use a magnifying hand mirror to look at the bottom of your feet. Call your doctor if you notice anything.

Wash your feet in lukewarm (not hot!) water. Keep your feet clean by washing them daily. Use only lukewarm water – the temperature you would use on a newborn baby.

Be gentle when bathing your feet. Wash them using a soft washcloth or sponge. Dry by blotting or patting, and carefully dry between the toes.

Moisturize your feet – but not between your toes. Use a moisturizer daily to keep dry skin from itching or cracking. But DON’T moisturize between the toes – that could encourage a fungal infection.

Cut nails carefully. Cut them straight across and file the edges. Don’t cut nails too short, as this could lead to ingrown toe nails. If you have concerns about your nails, consult your doctor.

Never treat corns or calluses yourself. No “bathroom surgery” or medicated pads. Visit your doctor for appropriate treatment.

Wear clean, dry socks. Change them daily.

Avoid the wrong type of socks. Avoid tight elastic bands (they reduce circulation). Don’t wear thick or bulky socks (they can fit poorly and irritate the skin).

Wear socks to bed. If your feet get cold at night, wear socks. NEVER use a heating pad or hot water bottle.

Shake out your shoes and feel the inside before wearing. Remember, your feet may not be able to feel a pebble or other foreign object, so always inspect your shoes before putting them on.

Keep your feet warm and dry. Don’t let your feet get wet in snow or rain. Wear warm socks and shoes in winter.

Never walk barefoot. Not even at home! Always wear shoes or slippers. You could step on something and get a scratch or cut.

Take care of your diabetes. Keep your blood sugar levels under control.

Don’t smoke. Smoking restricts blood flow in your feet.

Get periodic foot exams. Seeing your foot and ankle surgeon on a regular basis can help prevent the foot complications of diabetes.

Please call Foot, Ankle & Lower Leg Center office located in Las Vegas and the Henderson area, which we have 3 locations to serve you. Call to schedule you appointment @702-878-2455 between 9am to 5pm, Monday thru Friday and closed for lunch between 1pm to 2pm. Please visit our website @ www.FallCenter.com where all of your questions may be answered and to also schedule your appointment.

When pain or injury occurs, you deserve highly personalized treatment using the most advanced techniques. At the Foot, Ankle & Lower Leg Center (FallCenter), you’ll enjoy an unsurpassed level of quality care. Dr. Ricciardi, Dr. Shalev and Dr. McLeod are proud to provide comprehensive solutions for all types of foot and ankle problems.

Your quality care begins the minute you arrive, as our staff greets you by name and answers your questions. Our team of foot and ankle specialists will inspire your confidence and their genuine warmth and compassion will earn your trust.

You’ll receive a prompt and thorough assessment, including on-site diagnostic ultrasound and digital x-rays. Your treatment plan is designed to resolve your condition without surgery whenever possible. When surgery is needed, your feet are in the hands of leading physicians with expertise in the latest minimally invasive techniques. As a result, you’ll be back on your feet and back to your active life as quickly as possible.

Without proper treatment, an injury or chronic condition can keep you from performing even the simplest everyday tasks. To meet patients’ most critical health needs, Dr. Ricciardi, Dr. Shalev and Dr. McLeod have developed the following treatment programs: Bunion Solutions, Heel Pain, Diabetic Foot Care and Sports Performance Center.

Monday, November 5, 2012

What causes foot pain and how to deal with it...

Published by Tampa Bay Times

Imagine walking around the earth — about 25,000 miles — four times. That's how many miles the American Podiatric Medical Association estimates the average person puts on his or her feet in a lifetime. But most of us don't pay much attention to our feet until they hurt — and sometimes we wait until they really hurt.

That's too bad. Because if you seek help early, "most people can be treated with conservative measures," said Dr. Heidi Stephens, a foot and ankle surgeon and associate professor of orthopaedic surgery at USF Health.

Address your foot pain early, and you'll likely relieve it with simple measures such as bracing, taping, padding, stretching, changing shoes, placing orthotic inserts in shoes, taking anti-inflammatory medication or steroid injections. If all that fails, then "we talk about surgical options," Stephens said.

Most foot problems can be prevented, and the ones that can't — bunions, for example, may be genetic — can at least be minimized with commonsense measures. And that doesn't mean being sentenced to life in ugly shoes. "We know we're fighting a losing battle on that one," said Dr. Timothy Runyon of St. Anthony's Hospital and the Tampa Bay Sports Medicine Center in St. Petersburg.

"Women love their high heels. Instead, I try to educate women and help them at least find the appropriate high-heeled shoes and make sure they fit properly." More on that later. First, take a load off your feet and read about the most common foot problems and how to deal with them.

1. Bunions

Bunions are those bony bumps on the side of the foot at the base of the big toe. As they grow, they cause the toe to turn in, toward the second toe.

Causes: Genetics, foot shape, flat feet and wearing tight shoes all put too much pressure on the big toe joint.

Symptoms: Pain, redness and swelling at the base of the big toes; other toes may become painful as the big one crowds them.

What to avoid: High heels, narrow shoes and shoes with a pointed toe box.

What to do: Anti-inflammatory medication, orthotics in shoes to improve arch support and relieve pressure on toes, wearing a foot splint at night.

Next steps: When other toes become painful, you can't find comfortable shoes or daily activities are disrupted, you might consider surgery. Most procedures involve shaving down the bump and realigning the bones of the big toe; usually outpatient. Recovery varies depending on procedure chosen. "The one I like has you walking without crutches in two or three days," said Stephens. "You can do low-impact exercise in two months and high-impact in three months. No shoe shopping for six months."

2. Heel pain or plantar fasciitis

Plantar fasciitis strikes along the bottom of the foot, the ligament that supports the foot arch and connects the heel bone to the toes.

Causes: A weak arch that allows the foot to roll inward, or pronate; flat feet; tight calf muscles or Achilles tendons; running, walking or standing for long periods especially on hard or irregular surfaces; aging; being overweight; wearing shoes that don't fit well, are worn out or are poorly cushioned.

Symptoms: Pain while walking or standing, especially with first steps of the day or after rest. You may find pain improves with activity, then worsens as the day progresses. Foot pain, while climbing stairs or standing on toes (to reach high, for example) also is a sign to watch for.

What to avoid: Don't go barefoot; take a break from pounding exercise like running and jumping rope.

What to do: Stretch the foot and calf muscles with simple exercises throughout the day. Wear shoes with good arch support and well-cushioned soles. Try orthotics to improve arch support and cushion the heel. Lose weight. Try anti-inflammatories. In severe cases, steroid injections, physical therapy or wearing a walking cast to force the foot to rest can be tried.

Next steps: Only about 5 percent of people may need surgery, which usually involves cutting the plantar fascia ligament to release tension along the bottom of the foot. According to Stephens, patients can be up and walking within a couple of days and must wear a protective boot for two to three weeks.

3. Neuroma

Also known as Morton's Neuroma, this is a swollen, thickened nerve in the ball of the foot that can feel like your foot's on fire.

Causes: Toes squeezed together because of tight, narrow shoes, especially high heels.

Symptoms: Sharp, shooting, burning pain in the ball of the foot (usually between third and fourth toes) that worsens with walking.

What to avoid: Tight, high-heeled and/or pointed shoes. Sports and activities that put pressure on the toes.

What to do: Get shoes with lots of toe room; use ice and anti-inflammatories. Get pads for the ball of the foot. Use a device that spreads the toes so they don't squeeze the nerve. Try steroid injections.

Next steps: "This is one you want to treat early to prevent chronic inflammation and swelling, which can cause a wad of scarring around the affected nerve," said Stephens. If it gets too severe, surgery can be performed to remove the affected nerve through an incision on the top of the foot.

4. Achilles tendon problems

Also known as tendonitis, this involves the tendon that connects the calf muscle to the heel bone and allows you to stand up on your toes or push off from your toes when you walk or run. Overuse and abuse, such as during sports, can cause tiny tears in the tissue around the tendon. In severe cases, the tendon can tear or rupture completely.

Causes: This can happen to athletes who engage in repeated pushing off or stop and go movement. But it also happens to out-of-shape middle-aged people who suddenly put a lot of stress on the tendon, or who fail to warm up before exercise. Shoes with poor arch support can be a factor. But an actual rupture usually only happens during vigorous exercise or sports.

Symptoms: Swelling in the ankle area, mild to severe pain that may come on gradually or occur only with walking and running. Athletes notice weakness, less foot strength or less movement in the ankle. A rupture of the tendon usually causes a sudden, sharp pain, a popping sound and collapse.

What to do: Rest — for weeks or even months. Anti-inflammatories, stretching, well-cushioned shoes, shoe inserts such as a wedge-shaped heel lift. Immobilizing the ankle with a walking boot or a lace-up brace. "For many athletes, the ankle brace is all they need to continue their sport," said Stephens. Physical therapy may be prescribed.

Next steps: In severe cases, surgery can be performed to repair the tears or reattach the ruptured ends of the tendon.

Wait! There's more! More reasons your feet hurt:

• Calluses, corns, blisters: Generally develop from poorly fitting shoes or even socks.

• Warts: Caused by a virus and can spread. May need to be professionally removed!

• Ingrown toenails: Avoid by keeping nails cut straight across.

• Toenail fungus, athlete's foot: Can be addressed by keeping feet dry, changing shoes and socks often, avoiding tight shoes. If you get pedicures, bring your own instruments and sanitize them at home. Medication and laser therapy are available for fungus if it's really bothersome.

• Swelling of feet or ankles: Can be caused by poor blood flow, injury, medication side effects, heart, liver, kidney disease. If one leg swells painfully, you may have a blood clot. Seek medical help right away.

• Peripheral neuropathy: Poor blood flow to the feet; bumps and sores become easily infected. Caused by, diabetes and certain drugs, particularly those for cancer.

• Arthritis: May cause painful deformity of the toes.

• Gout: Causes pain, redness, swelling in big toe. See your doctor. Medication and diet changes can help.

• Heel spurs: A bony growth usually from ill-fitting shoes, standing for long periods or being overweight.

TIPS FOR SHOE SHOPPING

What woman hasn't suffered through an event wearing a pair of killer shoes, complete with pointy toes or staggeringly high heels — or both? An occasional evening won't do too much damage, provided you don't topple off your sky-high heels and break an ankle.

But if you love heels, consider a stylish pair of platforms rather than thin-soled shoes. "They have more stability in the long run. The shoe should be inflexible in the forefoot and the heel area firm," says Dr. Timothy Runyon of St. Anthony's Hospital and the Tampa Bay Sports Medicine Center in St. Petersburg.

This Rockport Women's Janae Platform Pump ($78 to $140 at amazon.com) fits the bill. Alternate with lower heels to protect your Achilles tendon — try walking from your car to the office in comfier shoes, then slip on the heels. But note: Ballet flats aren't so great for your feet either. You're better off with a low heel and good arch support.

You live in Florida, you wear flip-flops. The cheap flimsy ones may seem fun, but your feet won't think so, especially if you have plantar fasciitis. Invest in a pair with some arch support like these from Spenco ($44 at Zappos). They're particularly comfy if you have bunions. But remember, they're not for distance walking — gripping them with your toes causes strain over the long haul.

Minimalist running shoes — some of which, like this ZEMgear Men's Terra Barefoot Running Shoe ($70 at runoutlet.com) even fit your toes like gloves — are all the rage. But not among doctors.

"I'm seeing lots more fractures in athletes who use them for long distances and competitions. They're not designed for that," said Runyon, who is team podiatrist for the Tampa Bay Rays and runs marathons in his spare time. Save these trendy numbers for short, 15-minute runs on grass, he advises.

Most of us could use more support, especially for sports. These Brooks Adrenaline GTS 12 shoes are lightweight but supportive enough to win praise from a man who's a 260-pound triathlete.(Similar models are available for women.) They're $110 at Zappos. But unless you're familiar with running shoes, you'd do well to go to a local vendor like Feet First to be fitted with shoes that meet your needs. As Runyon noted, your dress shoe size may not be the same as your athletic shoe size.

Also, when was the last time you had your feet measured? If it's been a while, it's probably time to have a proper measurement taken, especially if you've lost or gained a significant amount of weight, or if you've had a baby. Over time, feet can get both wider and longer, and denial will only lead you to the foot doctor.

Without proper treatment, an injury or chronic condition can keep you from performing even the simplest everyday tasks. To meet patients’ most critical health needs, Dr. Ricciardi, Dr. Shalev and Dr. McLeod have developed the following “Center of Excellence” treatment programs: Bunion Solutions, Heel Pain, Diabetic Foot Care and Sports Performance Center.

Saturday, November 3, 2012

Be sweet to your feet: Diabetic foot ulcers associated with higher risk of early death

Posted on: The Courier-Journal

People with diabetes who have foot ulcers are at increased risk for premature death, often from heart attack or stroke, according to a new study.

The findings stress the need for improved detection and management of diabetes and foot ulcers caused by the condition, according to the researchers at St. George’s, University of London.

Diabetes can damage blood vessels and nerves, especially if a patient’s blood sugar is not well controlled. Poor circulation and nerve damage in the feet make people less likely to notice cuts or other injuries, which can turn into ulcers. In severe cases, foot ulcers can lead to amputation of the foot or leg.

This analysis of data from more than 17,000 diabetes patients in eight studies found that the more than 3,000 patients with a history of foot ulcers had an extra 58 deaths per 1,000 people each year than those without foot ulcers.

The study also found that patients with foot ulcers had more cardiovascular risk factors, such as high blood pressure, and that about half of the additional deaths among these patients were due to cardiovascular causes, such as heart attack and stroke.

Non-cardiovascular deaths among people with diabetic foot ulcers are likely caused by infections and complications such as blood poisoning, according to the authors of the study, which is published in the November issue of the journal Diabetologia.

The results highlight the importance of a two-pronged approach for people with diabetes, the researchers said.

The first is enhanced screening for foot ulcers, because early detection and treatment may help reduce some of the complications of foot ulcers.

The second is lowering cardiovascular risk factors in people with diabetes, study co-leader Kausik Ray said in a university news release.

“Our results warrant further investigation as to whether even greater control of risk factors such as blood pressure, blood glucose and early preventive screening can further reduce mortality among those with foot ulcers,” Ray said. “There is likely an unmet potential to reduce deaths in this group.”

Although the study found an association between diabetic foot ulcers and higher death risk, it did not prove a cause-and-effect relationship.

Without proper treatment, an injury or chronic condition can keep you from performing even the simplest everyday tasks. To meet patients’ most critical health needs, Dr. Ricciardi, Dr. Shalev and Dr. McLeod have developed the following “Center of Excellence” treatment programs: Bunion Solutions, Heel Pain, Diabetic Foot Care and Sports Performance Center.

Wednesday, October 17, 2012

Why Women's Feet Hurt More in Autumn

published by American College of Foot and Ankle Surgeons

Fall is not a fun time of year for women like Elaine Powers. In the summer months, "like everybody else, I like to wear flip-flop sandals, open-toed shoes, a nice pedicure with good nail polish," she says.

But as autumn arrives, the 49-year-old South Carolina hospice nurse is making the annual changeover to closed-in shoe styles more appropriate to the cooler weather. It's a transition many women are making in their wardrobes. But it's more painful for women like Powers, and not because she's a slave to foot fashion. Powers has bunions.

"Even after you take your shoes off, or put your feet up, it's just a throbbing… It's almost like every time your heart beats, that bunion throbs," she says. Women with bunions are a common sight in the waiting rooms of many foot and ankle surgeons during this time of year.

St. Louis foot and ankle surgeon Karl Collins, DPM, FACFAS, gives two additional reasons for this annual trend. One is financial. Women are closer to meeting insurance deductibles near the end of the year. "The other thing is, people are very active in the summer," Collins says. "They're always outdoors, they're always at the pool or whatever, so they will decide to get their bunion fixed in the winter, because in their mind, they're not missing anything fun."

Powers has suffered with bunion pain for nearly 25 years. However, many women never experience pain from their bunions, even when the deformity looks severe. Shoes do not cause bunions, but they may cause bunion pain. That's why foot and ankle surgeons recommend shoe modifications to new patients. Avoiding high heeled shoes and styles that crowd the toes together can help. Collins says proper shoe selection and adjustment can go a long way.

"If they have a shoe that fits well everywhere else, but there's just a little bit of irritation at just that one spot, we may recommend that they have the shoe modified (by a shoe repair shop)," he says. South Carolina foot and ankle surgeon Michelle L. Butterworth, DPM, FACFAS, treats a lot of teachers with back to school bunion pain. She says many women don’t understand what doctors mean about shoe width: It's the front of the shoe that needs to be wide.

"Anything that's real pointy is going to put more pressure on that (bunion) bump," she explains. In addition to recommending shoe changes, foot and ankle surgeons may also prescribe foam- or gel-filled padding, orthotics, anti-inflammatory medications, and injections for bursitis, nerve irritation and joint irritation. While these techniques address pain, they do not stop the bunion from getting worse. Only surgery can correct the deformity.

Bunion surgery boasts a high success rate. But surgeons agree that patients need to understand what their procedure and recovery will involve. "Probably the biggest thing is, they think surgery's not going to work and (the bunion is) going to come back," says Butterworth. "It's probably the biggest myth I dispel."

Powers is one of her patients. "That's one of the reasons why I haven't had this surgery before now," Powers says. "A lot of people tell me once you have (bunions), you are always prone to have them, they'll come back."

Following the surgeon's instructions for recovery can significantly reduce the chances of a bunion returning. "If wearing four-inch heels and working on your feet all day wasn't good for you before the surgery, it's certainly not going to be good for you after the surgery," notes Michael Loshigian, DPM, FACFAS, a New York City foot and ankle surgeon.

Powers hasn't made up her mind about bunion surgery. She's already tried prescription pain medication, and struggles to find comfortable shoes. This fall, Butterworth will perform bunion surgery on Powers' 19-year-old daughter, who inherited her mother's feet. Powers wants to see how that turns out. She also has to worry about finding someone to cover her 12-hour work shifts for several weeks. But if she does choose surgery, she already knows how she'll celebrate after her recovery.

"I'm buying a pair of stiletto heels and I'm wearing them everywhere I go," she jokes.

Without proper treatment, an injury or chronic condition can keep you from performing even the simplest everyday tasks. To meet patients’ most critical health needs, Dr. Ricciardi, Dr. Shalev and Dr. McLeod have developed the following “Center of Excellence” treatment programs: Bunion Solutions, Heel Pain, Diabetic Foot Care and Sports Performance Center.

Tuesday, October 9, 2012

Are Foot Tattoos Sexy?

Published in The Huffington Post

In my reconstructive foot surgery practice, I have seen my share of foot tattoos. Some foot tats are small and discreet, others are large and obvious. Women are usually the ones with the foot ink, not men. Popular seems to be names, vegetation (flowers and vines), stars and oriental wording. Sometimes an elaborate ankle tattoo will extend onto the foot. People have even tattooed the bottom of the foot. Celebrities have been known to get foot tattoos as well.

Some women consider the foot tattoo the ultimate shoe accessory as they continue their hunt for the perfect shoe. Many say they are just plain sexy. Others regret them and want them removed. Wacky and bad taste tats also find their way onto the foot.

There are medical reasons to get tattoos on the foot as some use the ink to detract attention from structural foot problems -- such as bunions and hammer toes (...that's one way to put off surgery). People with flat feet can give the appearance of having an arch by inking concave designs on the inside of the foot. A common tattoo for people with webbed toes is to get a line drawn between the toes.

Sexy??? Perhaps the foot is better off without a tattoo? Nonetheless, that's for you to decide. We would like to hear your thoughts and experience with foot tattoos...

Here are 5 things to strongly consider when planning on getting foot tattoos:

1. They can get tremendous wear and tear.

Shoes cause a lot of friction on the skin of the foot, and this can lead to excessive wearing of the tattoo. Over time, this could result in premature fading and disfiguration of the artwork. For this reason alone, some tattoo artists refuse to place tattoos on the feet.

2. Pain. Pain. Pain

The foot has a lot of nerve endings! The bottom of the foot is particular sensate. The borders of the feet can also be quite sensitive as the skin transitions to the skin on the bottom. Foot tattoos can be more painful to place because there is not a lot of subcutaneous fat or muscle, and people could feel things more. Of course, everyone's pain threshold is different as well as the amount of fat tissue on their feet, but still something to consider.

3. Difficult short-term aftercare

It is well known that tattoo aftercare is surrounded by keeping the skin moisturized and clean, to avoid both scarring and infection. As such, this could be a challenge as one needs to wear shoe gear during the few weeks it takes for a foot tattoo to heal. Also, before getting a foot tattoo, make sure that you don't have a fungal infection hiding between the toes as bacteria can fester in these areas.

4. Removal can be difficult.

There are several methods to remove tattoos -- common methods involve laser, excision or dermabrasion. Laser removal is popular but can be a challenge on the foot because there is not a lot of fat, and can make the removal process more involved. As such, try to avoid placing a tattoo directly over bone -- like on the bunion region. Excision is popular for small tats on the top of the foot.

5. Consider future foot surgery.

If you wear high heels and pointy-toed shoes often, then you may develop bunions and hammer toes, so you should consider that you may undergo surgery for this at some point in your life. As such, your tattoo can get intersected by surgical incisions and could become malaligned. Fortunately, bunionplasty and plastic surgery techniques can minimize this occurrence. Areas where incisions are typically placed are located directly on the tops of the toes, on the inside of the big toe, and behind the 3rd and 4th toe.

What do you think about a foot tattoo?

Please call the Foot, Ankle & Lower Leg Center office in Las Vegas and the Henderson area anytime @702-878-2455 between Monday – Friday (9am to 5pm) and we would be happy to set up an appointment for you. Please visit our website @ www.FallCenter.com.

Without proper treatment, an injury or chronic condition can keep you from performing even the simplest everyday tasks. To meet patients’ most critical health needs, Dr. Ricciardi, Dr. Shalev and Dr. McLeod have developed the following “Center of Excellence” treatment programs: Bunion Solutions, Heel Pain, Diabetic Foot Care and Sports Performance Center.

Monday, October 8, 2012

That Pain in Your Back Could be Linked to Your Feet

Published by: American College Foot and Ankle Surgeons

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!

Without proper treatment, an injury or chronic condition can keep you from performing even the simplest everyday tasks. To meet patients’ most critical health needs, Dr. Ricciardi, Dr. Shalev and Dr. McLeod have developed the following “Center of Excellence” treatment programs: Bunion Solutions, Heel Pain, Diabetic Foot Care and Sports Performance Center.