Osteopenia/Osteoporosis and Foot Pain
Osteopenia has recently been in the news as Gwyneth Paltrow made her diagnosis public. Her injury involved her lower extremity, specifically her tibial plateau.
What is Osteopenia/Osteoporosis?
Osteopenia is a condition where the bone density is below normal, but not yet within the range of osteoporosis. Osteopenia is often considered a precursor to osteoporosis. Osteoporosis is a condition that causes weakening of your bones, and can increase your chance of sustaining a fractured bone. The progression of osteoporosis can often be slowed, but only when you check for the problem and initiate treatment. Here are some signs that you should be screened for osteoporosis. All women age 65 and older should consider having a bone density test. Just being a woman over the age of 65 places you in a category of individuals most likely to develop osteoporosis. Knowing your bone density before any problems arise can help you treat your condition, and hopefully avoid fractures.
Here in Naples Florida beach walking, golf, and tennis are only a few of the activities residents enjoy. Often times stress fractures are the first sign of bone weakness or osteopenia. Stress fractures of the foot are especially common. Your feet absorb impact with each step taken. Natural foot types also contribute to your risk of stress fractures, as different foot types distribute pressure differently across the foot. In the setting of osteopenia stress fractures may develop with simply everyday walking. Simple walking can create repetitive stress leading to hairline or stress fracture. Metatarsals are most commonly affected, especially the second metatarsal. Often times podiatrist initiate the work up for bone loss in the setting of stress fractures. Fortunately, for those patients who are diagnosed with osteopenia and who wish to remain active and pain free, treatment options are available to prevent stress fractures of the foot. Custom orthotics are the most effective option is preventing stress fractures of the feet with or without the diagnosis of osteopenia. Custom orthotics facilitate the redistribution of uneven pressure minimizing repetitive stress and/or trauma, and ultimately pain and injury. We Keep You Walking in Naples Florida.
Thursday, October 14, 2010
Tuesday, August 17, 2010
My Son's Heel Pain
My son just started football with the Naples Gators. He came home complaining of posterior heel pain during and right after football. Luckily his mom is a podiatrist and I new exactly what to do. Robert's symptoms are consistent with apophysitis or inflammation of a growth plate specifically in the heel bone or calcaneus. Posterior heel pain in kids, active kids especially is very common. After a week of childrens' Motrin, stretching and gel heel cups Robert's only complaints are all the new bumps and bruises from Naples Gators tackle football.
Unfortunately, for some children more aggressive treatment is required including physical therapy, immobilization, and activity modification. With fall sports starting her in Naples Florida, keep an eye on your children and seek medical care heel pain symptoms linger longer than a week. Go Naples Gators!
Unfortunately, for some children more aggressive treatment is required including physical therapy, immobilization, and activity modification. With fall sports starting her in Naples Florida, keep an eye on your children and seek medical care heel pain symptoms linger longer than a week. Go Naples Gators!
Wednesday, March 10, 2010
Diabetic Shoe Program
What is the Diabetic Shoe Program?
Most Insurance companies recognize the benefit of proper fitting shoes and supportive inserts in diabetic patients. For many diabetic patients secondary complications from diabetes, such as neuropathy and poor circulation jeopardize foot health. The diabetic shoe program offers a first line defense in protecting your diabetic feet. Patients must meet specific criteria to qualify. With criteria met, patients are fitted and issued a pair of approved shoes and 3 pairs of custom inserts yearly. Patients are sized according to length as well as appropriate width. This avoids excessive pressure points and shoe irritation which can leads to ulcerations, infection and ultimately amputations. Custom molded inserts also are modified to provide the specific support and protection each patient needs. Together custom inserts and diabetic shoes, optimizes diabetic foot health and again prevent ulceration, infection, and amputation.
A mold is taken of the patients feet and custom inserts and made to fit patients diabetic shoe selection. Modifications can also be made to accommodate current pressure points or ulcerations and prevent complications.
Please contact your podiatric physician to discuss if you qualify for the Diabetic Shoe Program. Many styles and colors to select from.
NEW BALANCE
HUSH PUPPIES
SEBAGO
HUSH PUPPIES
SAS
Please note coverage and benefits varies in accordance with insurance carrier.
What is the Diabetic Shoe Program?
Most Insurance companies recognize the benefit of proper fitting shoes and supportive inserts in diabetic patients. For many diabetic patients secondary complications from diabetes, such as neuropathy and poor circulation jeopardize foot health. The diabetic shoe program offers a first line defense in protecting your diabetic feet. Patients must meet specific criteria to qualify. With criteria met, patients are fitted and issued a pair of approved shoes and 3 pairs of custom inserts yearly. Patients are sized according to length as well as appropriate width. This avoids excessive pressure points and shoe irritation which can leads to ulcerations, infection and ultimately amputations. Custom molded inserts also are modified to provide the specific support and protection each patient needs. Together custom inserts and diabetic shoes, optimizes diabetic foot health and again prevent ulceration, infection, and amputation.
A mold is taken of the patients feet and custom inserts and made to fit patients diabetic shoe selection. Modifications can also be made to accommodate current pressure points or ulcerations and prevent complications.
Please contact your podiatric physician to discuss if you qualify for the Diabetic Shoe Program. Many styles and colors to select from.
NEW BALANCE
HUSH PUPPIES
SEBAGO
HUSH PUPPIES
SAS
Please note coverage and benefits varies in accordance with insurance carrier.
Friday, January 29, 2010
Childrens' Ingrown Toenails
What causes an ingrown toenail?
An ingrown toenail can have a number of different causes. Cutting your toenail too short or rounding the edge of the nail can cause it to grow incorrectly and into the skin. Wearing shoes or socks that don't fit well can also cause an irritation and develop into an ingrown toenail. If your shoes are too tight, they might press the nail into the toe and cause it to grow into the skin.You can get an ingrown toenail if you injure your toe, such as stubbing it. This can cause the nail to grow inward. Repeative activties such as running, soccer, basketball, and or tennis may aggravate toenails and led to ingrown toenails.
What are the symptoms?
The main symptom of an ingrown toenail is the pain from the nail growing into the skin instead of over it. If the ingrown toenail gets infected, it might be swollen or red, and it might drain pus. The area around the ingrown toenail is often painful.
The most common symptoms are the following:
Swelling
Redness
Pus collection
Pain and tenderness to touch
How is an ingrown toenail diagnosed?
Your podiatrist will make the diagnosis based on your symptoms and an evaluation of the toenail.
How is it treated?
You can try the following steps at home to relieve the pain caused by your ingrown toenail and help the nail to grow out naturally:
It is best to see a podiatrist to manage an ingrown toenail.
To help control pain until you can see a podiatrist you may soak your sore toe in warm water for 15 minutes 2 to 3 times a day.
Do not use a sharp object like manicure scissors to dig under your nail, because the toe might get infected.
Do not try to use a needle to drain the pus from your toe. This could make the infection worse.
Your doctor might give you antibiotics. If your toenail is very ingrown, your doctor might suggest minor surgery to remove all or part of the ingrown nail.
During this surgery, the doctor will numb your toe. Then he or she will cut the edge of the ingrown toenail and pull out the piece of nail. To prevent the nail from growing into the skin again, your doctor might destroy all or part of the nail root. If your doctor removes all or part of your nail but does not destroy the root, it will begin to grow back within a few months.
After the surgery it is important to take care of your toe so that it can heal. Your doctor will give you specific instructions to follow. He or she may tell you to:
Soak your toe in warm water with soaking crystals for 15 minutes 2 to 3 times each day.
Rub antibiotic ointment 2 times each day on the toe where the nail was removed.
Wear a bandaid on your toe.
Wear loose-fitting shoes that don't press on the toe where the nail was removed.
Take pain medicine if your toe hurts. NSAIDS, ibuprofen (such as Advil), or naproxen sodium (such as Aleve), might help your toe feel better.
How can ingrown toenails be prevented?
You may be able to prevent ingrown toenails by wearing roomy and comfortable shoes and socks that do not press on your toes. If you work in a place where your toe might get hurt, wear sturdy shoes such as steel-toed boots to protect your toes.
It is important to trim your toenails properly. You can do this by cutting your toenail straight across, not curved. Make sure you do not cut your toenail too short. You can also leave your toenail a little longer at the corners to help it grow over the skin.
An ingrown toenail can have a number of different causes. Cutting your toenail too short or rounding the edge of the nail can cause it to grow incorrectly and into the skin. Wearing shoes or socks that don't fit well can also cause an irritation and develop into an ingrown toenail. If your shoes are too tight, they might press the nail into the toe and cause it to grow into the skin.You can get an ingrown toenail if you injure your toe, such as stubbing it. This can cause the nail to grow inward. Repeative activties such as running, soccer, basketball, and or tennis may aggravate toenails and led to ingrown toenails.
What are the symptoms?
The main symptom of an ingrown toenail is the pain from the nail growing into the skin instead of over it. If the ingrown toenail gets infected, it might be swollen or red, and it might drain pus. The area around the ingrown toenail is often painful.
The most common symptoms are the following:
Swelling
Redness
Pus collection
Pain and tenderness to touch
How is an ingrown toenail diagnosed?
Your podiatrist will make the diagnosis based on your symptoms and an evaluation of the toenail.
How is it treated?
You can try the following steps at home to relieve the pain caused by your ingrown toenail and help the nail to grow out naturally:
It is best to see a podiatrist to manage an ingrown toenail.
To help control pain until you can see a podiatrist you may soak your sore toe in warm water for 15 minutes 2 to 3 times a day.
Do not use a sharp object like manicure scissors to dig under your nail, because the toe might get infected.
Do not try to use a needle to drain the pus from your toe. This could make the infection worse.
Your doctor might give you antibiotics. If your toenail is very ingrown, your doctor might suggest minor surgery to remove all or part of the ingrown nail.
During this surgery, the doctor will numb your toe. Then he or she will cut the edge of the ingrown toenail and pull out the piece of nail. To prevent the nail from growing into the skin again, your doctor might destroy all or part of the nail root. If your doctor removes all or part of your nail but does not destroy the root, it will begin to grow back within a few months.
After the surgery it is important to take care of your toe so that it can heal. Your doctor will give you specific instructions to follow. He or she may tell you to:
Soak your toe in warm water with soaking crystals for 15 minutes 2 to 3 times each day.
Rub antibiotic ointment 2 times each day on the toe where the nail was removed.
Wear a bandaid on your toe.
Wear loose-fitting shoes that don't press on the toe where the nail was removed.
Take pain medicine if your toe hurts. NSAIDS, ibuprofen (such as Advil), or naproxen sodium (such as Aleve), might help your toe feel better.
How can ingrown toenails be prevented?
You may be able to prevent ingrown toenails by wearing roomy and comfortable shoes and socks that do not press on your toes. If you work in a place where your toe might get hurt, wear sturdy shoes such as steel-toed boots to protect your toes.
It is important to trim your toenails properly. You can do this by cutting your toenail straight across, not curved. Make sure you do not cut your toenail too short. You can also leave your toenail a little longer at the corners to help it grow over the skin.
Wednesday, October 7, 2009
Pediatric Heel Pain
Heel Pain in Kids
By far the most common cause of heel pain in children is a disturbance of the growth plate. This is often referred to as Sever’s Disease and/or Calcaneal Apophysitis. The same can occur in the knee and commonly known as Osgood-Schlatters Disease. In these instances the child’s growth plate is inflamed and irritated.
Anatomy of Heel Pain in Kids
The growth plate involved in heel pain found in children is located at the posterior heel bone (calcaneus). This is also the region where the Achilles tendon attaches. The pull of the Achilles tendon is an aggravating factor in children’s heel pain.
By far the most common cause of heel pain in children is a disturbance of the growth plate. This is often referred to as Sever’s Disease and/or Calcaneal Apophysitis. The same can occur in the knee and commonly known as Osgood-Schlatters Disease. In these instances the child’s growth plate is inflamed and irritated.
Anatomy of Heel Pain in Kids
The growth plate involved in heel pain found in children is located at the posterior heel bone (calcaneus). This is also the region where the Achilles tendon attaches. The pull of the Achilles tendon is an aggravating factor in children’s heel pain.
Symptoms
Onset of symptoms often correlates to the start of sports and increased activity. Activities likely incorporate overuse and/or repeated minor trauma. Also, a tight Achilles tendon can increase the pull of the Achilles tendon and predispose a child to heel pain. Symptoms arise most commonly between the ages 10-14. Typically, by the age of 16 the growth plate is closed and immune to inflammation. Symptoms can last for as long as the growth plate is open, however flare ups are typically managed successfully within 3-8 weeks.
Treatment
The goal of treatment is to minimize inflammation and therefore reduce pain. Activity modifications are a last resort. First line of defense is NSAIDS, Ice, Stretching and Physical Therapy. In addition, protected weigh-tbearing can be achieved using a cam walker. Relieving tension along the achilles tendon can be achieved using gel heel lifts which also provide cushion. If symptoms persist activities can be reduced and/or stopped. In rare and severe cases a child may need to be casted and use crutches.
Onset of symptoms often correlates to the start of sports and increased activity. Activities likely incorporate overuse and/or repeated minor trauma. Also, a tight Achilles tendon can increase the pull of the Achilles tendon and predispose a child to heel pain. Symptoms arise most commonly between the ages 10-14. Typically, by the age of 16 the growth plate is closed and immune to inflammation. Symptoms can last for as long as the growth plate is open, however flare ups are typically managed successfully within 3-8 weeks.
Treatment
The goal of treatment is to minimize inflammation and therefore reduce pain. Activity modifications are a last resort. First line of defense is NSAIDS, Ice, Stretching and Physical Therapy. In addition, protected weigh-tbearing can be achieved using a cam walker. Relieving tension along the achilles tendon can be achieved using gel heel lifts which also provide cushion. If symptoms persist activities can be reduced and/or stopped. In rare and severe cases a child may need to be casted and use crutches.
Management by a podiatric physician is often wise to be sure diagnosis is correct.
Friday, October 2, 2009
Achilles Tendonitis
Tendons by definition connect a muscle to a bone. The Achilles tendon connects the calf (gastrocnemius) muscle to the heel bone.
Achilles tendonitis is an inflammation of the Achilles tendon. This inflammation is typically episodic initially but can develop into a chronic problem. Over time the chronic condition usually leads to degeneration or micro trauma of the tendon. Often the insertion of the Achilles tendon is the focus and micro tears and thereafter pain, stiffness and swelling. When the disorder progresses to degeneration and micro tears, the tendon may also become enlarged as a consequence of chronic inflammatory changes and damaged tissue.
Achilles tendonitis is categorized as “overuse” injuries and are precipitated by a sudden increase of a repetitive activity involving the Achilles tendon. This repetitive activity leads to micro-injury of the tendon fibers and without appropriate rest the body is unable to repair the injured and inflamed tissue. Chronic inflammation and repetitive trauma will reduce the structural integrity of the tendon and likely cause pain at the site.
The phrase “weekend warrior” is commonly associated with Achilles tendon injury. In the setting of poor conditioning and repetitive stress Achilles tendons are susceptible to strain, inflammation, and/or rupture.
In diagnosing Achilles tendonitis, the patient’s history is most telling along with an exam with reproducible pain at the Achilles insertion, posterior heel, and/or along the tendon. The extent of the condition can be further assessed with x-rays, ultrasound or MRI.
Treatment approaches for Achilles tendonitis is selected on the basis of how long the injury has been present and the degree of damage or degeneration to the tendon.
Initially when there is sudden (acute) inflammation, treatment is focused on immobilization, “deflamming” the area with ice, anti inflammatory medications, and physical therapy, which may include stretching, soft tissue massage, and/or ultrasound therapy. Also heel lifts decrease strain and reduces pain at the Achilles tendon
If non-surgical approaches are ineffective and complete resolution is not attained surgery may be necessary. The foot and ankle surgeon will select the best procedure to repair the tendon.
Achilles tendonitis is an inflammation of the Achilles tendon. This inflammation is typically episodic initially but can develop into a chronic problem. Over time the chronic condition usually leads to degeneration or micro trauma of the tendon. Often the insertion of the Achilles tendon is the focus and micro tears and thereafter pain, stiffness and swelling. When the disorder progresses to degeneration and micro tears, the tendon may also become enlarged as a consequence of chronic inflammatory changes and damaged tissue.
Achilles tendonitis is categorized as “overuse” injuries and are precipitated by a sudden increase of a repetitive activity involving the Achilles tendon. This repetitive activity leads to micro-injury of the tendon fibers and without appropriate rest the body is unable to repair the injured and inflamed tissue. Chronic inflammation and repetitive trauma will reduce the structural integrity of the tendon and likely cause pain at the site.
The phrase “weekend warrior” is commonly associated with Achilles tendon injury. In the setting of poor conditioning and repetitive stress Achilles tendons are susceptible to strain, inflammation, and/or rupture.
In diagnosing Achilles tendonitis, the patient’s history is most telling along with an exam with reproducible pain at the Achilles insertion, posterior heel, and/or along the tendon. The extent of the condition can be further assessed with x-rays, ultrasound or MRI.
Treatment approaches for Achilles tendonitis is selected on the basis of how long the injury has been present and the degree of damage or degeneration to the tendon.
Initially when there is sudden (acute) inflammation, treatment is focused on immobilization, “deflamming” the area with ice, anti inflammatory medications, and physical therapy, which may include stretching, soft tissue massage, and/or ultrasound therapy. Also heel lifts decrease strain and reduces pain at the Achilles tendon
If non-surgical approaches are ineffective and complete resolution is not attained surgery may be necessary. The foot and ankle surgeon will select the best procedure to repair the tendon.
Tuesday, September 29, 2009
Juvenile Bunions
"Kiddie" Bunions
When we think of bunions we think of our mothers and mothers. However, bunions can affect, quite severely children and teens alike. For the most part children are without symptoms of pain as they are not subject to the degenerative changes seen in long standing adult deformities. A child’s first complaint is difficulty fitting into shoe gear. For many, cosmesis and feelings of self-consciousness are a concern at initial presentation.
Juvenile bunions are by definition more severe as the onset of the deformity is earlier and the progression faster and left untreated can lead to significant disability. Therefore juvenile bunions are treated aggressively to ensure the lowest rate of reoccurrence. At least 50% of juvenile bunions are associated with a flexible flat foot. Both the flattening appearance of the arch and the protruding big toe are secondary to hypermobility of multiple joints.
Juvenile bunions are more challenging to manage because children and teens are still growing and must be taken into account when directing a treatment plan. Girls growth plates tend to close be age 16 where as boys can take an additional year or so. Closing of the growth plates is what dictates when surgical intervention can be entertained.
Prior to surgical intervention there are a number of effective conservative options, which can be utilized with excellent results. Conservative options include custom orthotics, shoes gear modifications, padding, and anti inflammatory medications. Custom orthotics control excessive motion (hypermobility), which lead to the bunion deformity. Padding and shoe gear modifications are meant to relieve irritation and “bump pain” which can be a constant source of discomfort.
Regardless of age or symptoms children and teens with bunions can remain active and pain free with the help of a podiatric physician.
When we think of bunions we think of our mothers and mothers. However, bunions can affect, quite severely children and teens alike. For the most part children are without symptoms of pain as they are not subject to the degenerative changes seen in long standing adult deformities. A child’s first complaint is difficulty fitting into shoe gear. For many, cosmesis and feelings of self-consciousness are a concern at initial presentation.
Juvenile bunions are by definition more severe as the onset of the deformity is earlier and the progression faster and left untreated can lead to significant disability. Therefore juvenile bunions are treated aggressively to ensure the lowest rate of reoccurrence. At least 50% of juvenile bunions are associated with a flexible flat foot. Both the flattening appearance of the arch and the protruding big toe are secondary to hypermobility of multiple joints.
Juvenile bunions are more challenging to manage because children and teens are still growing and must be taken into account when directing a treatment plan. Girls growth plates tend to close be age 16 where as boys can take an additional year or so. Closing of the growth plates is what dictates when surgical intervention can be entertained.
Prior to surgical intervention there are a number of effective conservative options, which can be utilized with excellent results. Conservative options include custom orthotics, shoes gear modifications, padding, and anti inflammatory medications. Custom orthotics control excessive motion (hypermobility), which lead to the bunion deformity. Padding and shoe gear modifications are meant to relieve irritation and “bump pain” which can be a constant source of discomfort.
Regardless of age or symptoms children and teens with bunions can remain active and pain free with the help of a podiatric physician.
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