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Monday, 18 February 2013 01:05

Nerve Disorders of the Foot and Ankle

Similar to well known nerve disorders in the hands, such as carpal tunnel syndrome, nerve disorders that affect the foot and ankle occur in patients for reasons ranging from stress to genetics. Nerve disorders of the foot should be addressed right away because they may be immobilizing in serious cases. Two of the most common nerve disorders of the foot and ankle are Interdigital Neuroma and Tarsal Tunnel Syndrome.

Interdigital Neuroma is caused by localized inflammation of one of the nerves that controls toe sensitivity in the frontal area of the foot. This inflammation is generally only found in the second or third interspace, and any other symptoms similar to Neuroma on other digits should be checked against other disorders. Symptoms include chronic burning or tingling sensations between the affected toes which can, at times, migrate to the toes themselves. This pain is often increased by walking, running, or by wearing shoes that compress the toes, such as high heels. A doctor should be consulted if this pain is chronic and if the symptoms get worse.

Typical examinations to determine the presence of Neuroma include radiographs, MRIs, and even bone scans of the affected area. Bone scans are only required if degeneration of bone is suspected, however. Surgery is often not required to alleviate the symptoms of Neuroma, and in many cases functional orthotics can be used to alleviate the stress of constant weight on the affected toes. Surgery is recommended for those patients that suffer from symptoms for 6 months or more, so reporting symptoms early can increase the rate of non-surgical recovery.

Tarsal Tunnel Syndrome, a condition that is less common than Interdigital Neuroma, is similar to Carpal Tunnel Syndrome in that it is caused by a compression of the nerve caused by any number of factors (mostly associated with excess pronation). Typically seen in those that have either flatfeet or valgus heel positions, Tarsal Tunnel Syndrome has patients complaining of moderate to severe ankle pain that starts along the bottom of the foot and often proceeds to the calf. Some more extreme cases occur with partial numbness and even atrophy of the foot and surrounding muscles.

If there is a good chance that someone has Tarsal Tunnel Syndrome, an EMG test is often used to diagnose the condition.  If the diagnosis is positive, an MRI can be used to identify the compression of the nerve. Treatment with NSAIDS, functional orthotics, and rest off of the feet is often prescribed, but again, long standing symptoms require surgery, as do exacerbated symptoms caused by lesions present between nerves.

Thursday, 07 February 2013 15:12

Sever's Disease

Sever's disease, also known as calcaneal apophysitis, is a medical condition that causes heel pain in one or both feet of children during the period when their feet are growing. Sever's disease occurs most commonly in boys and girls between the ages of 8 and 14 years of age.

Sever's disease occurs when the part of the child's heel known as the growth plate, or the calcaneal epiphysis, an area attached to the Achilles tendon, suffers an injury or when the muscles and tendons of the growing foot do not keep pace with bone growth. The result is constant pain experienced at the back of the heel and the inability to put any weight on the heel, forcing the child to bear weight on their toes while walking. A toe gait develops in which the child must change the way they walk to avoid placing weight on the painful heel, a position that can lead to other developmental problems.

The most common symptom of Sever's disease is acute pain felt in the heel when a child engages in physical activity such as walking, jumping or running. Children who are very active athletes are among the group most susceptible to experiencing Sever's disease because of the extreme stress and tension they place on their growing feet. Improper pronation, the rolling movement of the foot during walking or running, and obesity are all additional conditions linked to causing Sever's disease.

The first step in treating Sever's disease is to rest the foot and leg and avoid sports activity which only worsens the problem. Over the counter pain medications targeted at relieving inflammation can be helpful for reducing the amount of heel pain. Combined with rest and pain medication, a child with Sever's disease should wear shoes that properly support the heel and the arch of the foot. Consider purchasing orthotic shoe inserts which can help support the heel and foot while it is healing. Most patients with Sever's disease symptoms report an eventual elimination of heel pain after wearing orthotic insoles that support the affected heel.

Sever's disease may affect just one heel of either foot as well as the heels of both feet. It is important to have a child experiencing heel pain get an examination by a foot doctor who can apply the squeeze test, which compresses both sides of the heel in order to determine if there is intense pain. Discourage any child diagnosed with Sever's disease from going barefoot as this can intensify the problem. Apply ice packs to the affected painful heel two or three times a day for pain relief.

Exercises that help to stretch the calf muscles and hamstrings are effective at treating Sever's disease. An exercise known as foot curling, in which the foot is pointed away from the body, then curled toward the body in order to help stretch the muscles, has also proven to be very effective at treating Sever's disease. The curling exercise should be done in sets of 10 or 20 repetitions, and repeated several times throughout the day.

Treatment methods should usually continue for at least 2 weeks and as long as 2 months before the heel pain goes completely away and the child can resume normal physical and athletic activities again. A child can continue doing daily stretching exercises for the legs and feet to prevent the heel pain of Sever's disease from returning.

Both running and walking are great exercises, but should a person wear the same shoes for running and for walking? The answer is no, because there is a difference between the way that a person’s feet hit the ground when they are walking and when they are running. Therefore, the shoes for each activity are designed totally different. Before you begin any exercise program it is always recommended that you speak with your doctor.

Walking is a low impact exercise that is often recommended by doctors to their patients. Walking is the simplest exercise there is, but it still requires some degree of preparation. If you think about walking and how your feet strike the ground as you walk along, you will notice that your heel hits the ground first and then your foot continues to roll forward until your next step begins. Because of this rolling motion, walking shoes are designed to be more flexible than running shoes. The flexibility helps the walker to push off with each step taken.

Another thing about walking shoes is that your heel hits the ground first, therefore it absorbs most of the shock. This is why walking shoes need to have a beveled or angled heel. The angle of the heel helps to absorb some of the shock instead of putting all of the pressure on the ankles. This is especially important for speed walkers as their feet will hit the ground twice as often as the normal walker.

When people decide to run as a hobby or for their health, they must first realize that running is a high impact exercise that if not done with the proper equipment, could cause damage to their feet and legs. Running shoes are designed to be more light weight and to have thicker soles. The thicker soles act as shock absorbers for the rest of the body. For this reason alone it is never recommended that a person wear walking shoe to run in. However, it's fine if you want to walk in running shoes. Walking shoes most often do not have the proper arch support that runners do.

One very important thing to remember is that a proper fit can make or break a runner or a walker. If a runner or walker’s shoes are too big, their feet will slide back and forth inside the shoe and cause blisters. What ever your sport, running or walking, the right equipment can make all of the difference in the world.

About the Author: Dr. Howard Hyman from The Podiatry Center is a board certified podiatric surgeon who has over 30 years of experience. With help from his reliable and personable staff, Dr. Howard Hyman treats a wide range of podiatric needs from athlete's foot to broken ankles and everything in between. Visit http://www.thepodiatrycenter.net/ or call 973-313-5592

Wednesday, 16 January 2013 07:31

Orthoses

Orthoses are devices used to correct physical impairment caused by scoliosis, spina bifida, cerebral palsy, or foot deformities. Orthopedic devices control, guide, limit or immobilize body segments. They assist in movement; reduce weight bearing forces and aid in rehabilitation from fractures. They also correct the shape and function of the body.

Orthoses include ankle foot orthosis, thoracolumbosacral orthosis, knee orthosis and wrist hand orthosis. When orthoses were first made, plaster of Paris molds were made of the patient and then materials like plastic, elastic, metal or a combination of those materials. Now braces for participants in contact sports are made from neoprene to allow movement but reduce the range of movement.

The Boston Brace is used to assist scoliosis sufferers. It is also called a low-profile or underarm brace. It fits under the breast to above the pelvic area in the front and below the shoulder blades to the tail bone in the back. By applying three point of pressure to the curve, the lumbar area is forced to flex, the abdomen is pushed in and the posterior is flattened.

The Charleston Bending Brace is only worn at night. A mold is made of the patient’s body bent towards the outward bulge of the curve. The design of the brace is built to correct the curve of the scoliosis. Repeatedly wearing this brace for eight hours should eventually correct the problem somewhat if not completely. The brace is good for patients with a curve of 20 to 36 degrees.

The Milwaukee Brace is used for mid-back curves. This brace consists of a plastic pelvic girdle and a neck ring. The pieces are connected in the front and back by metal bars. Pressure pads are place along the patient’s curve pattern along the metal bars. This brace is rarely used but patients with a curve very high in the spine can benefit from wearing it.

A knee orthosis is a brace worn to give the knee strength. Osteoarthritis can cause significant pain in the knee resulting in immobility. Knee braces allow a person to remain active. Often therapy and drugs are used in conjunction with a knee brace.

Orthoses have changed over the decades. The materials used for the actual orthotic devices have evolved to include hydraulics as it appears in some knee braces that the patient adjusts to compensate for stability. When this is adjusted, it helps the knee by giving the sense of space between the bones which stops the pain that radiates when the bones rub together. Orthoses products stop pain and give patients the ability to move pain free.

Monday, 07 January 2013 01:33

Bunions

The term bunion refers to an enlargement of the base joint of the toe, the connection to the foot. This enlargement may be formed of swollen tissue or a bony growth, and is caused by the shifting of the bones in the big toe inward, toward the other toes of the foot. The area around the base of the big toe may become inflamed, red, and painful.

Genetic factors are important in the formation of bunions – people who get bunions are usually genetically predisposed to this bone displacement, and may cause its onset by wearing improperly fitting shoes, or by running or walking in a way that causes stress to the feet. Another common cause for bunions is wearing high heeled shoes. The weight of the body in these shoes pushes the toes into an unnatural position, possibly causing bone displacement.

A podiatrist who specializes in foot structure and bio-mechanics will be able to quickly diagnose bunions. Bunions must be distinguished from gout or arthritic conditions, so blood tests may be necessary. The podiatrist may order a radiological exam to provide an image of the bone structure. If the x-ray demonstrates an enlargement of the joint near the base of the toe and a shifting toward the smaller toes, this is indicative of a bunion.

Wearing wider shoes can remove the pressure on the bunion and reduce pain. High heeled shoes should be eliminated for a period of time as this type of shoe generally pushes the big toe outward toward the smaller toes. This may be enough to eliminate the pain associated with bunions; however, if pain persists, anti-inflammatory drugs may be prescribed. Severe pain may require an injection of steroids near the bunion. Orthotics for shoes may be prescribed which, by altering the pressure on the foot, can be helpful in reducing pain. These do not correct the problem, but by eliminating the pain, they can provide relief.

For cases that do not respond to these methods of treatment, surgery can be done to reposition the toe. A surgeon may do this by taking out a section of bone, or may rearrange the ligaments and tendons in the toe to help keep it properly aligned. It may be necessary even after surgery to wear more comfortable shoes that do not put undue pressure on the toe as the big toe can easily move back to its orientation toward the smaller toes.

Thursday, 27 December 2012 17:07

Morton's Neuroma

Morton's neuroma is a painful foot condition that commonly affects the areas between the third and fourth toe and the ball of the foot. Other areas of the foot can also be susceptible to this condition. Morton’s neuroma is caused by an inflamed nerve in the foot that is being squeezed and aggravated by surrounding bones. Women are more likely than men to have an occurrence of this foot condition. When a person has Morton's neuroma, it can feel as if they are walking on stones or marbles.

There are risk factors that can increase a person's chance of having Morton's neuroma. Ill-fitting high heels or shoes can add pressure to the toe or foot area. Jogging, running and any other sports that involve constant impact to the foot area can make a person more susceptible to this condition. If a person has flat feet, bunions or any other foot deformities, it can put them at a higher risk for developing Morton's neuroma.

There is no one major sign that indicates a person has Morton's neuroma, but rather certain symptoms to look for. A person who has burning in the ball of the foot or tingling and numbness in the toe areas are signs they may have Morton's neuroma. The pain increases greatly when wearing shoes or being active. There usually is little or no pain at night.

If a person suspects that they have this condition, they should visit their doctor. A physician will check for palpable masses between the bones of the foot. A doctor will also apply pressure to the foot or toe area to replicate the pain a person experiences when active. Range of motion tests and X-rays are other options a doctor may offer a patient to rule out other conditions or problems.

Treating Morton's neuroma can be as simple as changing the type of shoes a person wears. Wear wider shoes or flat shoes with a soft sole. Doing this may help reduce the pressure on the nerve that is aggravated. If necessary, a person can have a cortisone injection to help reduce swelling and pain in the foot area. If these methods don't relieve the symptoms, consulting with an orthopedic surgeon should be the next option. During a consultation, a patient will find out about the treatment methods available for Morton's neuroma. A surgeon can release the tissue around the nerve that is causing this pain, or they can remove a small area of the nerve completely. There is a short recovery time for this type of surgery, and afterward, patients can return to their normal lifestyle.

Wednesday, 05 December 2012 03:00

Rheumatoid Arthritis in the Feet

Although rheumatoid arthritis actually attacks multiple bones and joints throughout the entire body, ninety percent of people who actually develop this condition usually do so in the foot or ankle area. Those who develop this kind of arthritis in the feet usually develop symptoms around the toes and forefeet first, before anywhere else. Rheumatoid arthritis appears to have a genetic component. If it runs in the family, then you will be more likely to develop it as well.

Rheumatoid arthritis is an autoimmune disorder in which the body’s own immune system attacks the lining of the membranes surrounding the joints. This causes inflammation of the membrane lining, and the gradual destruction of the joint’s cartilage and even bone.

Some of the most common symptoms that are associated with RA include pain and swelling of the feet. Stiffness in the feet is also another common symptom that people experience. Those who have RA in the feet usually feel the pain in the ball or sole of their feet. This can get to be very painful at times. A person's joints can even shift and become deformed after a period of time.

In order to properly diagnose RA in the feet it is usually necessary for a doctor or podiatrist to evaluate the area. Your doctor will also question you about your medical history, occupation, etc., to determine whether anything in your lifestyle may have triggered the condition. There are a number of tests that may be performed to help diagnose RA such as a rheumatoid factor test, although there is no one single test that will tell you for sure if you have RA. There are different X-rays that can be taken as well to determine if a person has RA in their feet.

There is a range of treatment options for rheumatoid arthritis. Treatment of RA is usually a lifelong process that includes a variety of methods of treatment and therapy. Your doctor can prescribe special shoes that should help with arch support as well as heel support. A physical therapist can help those with this condition learn exercises which will keep their joints flexible. Surgery may be needed to correct some of the issues with the feet, such as bunions, and hammertoes. Fusion is usually the most successful surgical option for rheumatoid arthritis. However, people need to keep in mind that there are some risks associated with these surgeries.

Poor blood circulation in the feet and legs is often caused by peripheral artery disease (PAD), which is usually the result of a build up of plaque in the arteries. Plaque build up, or atherosclerosis, can be the result of excess calcium and cholesterol in the bloodstream, which restricts how much blood can flow through arteries. Reduced blood flow to a certain area of the body severely limits the amount of oxygen and nutrients that part of the body receives, causing degeneration in the muscles and other tissues. Sometimes, poor blood circulation in the feet and legs can be caused by other conditions, such as damage to or inflammation of blood vessels, known as vasculitis.

The lack of oxygen and nutrients caused by poor blood circulation can restrict muscle growth and development, as well as cause muscle pain and cramps, weakness, and stiffness. Other common symptoms include numbness in the legs and feet, skin discoloration in the affected limbs, slower nail and hair growth, and erectile dysfunction in men. In more severe cases of PAD, pain can be present even when a person isn't exercising, and may range from mildly uncomfortable to completely debilitating.

Poor blood circulation in the feet and legs is more common in those who are overweight or obese, have diabetes, high blood pressure, high cholesterol, who smoke, or who have a family history of PAD or related conditions (heart attack, stroke, etc.). Diabetes and smoking place a person at greatest risk for developing poor blood circulation, although advanced age (over 50) can also increase risk.

If you are experiencing poor blood circulation in the feet and legs caused by PAD, it is important to make changes to your lifestyle in order to reduce your risk of experiencing a heart attack or stroke caused by this condition. If you smoke, quit completely -- this will increase the amount of oxygen in your bloodstream. Exercising and reducing the saturated fats in your diet (which come from fatty meats, fried foods, whole milk, etc.) can make a difference in improving blood circulation in feet. It is also important to avoid developing influenza and to carefully control your blood sugar if you have diabetes.

Your doctor may recommend combining lifestyle changes with a prescription medication regimen to improve blood circulation. The most commonly-used medications for PAD are called statins and work by blocking the amount of enzymes in your body that produce cholesterol. They are known by the brand names Zocor, Lipitor, Crestor, and others.

Sunday, 28 October 2012 17:20

Sesamoiditis

Sesamoiditis is a condition that affects the joint that is just behind the big toe in the area known as the ball of the foot. It is most common in younger people and people who have just begun an exercise program. Since the sesamoid bones are like a pulley controlling the big toe, they can rub against each other and cause a gradual onset of pain. Pain may also be caused by the inflammation of tendons surrounding the bones. If ignored, sesamoiditis can lead to other, more serious problems such as severe irritation and fractures of the bones.

The cause of sesamoiditis is sudden increase in activity. The ball of your foot acts as a springboard to help you lift off when you are jogging or running. Sudden increase in the use of these bones or the tendon that controls them can cause irritation. The tendon then begins to develop inflammation and the joint begins to swell. People with smaller, bonier feet or those with a high arch are typically more susceptible to this condition.

Sesamoiditis is fairly simple to diagnose since the symptoms have a gradual onset rather than a sudden impact. The symptoms begin with slight irritation around the joint shortly after the increase in activity. The discomfort eventually turns to pain with light swelling and possibly redness. Although redness or bruising are rare, this may be a symptom. After each session of exercising, the aggravated joint becomes more irritated and increases into a very intense throbbing.

Treatment for sesamoiditis can vary depending on the severity of the situation. However, treatment is almost always approached in a noninvasive way. For a case that is just beginning the doctor may recommend a very strict rest period that will limit the activity allowed on the joint. If you must be active, a recommendation for as modified shoe or insole, along with bandaging and immobilizing the big toe will be made to ensure that pressure is not placed on the joint. For severe cases, it is typically recommended that the joint and the big toe be completely immobilized to allow adequate time to heal. Ice and an over the counter anti-inflammatory may can help with the pain and discomfort while you are at rest.

When you return to your regular exercise activities, it is recommended that you use an insole that will allow even distribution of impact to your entire foot, rather than just the balls of your foot. This will prevent further aggravation of the injury.

Thursday, 25 October 2012 04:18

The Importance of Proper Foot Support

Feet are the foundation of the body, and just like the foundation of any structure, they must be stable and balanced in order to support the all of the body's weight. If they are not, they could cause many problems.

Bad foot support can cause pain or discomfort in the lower back, hips, knees, neck, and shoulder. It can lead to much less obvious problems as well, like stomach aches and headaches. Issues with the feet can lead to emotional stress and physiological changes in the body, including fatigue, blood sugar problems, and adrenal stress. In order to avoid these issues, you must be sure to wear shoes that provide proper foot support.

Of all the different parts of the foot, the arch is the one that needs the most support. This vital structure handles most of the pressure exerted during movement--for each mile someone walks, the arch bears between 200,000 and 300,000 pounds of stress. Arch height varies greatly from one person to another, and changes as a person ages. Proper support can prevent many musculoskeletal problems that may cause inactivity or even disability.

When searching for footwear, one must remember to buy shoes that fit well and that properly support the feet. Otherwise, you could suffer from a slew of foot-related problems. If, for example, you buy shoes that are too tight, you could hinder the support mechanism in the foot that keeps the body standing upright. If this mechanism is not working correctly, you will soon begin to slouch when standing. This quickly causes discomfort throughout the entire body, especially the back, and if it is not corrected it may cause permanent posture issues and bone deformation.

When shopping for shoes, only buy those that provide good heel and arch support. Both the heel and arch areas need to be firm, but still flexible enough for walking. Also make sure the shoes you intend to buy are the proper length and width for your feet. Your feet and toes should not feel squished or cramped in the shoe, or (if it is an open-toed shoe) be hanging over its sides. Additionally, if you are looking for a laced shoe, be sure to buy one that has many eyelets. Laces help the shoes form to the feet, and having many eyelets allows the laces to better conform to your foot. Also make sure that the laces are tied correctly, as laces that are not pulled tightly and tied do not provide proper support.

Good foot health is vital to overall body health. If you do not care for your feet properly, you could suffer many short and long-term problems that will negatively affect your entire body. Wearing shoes that provide good foot support is an easy way to avoid these problems, and live comfortably.

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