Back to school backpack injuries

The children are returning to school soon, and all will be carrying their backpacks! Unfortunately, backpacks are often a source of injury, and many recent studies have brought attention to these risks.

Wearing heavy backpacks cause the body to lean forward, risking falls and putting strain on the lower back. The shoulders hunch forward, and the muscles along the spine and ribcage are irritated. As expected, the frequently seen painful areas include the neck, shoulders, and back. However, a recent Italian study found that carrying backpacks can cause pain in the forefoot and arch, especially in overweight children.

Another interesting study of children ages 6-18 years seen in a hospital emergency department for “backpack injuries” found that 89% did not involve the usual bodily locations. The head or face was injured in 22% of patients; the wrist or elbow in 13%; the foot or ankle in 12%; and shoulder in 12%. The mechanisms of injury were wearing backpack, 13%; tripping over backpack, 28%; and getting hit by backpack, 13%!

Injury prevention begins with selection of the appropriate backpack. It should have wide, well-padded shoulder straps, a padded back section, a waist strap, and should be lightweight.

The fully loaded backpack should not weigh more than 10-15% of the child’s weight. The child should be instructed to drop off books and other heavy items into their locker throughout the day if possible. Pack only essential items, and place the heavier items low toward the center of the backpack. Always tighten straps to keep load close to the back. Always use both shoulder straps to carry the backpack. If the child complains of neck, back, or shoulder pain, or pain or numbness of the hands or feet, evaluate the weight of the backpack and its proper use and fit. If the symptoms persist, seek medical advice.

Love those flip-flops?

Flip-flops sandals of every color, design, and material are always popular in the summertime for everyone. But, while these types of sandals are fun, they shouldn’t become the mainstay of your footwear wardrobe.

Wearing flip flops too often can result in foot problems. With no arch support, and no stability, flip flops cause abnormal stress on the plantar fascia (the band of tissue that extends from the heel to the base of the toes).The resulting condition, known as “plantar fasciitis”, usually causes pain in the heel immediately upon arising in the morning or after periods of inactivity during the day.

Plantar fasciitis can be a persistent problem that takes a long time to treat. The best way to deal with the condition is to avoid it in the first place by wearing supportive footwear that provides sufficient shock absorption.

It is not necessary to completely avoid the popular footwear style. But, to save yourself from a lot of unnecessary pain, think of your flip as your dessert, not he main dish in your summer wardrobe and wear them sparingly.

Summer running: Beware the sun

Running in the Florida summer presents its own set of challenges.  Many runners decrease their mileage during this time of year, while others change their  routines to run in the cooler morning or evening hours.  Still others stop running altogether during the summer (not recommended).

Sun exposure is both healthy and dangerous for the skin.  Sun exposure is healthy because it stimulates the body to produce vitamin D.  It can be unhealthy because sun exposure can damage the skin, leading to wrinkles and, even worse, skin cancers.

Sun exposure stimulates the production of vitamin D, thus its nickname as the “sunshine vitamin”.  Vitamin D is also found in many foods.  It has several functions in the body, especially the regulation of bone mineralization.  A lack of vitamin D results and the condition of softening of the bones called osteomalacia.  The pediatric form of osteomalacia is called rickets.  Vitamin D has also been shown to be useful in reducing blood pressure and depression.  It stimulates immune system function and may protect against certain cancers.

In addition to vitamin D production, sun exposure activates a chemical called nitric oxide, large amounts of which are stored in the skin.  Nitric oxide dilates blood vessels, reducing blood pressure, which lowers the risk of heart disease and stroke.  It also increases blood flow to the muscles, increasing power and endurance.

Now the bad news.  The ultraviolet (UV) rays of the sun damage skin.  Up to 90% of age spots and wrinkles are due to sun exposure.  Worse, UV rays cause skin cancer.  Up to 20% of Americans will get some type of skin cancer in their lifetimes.  There are 3 main types of skin cancer: Basal cell carcinoma (BCC); squamous cell carcinoma(SCC); and malignant melanoma.  The BCC and SCC are known as non-melanotic cancers and are not as dangerous as the melanoma. In  the USA, there are 80,000 deaths annually from all skin cancers, with 49,000 from melanoma and 31,000 from non-melanotic cancers.

The BCC is the mildest form of skin cancer.  It usually appears as a raised, smooth, pearly bump on exposed skin.  It also has visible blood vessels, which often bleed.  BCCs rarely spread to other parts of the body (metastasize) and are rarely fatal.

The SCC is more dangerous than the BCC.  It can appear as thickened patches or hard nodules.  It can also bleed or ulcerated.  It metastasizes more frequently than BCCs.

Melanomas are the most dangerous skin cancers.  Globally, 232,000 are reported annually, of which 55,000 are fatal.  Melanomas often begin as moles that change size and shape.  Melanomas are highly metastatic to other organs and then become more difficult if not impossible to cure.

You should check your body for new or changing moles at least monthly.  Any suspicious lesion should be brought to the attention of your physician.  If you are at risk for skin cancers (fair skin, history of previous skin cancers, etc.), an annual skin cancer screening by a dermatologist may be in order

Fortunately, it is possible to enjoy the benefits of the sun while preventing the risks.  This is accomplished by applying sunscreens.  Today’s sunscreens are very effective in blocking UV radiation.  Use one with an SPF (sun protection factor) of at least 30, which will block 97% of UV rays.  Use one that is sweat and water resistant, and apply often to exposed areas.

Unfortunately, the majority of runners still do not understand the risk of sun exposure.  A Runners World survey of 1550 runners found a 36% never wore sunscreen, 36% rarely use it, 19% usually use it, and 9% always do.

The scalp and face can be protected by wearing a book wide brimmed hat. This is very important as skin cancers often affect these areas.  Hats also keep the sun out of the eyes.

UV rays can also penetrate clothing.  A system of UV protection provided by fabric has been developed called UPF (ultraviolet protection factor) rating.  For example, holding with a UPF of 50 allows only 1/50th of UV rays to penetrate.

Finally, consider the eyes.  UV exposure can lead to the development of cataracts.  Wear sunglasses of block 99-100% of UV rays.  This will also prevent BCCs that often form around the nose and eyelids.

In summary, the heat and humidity of summer should not prevent the enjoyment of running.  Remember to stay hydrated and to protect  your skin and eyes from UV rays.

Golfers: Don’t be handicapped with foot pain

This summer when you head to your favorite golf course, make sure  your feet are in shape before you approach the tee.

Many golfers don’t realize that foot pain can be an obstacle to the perfect golf swing. As your body transfers weight from one foot to the other during your swing, the nerves in the ball of your foot may become compressed or irritated and can cause pain.

Another source for pain may be from your big toe joint. When you follow through on your golf swing, the big toe joint on the back foot may bend too far, eventually wearing out the cartilage or jamming the joint. The wear and tear can lead to painful arthritis.

Heel pain can also make it uncomfortable for you to keep a solid stance during critical parts of your swing.

If these areas are causing you discomfort, call our office to schedule an appointment. There are many treatment options available to help keep your golf swing pain free.


Safety Tips For Barefoot Summer

Whether you are walking on the beach, wandering your local park, or

enjoying your own backyard, going barefoot on your adventure is one of the many simple pleasures of summertime.  But bare feet need to beware.  Every summer, our office treats patients for cuts, puncture wounds, and other barefoot injuries.  To help you and your family avoid similar injuries, we are sharing some tips for a safer barefoot summer.


This type of injury can embed unclean foreign objects deep inside your foot and trap bacteria.  A puncture wound must be cleaned properly and monitored throughout the healing process.  This will help to avoid complications, such as tissue and bone infections or damage to tendons and muscles of the foot.


Many patients are surprised to learn that skin cancer, including the most serious form, melanoma, does occur on the feet.  In fact, melanoma of the foot is particularly dangerous because people rarely think to look for it on their feet , which may result in a later stage diagnosis and poor prognosis for recovery.


It’s best to keep your feet protected to avoid cuts and abrasions from rough surfaces and sharp objects hidden beneath sandy beaches and to prevent contact with bacteria, viruses, and fungi that can skin conditions such as warts and athlete’s foot.


Going barefoot can increase your risk for athlete’s foot, warts, calluses, and other problems.  Inspect feet regularly for any changes or signs of problems.  The earlier a skin condition is detected, the easier it is to treat.


Every year, people lose toes from mowing the lawn barefooted.  Others suffer serious burns from accidentally stepping on stray campfire coals or fireworks. Murky rivers, lakes and ponds can conceal sharp   objects underwater.  Plus, those with diabetes should never go barefoot, even indoors, because  their nervous system may not feel and injury and their circulatory system will struggle to heal breaks in the skin.


Keep Young Athletes Injury Free

The majority of athletic injuries affect the foot, leg, or ankle. This is true in both adults and children.To reduce the incidence of sports injuries in children, the American College of Foot and Ankle Surgeons has recently developed some recommendations for injury prevention.

  1. Treat foot and ankle injuries immediately. What seems like a sprain isn’t always a sprain. Aside from ligament injuries, your child might have injured bones or cartilage.Schedule an appointment with our office for proper treatment if your child has a foot or ankle injury. Failure to treat injuries appropriately and in timely manner can lead to long-term instability or arthritis later in life.
  2. Have old sprains checked before a sports season starts. A podiatric surgeon can tell whether a previous injury might be vulnerable to sprains and when an old injury may benefit from wearing a brace or other support during the season.
  3. Get the right shoes for the chosen sport. Each sport requires a different sports specific type of shoe. Football and baseball cleats are not interchangeable.
  4. Start each season with new, appropriately-fitted shoes. Old shoes wear down over time and become uneven on the bottom. When a shoe can’t lie flat, the ankle will tilt, increasing the risk of sprains and strains.
  5. Walk the field before any practice or game.Check for dips, divots, or holes, as most sports related ankle sprains are caused by running or jumping on uneven surfaces. This is especially a risk at nonprofessional settings such as parks. If you notice any irregularities, notify coaching officials.

Following these recommendations should be helpful in preventing athletic injuries. If your child experiences any type of injury, please do not hesitate to make an appointment at one of our offices.

Foot problems in children

When it comes to the feet, children are not “little adults”. Although they may suffer from some of the same conditions as adults, their presentations are different, as are the treatments. Additionally, some conditions are unique to childhood.

A recent study found that 25% of children ages 6-12 years have conditions of the foot or ankle serious enough to require professional treatment. The most common conditions are ingrown toenails, warts, other skin conditions, flatfoot, and gait abnormalities.

The foot and ankle are common locations of injuries in both children and adults. Athletic children are especially at risk for foot and ankle injuries. Ankle sprains are frequent in children, and are usually easily treated with a short course of immobilization. Fractures (broken bones) are also common in children. These often affect the growth plates of bones and can be difficult to diagnose, even with specialized X-rays. Our doctors have expertise in the diagnosis and treatment of these growth plate, or Salter, fractures. Any injuries to bones in children should always be evaluated for these fractures.

Children are prone to many skin conditions. Rashes due to fungal infections or to contact with irritants (contact dermatitis) are very common and are usually easily treated with prescription topical medications.

Warts are benign skin growths caused by viral infection. They often occur on the sole of the foot (plantar warts), and also between the toes. They can be painful with weightbearing and with shoe pressure. They are usually successfully treated with prescription topical medications.

Ingrown toenails are the most common condition of the foot in both adults and children. They can be caused b y improper trimming, tight shoes, injury, or hereditarily misshaped nails. They are easily treated with a simple procedure performed right in the office.

About 34% of children have flatfoot deformity, 7% of which are severe. This can result in pain and imbalanced gait. Usually, in-shoe insoles can improve and control the condition.

Although many very young children walk on their tip-toes, most outgrow this habit as toddlers. About 1% of children continue to toe walk. These children often have tight Achilles tendons and can be treated with a course of bracing and shoe insoles.
Other gait abnormalities such as in-toeing and out-toeing are occasionally seen. These must be carefully evaluated to determine their causes and appropriate treatments.

In summary, children have a variety of possible foot and ankle problems, all of which the doctors at Melbourne Podiatry Associates can evaluate and treat. A referral is not usually necessary. Please call our offices for your appointment.

It’s Only an Ankle Sprain

Ankle injuries are some of the most common injuries in the body. Often, these injuries are sprains, or damage to the ligaments that hold the ankle joint together on either side.

Ankle sprains account for 45% of all sports injuries and 16% of all hospital emergency department visits. Although many of these injuries are relatively minor, 19-72% of patients with ankle sprains will have another sprain on the same ankle, and 70% will develop chronic ankle instability (CAI).

Because ankle injuries are often insufficiently diagnosed and treated, the incidence of later complications remains excessively high. Unfortunately, patients are told that “It’s only an ankle sprain”, and the treatment, if any, is minimal.

To understand the reasons for complications of ankle injuries, one must understand the anatomy of the ankle. The outside or lateral portion of the ankle joint is held together by 3 ligaments, while the inside or medial portion of the ankle joint itself together by 4 ligaments. The lateral ligaments are weaker than the medial ligaments, so most (85%) of ankle injuries involve the lateral side.

Ligaments have poor blood supplies, so they take a long time to heal. Some studies have found that it takes up to 6 months for an ankle ligament to regain full strength. Protection of healing ligaments with bracing during the healing phase can help to prevent reinjury and CAI.

In addition to ligament damage, ankle injuries can involve tendons and bones. Sometimes, these injuries are subtle and difficult to diagnose. Special diagnostic testing and special imaging techniques are sometimes necessary. Failure to properly diagnose and treat these injuries can lead to arthritis and other problems.

The physicians at Melbourne Podiatry Associates are experts in all injuries of the foot and ankle. If you have any ankle injury, no matter how seemingly minor, call ouroffices for an appointment.


While the joy of motherhood may be one of life’s most precious gifts, expectant mothers have to endure the rigors of pregnancy before they can experience baby bliss. As a woman’s waistline expands, healthy weight gain during pregnancy can alter one’s center of gravity causing a sway -back posture called lordosis. This new posture, coupled with weight gain, can create pressure on the knees, legs and feet. Some of the most common lower extremity elements that pregnant women experience are swollen feet, overpronation (flattening of the arch), and cramps in the legs and feet.

Swelling, or edema, of the foot and ankles results from increased pressure on leg veins and hormonal factors. This can result in feelings of heaviness and pain, and enlarged or varicose veins can develop. Elevation of the legs, frequent stretching while sitting, and waist high maternity support stockings can be helpful.
Flattening of the arch (pronation) occurs during to increased weight on the foot and hormonal influences. The foot may actually permanently increase in size. The plantar fascia tendon of the arch can become chronically inflamed, causing heel or arch pain (plantar fasciitis). These symptoms can be improved with the use of well -cushioned supportive shoes, and with insoles that your podiatrist can provide.
Falls are another frequent problem in pregnancy, affecting 27% of pregnant women, 10% of whom have recurrent or continued falls. These are due to imbalances caused by increased pelvic tilt, wider stance, and increased joint laxity. Because falls can lead to risk of injury to the mother and/or baby, they should be aggressively prevented. This is accomplished with proper shoe gear, insoles, and ankle bracing.
Many conditions described in pregnancy continue after delivery. These include enlarged feet, plantar fasciitis, edema, varicose veins, balance problems. These postnatal problems require evaluation and treatment as well.
Many gynecologists and obstetricians are knowledgeable about the services that podiatrists can provide to their pregnant and postpartum patients and refer them. However, you do not need a referral to visit us. If you are pregnant or postpartum and have any problems related to the foot, leg or ankle, please call for an appointment.


“Flatfoot” in children is a very controversial and misunderstood topic.  It can range from a very mild, insignificant variation of gait to a severely deforming condition.  It can have several causes, and treatment can vary in each case.  For these reasons, it is essential that children with flatfoot be evaluated by a podiatrist.

Flatfoot, also called “pronation”, and “pes planus”, is the flattening of the arch with weightbearing.  Because this produces an imbalance in gait, the feet must  externally rotate to gain balance.

A recent European study found that flatfoot accounted for 19% of all childhood visits to podiatrists.  This percentage is higher than previously suspected.

Due to looseness (laxity) of foot ligaments,98% of  18-month-old toddlers have flexible flatfoot.  These figures decrease to 24% of children of age 6 years, due to development of the medial arch in early childhood.  However, 7% of children of this age have more severe, rigid flat feet.

The majority of flexible flatfoot cases are asymptomatic.  However, some children do become symptomatic .  Common symptoms can include pain along the inside of the foot, pain along the outer foot beneath the ankle, diminished walking endurance, pain along shins, knee pain, back pain, and abnormal or clumsy gait.

All cases of flatfoot should be evaluated by a podiatrist.  Although many do not require any treatment, only an expert in the foot and ankle can properly evaluate this.  If the case is severe enough to require treatment, early treatment is crucial to prevent progression of symptoms and compensation and degenerative changes while aging.  Unfortunately, too many parents are told that the child will “grow out of it” and do not seek treatment, often leading to later problems.

Fortunately, the vast majority of cases needing treatment are treated nonsurgically, usually with some type of in-shoe insole device or orthotic.

If your child has flatfoot or any other gait disorder such as intoeing, out toeing,  or toe walking, call our offices for an appointment.