And Lower Extremity Stress Fractures

Dr. Breithaupt was puzzled. The year was 1855, and this Prussian army doctor was noticing that many of his young military recruits were experiencing severe pain in their feet or ankles early in their basic training, particularly after prolonged marching. Dr. Breithaupt discovered that the soldiers were actually developing incomplete fractures of the bones from overuse. He called the condition “march foot , and wrote the first paper describing it. Today we call it “stress fracture”.

Stress fractures are defined as incomplete partial fractures of bones. They comprise 10% of all sports injuries, with 99% of them occurring in the lower extremity.

Unlike “pathological fractures” which occur in weakened or porotic bone (especially in elderly patients), stress fractures occur in otherwise healthy bone due to repetitive mechanical loading. It non-athletes, they often occur when a sedentary period is followed by a sudden increase in activity, or performance of an unaccustomed activity. In athletes, they occur after increasing level of training too quickly.

Risk factors for stress fractures include female gender, increased chronologic age, white race, smoking, obesity, long-term alcohol use, and sedentary lifestyle.

The signs and symptoms of stress fracture include localized pain of relatively sudden onset without a specific injury. Some swelling may be present. Pain is aggravated by activity and is relieved by rest. The most common area involved as the top of the forefoot, in the area of the metatarsal bones.

Diagnoses in the early stage of the injury may be difficult. Although clinical signs are suspicious, the stress fracture will often not appear on x-ray for the first 2 weeks. Diagnostic ultrasound or MRI are valuable in the diagnoses of an early stress fracture and in the confirmation of the diagnosis.

Treatment is fairly simple and is highly successful. Modified activity and immobilization of the affected area for a period of time is the preferred treatment. Often, a removable walking boot will be utilized for more rapid and effective healing.

If you have pain and or localized swelling in the lower extremity, it might be a stress fracture. Seek a consultation from our doctors at Melbourne Podiatry Associates.

Varicose and Spider Veins of the Leg

Are you one of the 25 million Americans suffering from varicose veins? This condition affects 50% of all women and 40% of all men, with the incidence increasing with age. Over 70% of people over age 70 years have the condition.
What exactly are varicose veins? Veins are the blood vessels that bring blood back to the heart. They contain valves that prevent backflow of blood. If these valves fail, the blood “refluxes”, or back flows , causing the vein to become engorged. These engorged veins are referred to as “varicose veins”, “reticular veins”, or “spider veins”, depending on their size.

The engorged veins of all sizes are cosmetically unsightly. However, they can also cause problems such as leg swelling, burning, pain, itching, restless leg symptoms, skin breakdown (ulceration), and skin damage (dermatitis).
In addition to age, risk factors for varicose veins include female gender, obesity, heredity, estrogen therapy, and prolonged standing.

Treatment of varicose veins usually involves foam sclerotherapy, a painless injection of a sclerosant medication to disintegrate the damaged section of vein. Other treatments include radiofrequency ablation, compression to reduce the swelling caused by the varicose vein, and mini-phlebectomy, a simple office procedure done under local anesthesia in which a varicose vein is removed via a series of mini-incisions.

The doctors at Melbourne Podiatry Associates are experts in the treatment of lower extremity venous conditions including varicose veins. If you suffer from this condition, please call our offices for a consultation.

EQUINUS AND ACHILLES TENDON PROBLEMS

Just as with the mighty Greek warrior Achilles, whose only weak spot was his Achilles tendon (for whom it is named), the Achilles tendon continues to cause pain in people today.

The Achilles tendon begins in the muscles in the back of the calf and attaches to the back of the heel bone. Although ruptures , or tears, of the tendon are commonly treated injuries, most Achilles tendon problems are due to abnormal tightness.

Abnormal tightness of the Achilles tendon itself is referred to as “equinus”, from the Latin “equus”, meaning “horse”. The Achilles tendon pulls the foot down, or “plantarflexes” it. When tested, if the ankle cannot move up at least ten degrees from the neutral position, the patient is considered to have an equinus condition. Symptoms associated with equinus include Achilles tendinitis, pain in the back and/or bottom of heel (retrocalcaneal bursitis and plantar fasciitis), calf muscle pain, bunions, pain and/or calluses of the forefoot, arch pain, knee pain, back pain and toe-walking.

Fortunately, equinus and its symptoms are usually effectively treated with conservative measures including stretching, bracing, orthotics, physical therapy modalities, and anti-inflammatory medications. Although rarely necessary, surgical lengthening of the Achilles tendon itself or of the tight calf muscle can be performed.
Early evaluation and treatment of equinus deformity is recommended before compensatory problems develop. If you have any of the symptoms of equinus, please call our offices for an appointment.

INGROWN TOENAIL

The ingrown toenail is probably the most common condition that we treat. It presents as pain along the edge of the toenail. Although the great toenail is the commonly involved, any nail may be affected. Often, the ingrown toenail area is infected.

Treatment involves clearing any infection and removal of the ingrown section of nail. This is a minor procedure performed in the office. Patients may walk, wear shoes, and resume normal activities immediately after the procedure.

Treatment of ingrown toenails is available by all of our doctors in each of our offices: downtown Melbourne, Eau Gallie, and Palm Bay. If you or a loved one has been suffering from an ingrown toenail, please call us!

ORTHOTIC DEVICES

Because the feet support the entire body, it is important that they do so in a correctly-aligned manner. Many people have feet that are malaligned, and this malalignment affects the entire body. This can result in a variety of symptoms and compensation mechanisms.

One way to make feet “straighter” is to wear a device in the shoe called an “orthotic” or an “orthosis”. The terms “orthotic” and “orthosis” come from the Greek “orthos”, meaning “straight”. An orthotic device it is specifically designed to realign abnormal foot function. Unlike an arch support, which is a cushion that provides shock absorption, an orthotic device actually treats a biomechanical problem.

Pre-fabricated orthotic devices of different shapes are often dispensed for various conditions. These suffice in many patients, but others will have a greater benefit from a custom orthotic. A custom orthotic is made from a plaster impression of the foot and is specifically created from the impressions. It is the most effective type of orthotic device.

Many conditions can be improved with orthotic therapy. These include arch pain, heel pain, plantar fasciitis, Achilles tendinitis, foot arthritis, ankle instability, knee pain, back pain, hip pain, adult and children’s gait abnormalities, flatfoot, high arch foot, and foot strain, to name a few. Additionally, custom orthotic devices are used to treat a variety of sports conditions and there are even sports- specific orthotics available for many sports (including cycling, football, tennis, soccer, skating, etc.). Orthotics for high-heeled shoes are also available.
Melbourne Podiatry Associates offers both pre-fabricated and custom orthotic devices. This type of treatment may be just which you need !

Blood Clots in Travelers

Blood clots in the legs of airline travelers were first reported in the 1950s and were termed “traveler’s thrombosis”. The condition is now known as “venous thromboembolism” (VTE) and is not specific to travel. However, long-haul travel is
a significant risk factor for VTE, and the association has been extensively studied in recent years.

An international concensus statement categorizes VTE into three risk groups: low, moderate, and high. High risk includes people with a history of blood clots; malignancy; pregnancy; obesity; and coagulation disorders. The risk of long-haul airline travel ranges from 0-2%
in a low risk person and rises to 5% in a high risk person. Although there is a risk of VTE from all long distance travel including long
rides in cars, buses, and trains, air travel has a much higher risk, up to 26% highe, for unknown reasons.

VTE risk increases with the length of the flight. Also, taking several long flights within a short period of time increases risk. The prevention of VTE in all risk groups is the use of compression stockings. Sometimes, in certain high-risk travelers, anticoagulant therapy is prescribed. Although insufficiently documented, good hydration and leg exercises during flight are also recommended.

High-risk persons should consult their internists for specific recommendations for VTE prevention. Frequent travelers should consider decreasing back-to-back long flights. All travelers should consider compression stockings. The doctors at Melbourne Podiatry Associates can discuss VTE with you and recommend the appropriate stockings.

Fall Prevention

Falls are a serious health problem in the USA. Although all age groups can experience falls, the elderly are at higher risk. Indeed, one in four older adults is at risk for falls, and the number of fall-related deaths in the elderly has increased 31% in the last decade.

In the elderly, many risk factors contribute to falls. These include gait problems, poor balance, decreased strength, and medications. In people of all ages, 75% of those with foot problems are at risk for falls.

The importance of fall prevention cannot be over- emphasized. The physicians of Melbourne Podiatry Associates have developed fall prevention protocols. These include evaluation of biomechanics, strength, balance, gait, and range of motion. Treatment can include advice on footwear, recommendations regarding mobility aids, orthotics, bracing devices, possible referral to physical or occupational therapists, and treatment of specific risk factors.

Of special note is a new fall prevention device that we offer. It is called the “balance brace” and is lightweight, flexible, comfortable, and is usually covered by insurance. We have found this device to be very effective in preventing falls.

Our physicians at Melbourne Podiatry Associates will do everything that we can for our patients to help prevent falls.

DIAGNOSTIC ULTRASOUND AND ULTRASOUND-GUIDED INJECTIONS

Although X-ray imaging is useful for evaluating conditions of bones and joints, they are not as useful for evaluation soft tissue problems. MRIs are useful for soft tissue evaluation, but require referral to imaging facilities and can be expensive. A useful alternative to MRI for many conditions is diagnostic ultrasound. This is a quick and simple procedure that is done right in the office. Diagnostic ultrasound is offered as a service at all of our locations. The procedure is safe, quick, painless, is noninvasive, and utilizes no radiation. It is inexpensive and is covered by most insurance plans.

Diagnostic ultrasound involves the transmission of sound waves through the skin to image various tissues. These sound waves bounce off the deeper tissues, forming an image that can be studied. Many conditions can be diagnosed and/or evaluated with ultrasound, including tendinitis, arthritis, tumors, ganglia, nerve problems, plantar fasciitis, blood vessel problems, and wounds. Ultrasound is also very useful in the detection of foreign bodies that do not appear on X-ray.

In addition to the diagnostic use of ultrasound, the doctors of Melbourne Podiatry Associates also use ultrasound for what is known as “guided injections”. Placing an ultrasound probe over an area that is to be injected provides direct visualization of the area. This allows a more precise injection, permitting a maximum benefit with less discomfort and utilization of less medication. This technique is done in the office and is usually covered by insurance. It is particularly useful for joint injections, heel injections, and aspiration and/or injection of ganglia.

The doctors of Melbourne Podiatry Associates are all trained in the use of diagnostic ultrasound and ultrasound-guided injections. They would be happy to answer any questions regarding these techniques,

High Heels and Your Feet

When it comes to women’s shoes and fashion, high heels are here to stay! After a brief decline in popularity a few years ago, they are back, more popular than ever. Indeed, a recent study published in the Journal of Foot and Ankle Surgery reported that high heel related injuries doubled in the past decade. These included falls from imbalance from the shoes, as well as foot problems.
Why the popularity of high heels? Simply because they make the female leg look attractive and make the gait more alluring. They are nothing new. Although probably used in some cultures before, the current Western fascination with high heels is said to have begun in France in 1533. The petite Catherine de Medici was to marry King Henry ll . She had high heeled shoes designed for the wedding to make herself appear taller. She looked so fabulous at the wedding that high heels became the rage of fashion in Europe. They arrived much later in the USA, in the 1880’s.
High heels pose several potential risks for women who wear them. In addition to the imbalances that they can cause, creating a fall risk, they cause excessive pressure to be transferred to the front of the foot. This can aggravate such conditions as bunions, hammertoes, and neuromas. Additionally, their use causes shortening of the posterior leg muscles and lead to Achilles tendinitis.
Although it may be unrealistic to forbid high heel use completely, reducing the total amount of time in these shoes may be prudent, especially time spent walking or standing. Also, using a shoe with a heel height of 2 inches or less is preferable. Platform type-heels and wedges are also better for the feet than stiletto –type narrow heels. A soft upper and a more rounded toe box are also preferable. Finally, if high heels are to be worn for prolonged time periods in individuals prone to problems, a custom high heel orthotic can be prescribed.
Sensibility and moderation are the important factors in women who choose to wear these attractive, but potentially dangerous, fashion statements.

Gait Problems in Children

Gait abnormalities in children are not uncommon. These include in-toeing, out-toeing, flat –foot, and toe-walking (equinus).

Gait abnormalities can be caused by a deformity within the foot, the ankle, leg, knee, thigh, or hip. It is often difficult to diagnose the cause of the abnormality. A thorough clinical examination, including gait evaluation and possibly imaging techniques, such as radiographs, is essential. The treatment of the condition depends on the diagnosis and could include stretching, physical therapy, bracing, and shoe inserts (orthotics).

Unfortunately, parents are often told that their child will “grow out of the condition”. Although this may be true for certain conditions, more often it is not. Failure to treat gait abnormalities may lead to permanent problems later in life.

The physicians of Melbourne Podiatry Associates are very well-trained in the diagnosis and treatment of pediatric gait abnormalities. If you suspect such an abnormality in your child, please call our offices.