Friday, August 20, 2010

VT Foot Fumble


It was grim news for VT Football fans when they heard Nick Becton, starting left tackle, sprained one of his right toes. He is going to be on the sidelines for an undetermined amount of time and there is no guarantee he will be able to be back on the field for Sept. 6th - the big season opener against Boise State.

For those of you thinking - "Toe sprain? He's seriously out for that? Walk it off man!" Here's the definition of a "sprained toe" according to Aurora Health Care. "A toe sprain is caused by a partial tear of the ligaments that support a toe. Ligaments are strong bands of tissue that connect bones to each other." Now it sounds a little more serious than you thought, huh?

Toe sprains can be caused by any number of things, from stubbing your toe to suddenly stopping a run and causing your toe to jam into the front of your shoe. And people MOST at risk for this type of injury are people playing sports, dancing, moving on rough ground, or people with poor coordination or the tendency to be clumsy.

If you think there is any possibility that you may have a sprain of any kind, you need to immediately see a doctor. They will need to run tests and determine a course of treatment which will definitely include rest from whatever activity lead to the injury.

Check out this site for more info on this particular injury. Toe Sprain

You can also check our our website if you are not sure what is causing your foot discomfort or pain. We have some great info on several different common ailments that may be the culprits. Shenandoah Podiatry


Wednesday, August 4, 2010

Unhappy Feet


No, this is not a parody of the popular cartoon children's movie with the tap dancing penguins. It actually has more to do with the fact that fall sports are kicking off - literally, and as a former soccer player myself, we don't always listen to what are feet are telling us.

“Athletes will play through a level of pain in their feet that, if they felt it in their knees or their shoulders, they’d be hammering at a surgeon’s door,” says Glenn Pfeffer, the director of the Foot and Ankle Center at Cedars-Sinai Medical Center in Los Angeles. Aching feet are the “forgotten stepchild” of sports injuries, he adds.

He's absolutely right! When I read that, it took me way back to high school. I remember first hand how much I paid for ignoring my own foot pain.

I played an entire game in high school with an aching pain in my right foot, but I didn't even let it phase me. I was completely focused on the win. This was one of the biggest games of our season against our rival team. All I could think about as we were getting ready to take the field was my dad's favorite "motivational" (I use that description loosely) saying. "Walk if off girl, walk it off. Be a champion." So that's just what I did. Only instead of walking, I was running, pivoting, kicking, and juggling all at full speed, for about 2 hours. Probably not the best choice I had ever made, then again I was a teenager.

By the end of the game, my adrenaline was through the roof because we had one by one goal when we were not the favored team. I couldn't even feel the pain anymore. It was the best feeling in the world...until I took off my cleats and socks. My foot was swollen to twice it's normal size and there was extensive noticeable bruising. Oops!

To make a long story short, I had just played that game with a navicular fracture. A bone in the middle of my foot was broken and I had no idea. Apparently, it was due to forcing too much stress on my foot without enough recovery time. I was also told that it appeared that the fracture was severely worsened by playing in that game. Had I been responsible and listened to what my body was trying to tell me and sat that game out, I may have gotten to finish out the season only missing a few games for recovery. Since I played, I was forced to sit on the bench the rest of the season and I missed indoor tryouts for the winter season.

We really don't think too much about what are bodies are trying to tell us. Especially our feet since most of the time we attribute our discomfort to walking too much, wearing the wrong shoes, or just being plain old tired. Of course, sometimes those things are true, but if you truly enjoy being active or playing sports, do you really want to be taking that risk?

I came across an article today from the NY Times that might be of some use. It explains just how serious this lack of "listening" to our feet really is. They use Kobe Bryant as a prime example. In 2004, he had a serious struggle with plantar fasciitis, which is an extremely painful heel condition. Can you imagine being a basketball player, worth millions, and having to play the game of your career with crippling pain in your feet? I sure can't (partly because I'm a terrible basketball player and no ever paid me to play soccer - but that's beside the point.)

If you're an athlete, a parent or friend of an athlete, or even a person that just likes to got out and start pick up games I strongly encourage you to check out this article from the NY Times. And next time your feet are trying to tell you something from way down there...LISTEN UP!

Tuesday, July 13, 2010

Freiberg's Infraction


Freiberg's
Infraction is a condition that affects the lesser metatarsal heads. The most common affected location is the second metatarsal followed by the 3rd 4th then 5th. This condition is also known as AVN (avascular necrosis). Freiberg's Infraction causes a loss of blood supply to the metatarsal head. The condition occurs at the metaphysis of the bone where the nutrient artery of the bone supplies the distal metatarsal. This results in a collapse of the metatarsal head. The condition is more common in females and usually occurs between ages 10-18 and can occur in adulthood.


Classification

Smillie’s classification (1967)


Stage 1: Subtle fracture line through the epiphysis.
Radiographic changes at this stage may be subtle.

Stage 2: Central depression of the articular surface.

Stage 3: Central depression leads to medial and lateral projections at the margins. Plantar hinge remains intact.

Stage 4: Central portion frees from the intact plantar hinge, forming a loose body. Fractures of the medial and lateral projections are present.

Stage 5: Flattening of the metatarsal head with secondary degenerative changes.


Contributing Factors:

Freiberg disease in adolescents is thought to be due to growth disturbances of the epiphysis or apophysis.
  • Vascular insult- an injury of the blood supply to the metatarsal head
  • Traumatic insult- a single acute injury or multiple repetitive injuries

Symptoms
  • Local pain and Tenderness that usually increases with activity
  • Stiffness
  • Limping
Differential Diagnoses
  • Metatarsalgia
  • Morton neuroma
  • Stress fracture
Treatment

Non Surgical:
  • Stiff Soled shoe or Post Op Shoe
  • Non weight-bearing cast
  • Short leg walking cast or CAM boot
  • Rest /Activity modification
  • Steroid injection
Shoe Modifications:
  • Metatarsal pads
  • Rigid shanks
  • Rocker bottom
Surgical Treatment:
  • Simple debridement
Osteotomies:
  • Dorsal closing wedge osteotomies- reorients the plantar intact cartilage to articulate with the proximal phalanx.
  • Shortening osteotomies- metatarsal overloading of the is reduced

Arthroplaty
  • Total joint arthroplasty- Utilizing an implant

Wednesday, June 30, 2010

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is a condition that is caused by compression of the tibial nerve or its branches.

Tarsal tunnel syndrome is analogous to carpal tunnel syndrome of the wrist.

The tarsal tunnel is a narrow space that lies on the inside of the ankle.

The tunnel is covered with a thick ligament called the flexor retinaculum.

Structures within the tarsal tunnel include:

-Arteries

-Veins
-Tendons
-Nerves


Tarsal tunnel syndrome is a compression on the posterior tibial nerve.

This syndrome produces symptoms anywhere along the path of the nerve.

Possible symptoms include:

-Tingling
-Burning
-Numbness
-Shooting pain
-Paresthesias

Contribute Factors to Tarsal Tunnel:

-Soft tissue masses:
Lipomas-is a benign tumor composed of fatty tissue
-Tendon Sheath Ganglia:
Neoplasms- is an abnormal mass of tissue as a result abnormal proliferation of cells
-Nerve tumors
-Varicose Veins

Work up:

Tinel sign- Percussion of a nerve with radiation of pain along the course of the nerve.

The doctor may order any of the following tests to help with the diagnosis:

-Electromyography (EMG) - A technique for evaluating and recording the electrical activity produced by skeletal muscles
-Nerve conduction velocity (NCV)
-Magnetic resonance imaging (MRI)- In cases of suspected soft-tissue masses and other space-occupying lesions
-Ultrasonography
-Radiography

Conservative Treatment:

-Rest
-Ice
-Non steroidal anti-inflammatory drugs-to help reduce pain and inflammation
-Immobilization- Restricting movement of the foot by wearing a cast or cam boot
-Physical therapy
-Injection therapy
-Orthotic devices. To control any abnormal bio mechanics of the foot









-Surgical Therapy

Tarsal tunnel release surgical intervention may be needed if conservative therapy fails to alleviate pain and symptoms. This procedure is used to decrease pressure on the posterior tibial nerve. Any space occupying lesions may also be excised.

Wednesday, June 16, 2010

Anodyne Therapy


Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. These conditions are thought to result from diabetic microvascular injury involving small blood vessels that supply nerves

Neuropathy can present itself in a number of different ways including; numbness, pain, loss of feeling, weak muscles.

These symptoms can lead to secondary problems including difficulty with walking, balance and activities of daily living.


Anodyne Therapy is a treatment specifically for peripheral neuropathy. It works by relieving pain and/or increasing circulation in the area where the patient is experiencing pain.


The only contraindications are for pregnancy and active malignancy, according to the company.







How it works

The Anodyne Therapy System uses monochromatic infrared energy (MIRE) to release nitric oxide from the patient’s red blood cells.

Anodyne Therapy utilizes the healing power of infrared light to stimulate increased nerve function and blood flow to decrease pain and improve feeling

This form of treatment is usually given in addition to physical therapy

Anodyne Therapy is completely painless

The program usually involves 10-24 therapy sessions and may include:

Stretching and strengthening exercises

Dynamic and static balance exercises

Massage and the use of other therapeutic modalities for pain

Sensory integrative techniques