Next Step: Foot Care In Connecticut

Posts for: May, 2013

Cavus foot, or high-arched foot, is a condition in which the foot has a very high arch. Because of this high arch, an excessive amount of weight is placed on the ball and heel of the foot when walking or standing. Cavus foot can lead to a variety of signs and symptoms, such as pain and instability. It can develop at any age, and can occur in one or both feet.

Cavus foot is often caused by a neurologic disorder or other medical condition such as cerebral palsy, Charcot-Marie-Tooth disease, spina bifida, polio, muscular dystrophy, or stroke. In other cases of cavus foot, the high arch may represent an inherited structural abnormality.

An accurate diagnosis is important because the underlying cause of cavus foot largely determines its future course. If the high arch is due to a neurologic disorder or other medical condition it is likely to progressively worsen. On the other hand, cases of cavus foot that do not result from neurologic disorders usually do not change in appearance.

The arch of a cavus foot will appear high even when standing. In addition, one or more of the following symptoms may be present:

  • Hammertoes (bent toes) or claw toes (toes clenched like a fist).
  • Calluses on the ball, side, or heel of the foot.
  • Pain when standing or walking.
  • An unstable foot due to the heel tilting inward, which can lead to ankle sprains.

Some people with cavus foot may also experience foot drop, a weakness of the muscles in the foot and ankle that results in dragging the foot when taking a step. Foot drop is usually a sign of an underlying neurologic condition.

Diagnosis of cavus foot includes a review of the patient's family history. The foot and ankle surgeon examines the foot, looking for a high arch and possible calluses, hammertoes, and claw toes. The foot is tested for muscle strength, and the patient's walking pattern and coordination are observed. If a neurologic condition appears to be present, the entire limb may be examined. The surgeon may also study the patterns of wear on the patient's shoes.

X-rays are sometimes ordered to further assess the condition. In addition, the surgeon may refer the patient to a neurologist for a complete neurologic evaluation.

Non-surgical treatment of cavus foot may include one or more of the following options:

  • Orthotic devices. Custom orthotic devices that fit into the shoe can be beneficial because they provide stability and cushioning to the foot.
  • Shoe modifications. High topped shoes support the ankle, and shoes with heels a little wider on the bottom add stability.
  • Bracing. The surgeon may recommend a brace to help keep the foot and ankle stable. Bracing is also useful in managing foot drop. 

If non-surgical treatment fails to adequately relieve pain and improve stability, surgery may be needed to decrease pain, increase stability, and compensate for weakness in the foot.

The surgeon will choose the best surgical procedure or combination of procedures based on the patient's individual case. In some cases where an underlying neurologic problem exists, surgery may be needed again in the future due to the progression of the disorder.

If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.

Connecticut Foot Care Centers

Podiatrists in CT

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Hammertoe is a contracture (bending) of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop.

Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment.

Because of the progressive nature of hammertoes, they should receive early attention. Hammertoes never get better without some kind of intervention.

The most common cause of hammertoes is a muscle/tendon imbalance. This imbalance, which leads to a bends of the toe, results from mechanical (structural) changes in the foot that occur over time in some people.

Hammertoes may be aggravated by shoes that don't fit properly. A hammertoe may result is a toe is too long and forced into a cramped position when a tight shoe is worn.

Occasionally, hammertoes are the result of an earlier trauma to the toe. In some people, hammertoes are inherited.

Common symptoms of hammertoes include:

  • Pain or irritation of the affected toe when wearing shoes.
  • Corns and calluses (a buildup of skin) on the toe, between two toes, or on the ball of the foot. Corns are caused by constant friction against the shoe. They may be soft or hard, depending upon their location.
  • Inflammation, redness, or a burning sensation.
  • Contracture of the toe.
  • In more severe cases of hammertoe, open sores may form.

Although hammertoes are readily apparent, to arrive at a diagnosis the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor may attempt to reproduce your symptoms by manipulating your foot and will study the contractures of the toes. In addition, the foot and ankle surgeon may take x-rays to determine the degree of the deformities and assess any changes that may have occurred.

Hammertoes are progressive- they don't go away by themselves and usually they will get worse over time. However, not all cases are alike- some hammertoes progress more rapidly than others. Once your foot and ankle surgeon has evaluated your hammertoes, a treatment plan can be developed that is suited to your needs.

There is a variety of treatment options for hammertoe. The treatment your foot and ankle surgeon selects will depend upon the severity of your hammertoe and other factors.

A number of non-surgical measures can be undertaken:

  • Padding corns and calluses. Your foot and ankle surgeon can provide or prescribe pads designed to shield corns from irritation. If you want to try over the counter pads, avoid the medicated types. Medicated pads are generally not recommended because they may contain a small amount of acid that can be harmful. Consult your surgeon about this option.
  • Changes in shoewear. Avoid shoes with pointed toes, shoes that are too short, or shoes with high heels- conditions that can force your toe against the front of the shoe. Instead, choose comfortable shoes with a deep, roomy toe box and heels no higher than two inches.
  • Orthotic devices. A custom orthotic device placed in your shoe may help control the muscle/tendon imbalance. 
  • Injection therapy. Corticosteroid injections are sometimes used to ease pain and inflammation caused by hammertoes.
  • Medications. Oral nonsteriodal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
  • Splinting/strapping. Splints or small straps may be applied by the surgeon to realign the bent toe. 

In some cases, usually when the hammertoe has become more rigid and painful, or when an open sore has developed, surgery is needed.

Often patients with hammertoe have bunions or other foot deformities corrected at the same time. In selecting the procedure or combination or procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity, the number of toes involved, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.

Connecticut Foot Care Centers

Podiatrists in CT

Visit our website, friend and like our page on Facebook, and follow our tweets on Twitter.

A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe 

(metatarsophalangeal joint). Bunions form when the toe moves out of place. The enlargement and its protuberance cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles in toward the other toes, sometimes overlapping a third toe (known as Hallux Valgus). The growing enlargement or protuberance then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists, which is known as Hallus Abducto Valgus. Bunions can also lead to other toe deformities, such as hammertoebunion before operation

Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The skin over the toe becomes red and tender. Because this joint flexes with every step, the bigger the bunion gets, the more it hurts to walk. Over time, bursitis or arthritis may set in, the skin on the bottom of the foot may become thicker, and everyday walking may become difficult- all contributing to chronic pain. Wearing shoes that are too tight is the leading cause of bunions. Bunions are not hereditary, but they do tend to run in families, usually because of a faulty foot structure. Foot injuries, neuromuscular problems, flat feet, and pronated feet can contribute to their formation. It is estimated that bunions occur in 33 percent of the population in Western countries. 

Treatment for Bunions

Because they are bone deformities, bunions do not resolve by themselves. The goal for bunion treatment is twofold: first, to relieve the pressure and pain caused by irritations, and second, to stop any progressive growth of the enlargement. Commonly used methods for reducing pressure and pain caused by bunions include:

  • The use of protective padding, often made from felt material, to eliminate the friction against shoes and help alleviate inflammation and skin problems. 
  • Removal of corns and calluses on the foot.
  • Changing to carefully-fitted footwear designed to accommodate the bunion and not contribute toward its growth. 
  • Orthotic devices- both over-the-counter and custom made- to help stabilize the joint and place the foot in the correct position for walking and standing. 
  • Exercises to mbunion after operationaintain joint mobility and prevent stiffness or arthritis. 
  • Splints for nighttime wear to help the toes and joint align properly. This is often recommended for adolescents with bunions, because their bone development may still be adaptable. 

Surgical Treatment

Depending on the size of the enlargement, misalignment of the toe, and pain experienced, conservative treatments may not be adequate to prevent progressive damage from bunions. In these cases, bunion surgery, known as a bunionectomy, may be advised to remove the bunion and realign the toe. 

If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.

Connecticut Foot Care Centers

Podiatrists in CT

Visit our website, friend and like our page on Facebook, and follow our tweets on Twitter.

Osteomyelitis is a type of bacterial bone infection that moves from acute to chronic phases quickly. The infection usually begins in another part of the body and spreads to the bone via blood. Traumatic injury, frequent medication injections, diabetic ulcers on the foot, the use of a prosthetic device, and some surgical procedures can increase susceptibility to the underlying infection.

With osteomyelitis, the infected bone fill with a pus that deprives the bone of its needed blood supply. Over time, this can result in the death of bone tissue. It is caused by staphylococcus bacteria, a germ that can be found on healthy people. This bacteria can enter your bloodstream through pneumonia or a urinary tract infection and to the weakened bone. Staphylococcus bacteria can also be transmitted through other infections or wounds in your body and direct contamination via a compound fracture.

Those with osteomyelitis may find that they are experiencing chills and fever, pain in the area of the infection, and swelling, warmth, and redness over the affected area. Sometimes osteomyelitis has no signs or symptoms or has signs or symptoms that can easily be diagnosed as something else.

If you've recently had a compound bone fracture, deep puncture wound, or surgery to repair broken bones, you are at risk for osteomyelitis. Those with poorly controlled diabetes, peripheral arterial disease, and sickle cell disease impair good blood flow, and therefore your body has a difficult time fighting infections like osteomyelitis. Individuals who use medical tubing for dialysis machines, urinary catheters, or for long-term intravenuous tubing have an "open gateway" for germs to enter. Conditions and factors that impair the immune system, like chemotherapy, having an organ transplant, or needing to take corticosteroids also put you at risk. Finally, those who take illegal drugs through needles are at risk because the needles are not typically sterilized before use.

Complications from osteomyelitis may include:

  • Bone death. Infection in the bone will impede blood circulation to the bone, and cause bone death. Your bone can, however, heal after surgery to remove small sections of dead bone. But, if a large part of your bone has died, amputation may be necessary. 
  • Septic arthritis. Infection in bones can spread to nearby joints. 
  • Impaired growth. In children with osteomyelitis, the growth plates are commonly affected. Normal growth can be affected in these areas.
  • Skin cancer. In cases where osteomyelitis has turned pussy, the surrounding skin can develop squamous skin cancer. 

The presence of bone infection can be diagnosed with tests, such as bone scans, blood tests, X-rays, CT scans, MRIs, and bone biopsies.

Osteomyelitis infections are very difficult to cure with oral or intravenuous antibiotics. In chronic cases, surgical removal of the dead bone tissue is usually required. Antibiotics are typically given through a vein in your arm for four to six weeks. Side effects include nausea, vomiting and diarrhea. Surgery may include one of the following methods:

  • Drain the infected area. By opening the area around the infection, your podiatric surgeon can drain any pus or fluid that has accumulated.
  • Remove the diseased bone and tissue. The surgeon will debride, or remove, as much of the diseased bone and tissue as possible, taking a small portion of healthy bone to ensure the infection is gone.
  • Restore the blood flow. Your surgeon may fill in the empty space from the debridement with a piece of bone or tissue as a temporary filler until you are healthy enough to get a bone or tissue graft. 
  • Remove foreign objects. If you've had this procedure previously, old plates or screws may have to be removed. 
  • Amputate the limb. This is a final recourse and will not happen in all cases. 

If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.

Connecticut Foot Care Centers

Podiatrists in CT

Visit our website, like our page on Facebook, and follow our tweets on Twitter.

Xanthomas are skin lesions caused by fat accumulation of fat in the microphage immune cells in the skin.

They are indicative of lipid metabolism disorders, like high cholesterol levels, high blood fats, coronary artery heart disease, pancreatitis, and hyperlipidaemia.

There are several different types of xanthomas that can appear on the body, and one of the most common areas is on the Achilles tendon.

On the Achilles tendon they will appear slowly, and emerge as nodules on the tendon or ligament. This particular type of xanthoma is associated with severe hypercholesterolaemia and elevated LDL levels.

Most doctors will order blood and urine tests and X-rays to determine the cause of the elevated LDL levels and high cholesterol. It is crucial to determine the cause of the condition to lower the risk for further complications, which can include heart attacks, stroke, and peripheral vascular disease.

Treatment for xanthomas includes identifying and treating the underlying lipid disorder. In many cases, treating the disorder will reduce and sometimes eliminate the xanthoma. Dietary measures will be recommended, and may include:

  • Preparing meals from vegeatables, fish, and cereals.
  • Minimize intake of saturated fats (meats, dairy products, oils).
  • Minimize intake of simple, refined sugars (sodas, sweets).
  • Lose weight if overweight or obese.

Medications prescribed may include:

  • Statins, like simvastatin and atorvastatin, which reduce cholesterol production in the liver.
  • Fibrates, like bezafibrate, which can reduce the triglyceride production by the liver and increase HDL (good cholesterol).
  • Ezetimibe, which is given to the most severe patients. This medication will reduce cholesterol absorption in the stomach.
  • Nictinic acids lower cholesterol, LDL cholesterol, and increase HDL cholesterol.

Surgery may be recommended when the xanthomas do not resolve with appropriate treatment.

If you believe have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.

Connecticut Foot Care Centers

Podiatrists in CT

Visit our website, like our page on Facebook, and follow our tweets on Twitter.