New Year's Eve Foot Fixes

As the ball drops and rings in another exciting New Year, many enthusiastic revelers will sport their favorite pair of sassy sling-backs and other types of fashionable high heels. However, women, myself included, often pay a hefty price for their New Year’s footwear – resulting in blisters, arch and heel pain and much more! Therefore, start the New Year off on the right foot with these sole-saving, New Year’s footwear solutions from the American Podiatric Medical Association:

Problem: Burning sensation on the balls and toes of the feet.
Solution: Heaven 4 Toes’ Alba Round Toe Cushion.
The first-ever soft cushion insert designed especially for toes. These toe cushions are made of durable polyurethane for long-lasting comfort, and are virtually invisible in any pair of haughty heels. These toe cushions help to protect against painful skin abrasions and help to quell irritation and discomfort caused by friction.

Problem: Shoe soles hard on the feet, especially the heels.
Solution: SOLE Custom Footbeds, a product designed to provide custom-fit shock absorption in footwear. SOLE Footbeds feature a deep, cushioning heel cup that help to protect tootsies on the dance floor.

Problem: Slingbacks can dig deep into heels, leaving blisters and painful abrasions.
Solution: Provide a protective barrier between the strap and your skin by using moleskin or FootPetals’ Strappy Strips to prevent blisters and strap slippage, so you can comfortably
party into another successful New Year.

Follow these tips provided by APMA and dance into the New Year with happy, healthy feet, however if foot pain persists please contact our office, 440-946-5858, for an appointment.

Can Your Stress Fracture Be a Sign of an Underlying Medical Condition?

Unexplained foot fractures may be the first sign of osteoporosis, a bone thinning disease which affects over 28 million Americans and accounts for 1.5 million bone fractures a year.

Osteoporosis is frequently referred to as the “silent crippler” since it often progresses without any symptoms or isn’t diagnosed until a person experiences pain from a bone fracture. The porous nature of bones in people with osteoporosis makes them more susceptible to bone fractures, especially in the feet. Because the bones are in a weakened state, normal weight-bearing actions like walking can cause the bones in the foot to break. In fact, many patients visit their foot and ankle surgeon suffering from foot pain only to find out they actually have a stress fracture, without having experienced an injury.

Osteoporosis is most commonly seen in women over age 50, however younger people and men are also affected. Early symptoms can include increased pain with walking accompanied by redness and swelling on the top of the foot.

Diagnose of osteoporosis can be done through a bone densitometry test, which measures calcium and mineral levels in the bones through low-dose radiation x-ray or possibly through a routine x-ray.

If you are diagnosed with osteoporosis, it’s important to protect your feet from stress fractures. Wear shoes that provide support and cushioning, such as athletic running shoes, to provide extra shock absorption and protection. Custom orthotics may also be recommended to protect the foot from pressure and provide shock absorption, particularly during exercise.

If you are suffering from foot pain or suspect you may have osteoporosis, call our office at 440-946-5858 for an evaluation, or conveniently schedule your appointment online at www.drrobertrosenstein.com.

Snow and Ice Can Be Danagerous for Fashionable Boots

As a female, I too, like to wear fashionable shoes or boots, however with the constant snow and ice we get in Northeastern Ohio it can be very dangerous. The treacherous snow and icy conditions we endure, can lead to falls, which are not only embarrassing but can result in a number of injuries. If your ankle rolls inward or outward, a bone can be broken or if your ankle twists, ligaments can be stretched or torn causing an ankle sprain. If this does happen to you, collect your belongings, brush off your designer duds and get somewhere where you can immediately begin “R.I.C.E.” therapy– rest, ice, compression and elevation – to help reduce swelling, pain and further injury. Then pick up your phone and call my practice in Mentor to be seen, 440-946-5858. If treatment is delayed long-term complications, such as chronic ankle instability and pain, arthritis, or deformity can develop. Also, please do not believe the misnomer, if you can walk on it, it is not broken. If you develop pain, swelling, or bruising this is an indication of a serious injury requiring medication attention.

Five Tips for Healthy Holiday Feet

Don’t let sore, achy feet ruin your holiday season. Here are five tips to healthy holiday feet:

1. Chose proper shoes—When hitting the dance floor or the shopping malls during the holiday season, don’t compromise comfort and safety when picking the right shoes to wear. Narrow shoes, high-heeled shoes or shoes that aren’t worn very often, such as dress shoes, can irritate feet leading to blisters, calluses, swelling and even severe ankle injuries. To prevent problems, choose a shoe that has a low heel and fits your foot in length, width and depth while standing.

2. Don’t overindulge in holiday cheer— Did you know your feet can feel the effects of too much holiday cheer? Certain foods and beverages high in purines, such as shellfish, red meat, red wine and beer can trigger extremely painful gouty attacks. A condition where uric acid builds up and crystallizes in and around your joints, most commonly affecting the big toe.

3. Be pedicure-safety conscious—Before you head for your holiday mani/pedi, remember nail salons can be a breeding ground for bacteria, including MRSA. To reduce your risk of infection, choose a salon that follows proper sanitation practices and is licensed by the state. Consider also purchasing your own pedicure instruments to bring along to your appointment.

4. Watch for ice and snow—Holiday winter wonderlands can be beautiful but also dangerous. Use caution when traveling outdoors. Watch for ice or snow patches along your trail. Ice accelerates a fall and causes more severe trauma, because the foot can move in any direction after it slips. If you do experience a fall, take a break from activities until you can be seen by a foot and ankle surgeon. Use R.I.C.E. therapy (Rest, Ice, Compression, and Elevation) to help reduce the pain and control swelling around the injury.

5. “Listen” to your feet—Don’t let foot pain ruin your holiday fun. Inspect your feet regularly for any evidence of ingrown toenails, bruising, swelling, blisters, dry skin or calluses. If you notice any pain, swelling or signs of problems, make an appointment with your foot and ankle surgeon.

If you are suffering from foot pain or have concerns about your foot health, please call our office at 440-946-5858 for an evaluation, or schedule an appointment.

Diabetes Awareness Month

November is Diabetes Awareness Month, therefore listed below is guidelines all diabetics should abide by:

Inspect your feet daily: Check for cuts, blisters, redness, swelling, or nail problems. Use a magnifying hand mirror to look at the bottom of your feet. Call your doctor if you notice anything. (If your eyesight is poor, have someone else do it for you.)

Wash your feet in lukewarm (not hot!) water. Keep your feet clean by washing them daily. But only use lukewarm water, the temperature you'd use on a newborn baby.

Be gentle when bathing your feet. Wash them using a soft washcloth or sponge. Dry by blotting or patting and make sure to carefully dry between the toes.

Moisturize your feet—but not between your toes. Use a moisturizer daily to keep dry skin from itching or cracking. But DON'T moisturize between the toes, this could encourage a fungal infection.

Cut nails carefully—and straight across. Also, file the edges. Don't cut them too short, since this could lead to ingrown toenails.

Never trim corns or calluses. No "bathroom surgery" let your doctor do the job.

Wear clean, dry socks. Change them daily.

Avoid the wrong type of socks. Avoid tight elastic bands (they reduce circulation). Don’t wear thick or bulky socks (they can fit poorly and irritate the skin).

Wear socks to bed. If your feet get cold at night, wear socks. NEVER use a heating pad or hot water bottle.

Shake out your shoes and inspect the inside before wearing. Remember, you may not feel a pebble, so always shake out your shoes before putting them on.

Keep your feet warm and dry. Don't get your feet wet in snow or rain. Wear warm socks and shoes in winter.

Never walk barefoot. Not even at home! You could step on something and get a scratch or cut.

Take care of your diabetes. Keep your blood sugar levels under control.

Don't smoke. Smoking restricts blood flow in your feet.

Get periodic foot exams at Affiliated Podiatrists, Inc. 440-946-5858.

Got gout? Holiday Season Can Trigger Occurence.

Thanksgiving dinner, holiday office parties, are right around the corner. Tis the season to beware of the dreaded gout! Clevelanders are more likely to eat and drink alcohol in excess during the upcoming holiday season. Next thing you know your knee, ankle, or big toe starts throbbing in the middle of the night. The bed sheets touching the top of your foot feels like a hot prod. You get out of bed and your foot is red, hot, swollen and you can't place any weight on it. Got gout?

Gout attacks are extremely painful. They are caused when uric acid accumulates in the tissues or a joint and crystallizes. This most commonly occurs in the big toe joint because the big toe is the coolest part of the body and uric acid is sensitive to temperature changes.

Foods that are high in purines contribute to uric acid build-up. These foods include shellfish (shrimp, crab, etc.), organ meats (kidney, liver, etc.), red meat, red wine and beer.

Gout can be treated with medications, diet changes, increasing consumption of appropriate fluids, and immobilizing the foot. In some cases surgery is required to remove the uric acid crystals and repair the joint. For more information on gout, visit the ACFAS consumer Web site, FootHealthFacts.org, or contact Dr. Zienkowski's office at 440-946-5858.

Fallen Arches?????

The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot.

PTTD is often called “adult acquired flatfoot” because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it isn’t treated early.

Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.
These symptoms include pain, swelling, flattening of the arch, and an inward rolling of the ankle. As the condition progresses, these symptoms will change. With onset of PTTD, pain is experienced on the inside of the foot and ankle (along the course of the tendon) with possible associated redness, warmth and swelling. As PTTD progresses the arch begins to flatten and the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more and the pain shifts to the outside of the foot, below the ankle.

Because of the progressive nature of PTTD, early treatment is advised. Early treatment includes custom orthotics and bracing to give your arch the support it needs, immobilization via short leg cast or boot to immobilize the foot and allow the tendon to heal, physical therapy to help rehabilitate the tendon and/or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to help reduce the pain and inflammation. If treated early enough, symptoms will more then likely resolve without the need for surgery and progression of the condition will be arrested.

In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities which more then likely will require surgical intervention.

If you or someone you know is suffering from a condition, please do not hesitate to give our office a call to set-up a consultation, 440-946-5858.

P..R..P

PRP is "platelet-rich plasma," also known as autologous platelet concentrate (APC). Platelets are a specialized type of blood cell that is involved in healing injuries. With PRP, a concentrated platelet solution is injected into an injured area, for example chronically damaged ligaments and/or tendons, to stimulate healing.

Why Does PRP Work?

Human platelets are naturally rich in connective tissue growth factors. Injecting these growth factors into damaged ligaments and/or tendons stimulates a natural repairative process.

What Conditions Benefit From PRP?

PRP treatment works best for chronic ligament and tendon sprains/strains that have failed other conservative treatment, including:

- Lateral ankle sprains & instability

- Deltoid ligament injury

- Achilles tendinosis

- Plantar fasciitis

- Sesamoiditis

- Posterior Tibial Tendonitis

- Peroneal Tendonitis

What Does the Procedure Entail?

In the office, blood is drawn, placed in a special centrifuge and spun down to isolate the needed components. The platelets are separated from the red blood cells. The red blood cells are discarded, and the isolated platelet concentrate is used for treatment. While the blood is spinning in the centrifuge, the painful area is anesthetized with local anesthetic. The resultant platelet concentrate is injected into the injured area under direct ultrasound visualization. The entire treatment takes approximately 30-45 minutes.

How Often are Injections Given?

After the initial treatment, a follow up visit is scheduled. Some patients respond very well to just one treatment. However, typically 2-3 additional treatments are necessary at 4-6 week intervals.

Are There Risks With PRP?

The risks include infection, blood clot, skin discoloration, bleeding, and nerve damage; however, these complications are very rare.

What is the Success Rate?

Studies suggest an 80 - 85% improvement in pain and function at 6 months and 91% at 1 - 3 year follow up. Some patients experience complete relief in pain.

Additional Therapies

To get maximum benefit from the treatment, and to help prevent re-injury, a specially-designed home-based rehabilitation and exercise program is incorporated into your treatment. This helps the newly developing connective tissue mature into healthy and strong tendon or ligament fibers. Your doctor may also prescribe customized devices to correct improper biomechanics.

If you or someone you know is suffering from a condition that can benefit from this therapy, please do not hesitate to give our office a call to set-up a consultation, 440-946-5858.

Radio Personnel, Howard Stern, Fractures his Toe

Howard Stern revealed that he has done what so many people do, he broke his toe. He stubbed his toe on the corner of his desk and broke his left fifth toe, a common injury seen in many podiatry offices, including our office daily.

Many people, for unspecified reasons, think there is no treatment for a broken toe. For that reason, they don’t go into the doctor to get it checked out. Howard, however, is doing everything right with his broken toe. He went to the doctor had it evaluated, x-rayed and treated. He is currently taping his 5th toe to the 4th, neighboring toe, called buddy taping. He is also wearing a fracture walker boot, which will help to stabilize the fracture and prevent the affected bones from moving, causing pain and impede healing.

Toe fractures typically take 6-8 weeks to completely heal with conservative treatment. Surgery is rarely required to treat fractures in the toes or forefoot. However, when it is necessary, it has a high degree of success.

If Howard did what most do and ignore the problem, he would be putting himself at risk for the bones to displace, resulting in chronic swelling and pain that could only be corrected with surgery. The treatment that has been prescribed is absolutely necessary to ensure he is back to full strength and activity in the shortest period of time.

If you or someone you know is suffering from this condition, please do not hesitate to give our office a call to set-up a consultation, 440-946-5858.

Seneca Wallace Suffers High Ankle Sprain

Browns quarterback, Seneca Wallace, suffered a high ankle sprain injury during the next-to-last play of the first half of last Sunday’s game when Atlanta defensive end, John Abraham, sacked Wallace and fell on his ankle. A high ankle sprain is used to describe a particular type of ankle injury. Normally, when someone sprains their ankle, the ligaments that surround the ankle joint are stretched or torn. This injury causes pain and swelling around the ankle, and can be quite uncomfortable. A high ankle sprain injures the large ligament above the ankle that joins together the two bones of the lower leg. These two bones, the tibia (shin bone) and fibula, run from the knee down to the ankle. They are joined together by this ligament called the "syndesmosis" or "sydesmotic ligament."

A high ankle sprain causes symptoms similar to other ankle sprains, but patients often complain of pain when the ankle is turned to the outside or when the calf is squeezed. This later finding, the so-called "squeeze test," is the classic test for syndesmotic injuries, but it is not very reliable for diagnosis.

Syndesmotic injuries tend not to heal as well as more common ankle sprains, that is why trainers and coaches of athletes are often concerned about "high ankle sprains." If the injury is stable, then the high ankle sprain can be treated in a cast, usually for a period of 6 weeks. If the injury is unstable, then a "syndesmotic screw" can be placed between the tibia and fibula to hold the bones in proper position while the syndesmotic ligament heals.

If you or someone you know is suffering from this condition, please do not hesitate to give our office a call to set-up a consultation, 440-946-5858.

Spider Veins?

Varicose veins are no longer solely a cosmetic issue, they can also lead to further complications affecting physical appearance, quality of life and time off from work

Varicose veins are more common in women, however can also affect the male population. The prevalence ranging from 25% to 33% in women versus 10% to 20% in men. Varicose veins tend to increase in frequency as one ages. The most common initial symptoms of individuals presenting with varicose veins include swelling, heaviness, fatigue or throbbing pain in the legs. These symptoms usually disappear when patients elevate their legs or get off their feet.

So if you suspect varicose veins, what might some of your treatment options be? Some treatment options include external compression devices such as compression stockings (which remain the mainstay of therapy for varicose veins), drug therapy (diuretics and horse chestnut extract), sclerotherapy (injection of a substance that obliterates the vein), laser and pulsed-light therapy (indicated for small veins) and surgery. Treatment considerations depend on the level of necessary therapy needed.

If you or someone you know is suffering from this condition, please do not hesitate to give our office a call to set-up a consultation, 440-946-5858.

Diabetes and Foot Problems

Foot problems that develop in people who have diabetes (ex. ingrown toenails, calluses, corns) should be treated promptly by a podiatrist. In some diabetes cases, the body does not produce substances that are necessary to promote the healing process.

Treatment for foot sores or ulcers that do not heal properly due to poor circulation may involve a vessel bypass. Blocked blood vessels (i.e., atherosclerosis) can be bypassed with a blood vessel graft. Improved circulation promotes healing.

In some cases, a skin graft may be performed. In this procedure, a piece of skin is surgically removed from a healthy part of the body and used to cover the wound. However, skin grafts on the soles of the feet can be problematic because if the cause of the wound is not corrected, the wound can recur. For example, if the wound is caused by a bony prominence in the foot, padding the area is necessary to prevent the wound from recurring.

In patients with diabetes, an infected wound is a medical emergency. Signs of infection include the following:

• Blood sugar that is difficult to control or that requires a higher than normal dosage of insulin
• Discharge (pus) that oozes from the wound
• Excessive sugar in the urine
• Fever
• Redness
• Swelling

If you or someone you know is a diabetic and is experiencing foot problems, please do not hesitate to give our office a call, 440-946-5858 for an appointment.

Infection Within the Bone

Osteomyelitis is an infection involving the bone caused by various microorganisms such as bacteria and/or fungus. This disorder affects about 2 out of every 10,000 people.

Osteomyelitis can affect both adults and children. The bacteria or fungus that can cause osteomyelitis, differs among age groups as does the location of infection. In adults, osteomyelitis often affects the vertebrae and the pelvis. In children, osteomyelitis usually affects the adjacent ends of long bones. Long bones are large, dense bones that provide strength, structure, and mobility. These include the femur and tibia in the legs.

Osteomyelitis does not occur more commonly in a particular race or gender. However, some people are more at risk for developing the disease. These include: Patients with diabetes, weakened immune system, sickle cell or receiving hemodialysis, IV drug drug abusers or elderly patients.

Symptoms of osteomyeltis, may include:

• Pain and/or tenderness in the infected area
• Swelling and warmth in the infected area
• Fever
• Nausea, secondarily from being ill with infection
• General discomfort, uneasiness, or ill feeling
• Drainage of pus through the skin

There are many ways that infecting bacteria find their way to bone, resulting in the development of osteomyelitis. These include:

• An open injury to the bone or a soft tissue infection

• An infection from elsewhere in the body, such as pneumonia or a urinary tract infection, that has spread to the bone through the blood stream.
• Minor trauma, which can lead to a blood clot around the bone and then a secondary infection from seeding of bacteria.
• Bacteria in the bloodstream, which is deposited in a localized area of the bone.

The objective of treating osteomyelitis is to eliminate the infection and prevent the development of chronic infection. Chronic osteomyelitis can lead to permanent deformity, possible loss of limb, or life and other health issues, so it is important to treat the disease as soon as possible. If you or someone you know is suffering from this condition please contact our office for consultation, 440-946-5858 to prevent the complications noted above.

Shin Pain?

With the beginning of fall, means the beginning of many fall sports and possibility of new aches and pains for our athletes. One common complaint is pain to the front of the shin. Pain in this area is referred to as "shin splints."

“Shin splints” is a term used to describe pain and swelling to the front of the lower legs. The pain usually appears after and is aggravated by repetitive activities such as running or walking. Contributing causes are flat feet, calf tightness, improper training techniques, worn out or improper shoes/sneakers, as well as running or walking on uneven surfaces. The inflammation in the shin results from the repeated pull of a muscle in the leg from the shin bone (tibia).

This condition usually occurs bilaterally (both legs) and can be alleviated by rest, use of non steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, icing, a change in training habits, stretching exercises, and properly fitted shoes.

If you or someone you know is suffering please given our office a call, 440-946-5858, to allow us to properly treat the condition, recommend proper shoe gear and evaluate whether orthotics are needed. If not treated, shin splints may eventually result in a stress fracture of the shin bone.

Broken Toes

The structure of your foot is complex, consisting of bones, muscles, tendons, and other soft tissues. Of the 26 bones in your foot, 19 are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot). Fractures of the toe and metatarsal bones (broken toes) are common and require evaluation by a specialist.

A fracture is a break in the bone. Fractures can be divided into two categories.

Category 1 of fractures is traumatic fractures, also called acute fractures. Traumatic fractures are caused by a direct blow or impact, like seriously stubbing your toe. These types of fractures can be displaced or non-displaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated). Treatment of a traumatic fracture depends on the location and extent of the break and whether it is displaced. Surgery is sometimes required. Signs and symptoms of a traumatic fracture may include a popping sound, pin-point pain, deviation (mis-shapen or abnormal appearance of the toe) or brusing and swelling to the affected area.

Category 2 of fractures is stress fractures. Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. Or they may be caused by an abnormal foot structure, deformities, osteoporosis or improper footwear. Symptoms of stress fractures include pain with or after normal activity, pin point pain, swelling, but no bruising and pain that goes away when resting and then returns when standing or during activity.

Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself and may include these options: Rest, rigid or stiff-soled shoe and splinting or "buddy" taping the affected toe. If the break is badly displaced or if the joint is affected, surgery may be necessary. Surgery often involves the use of fixation devices, such as pins or screws.

Treatment of metatarsal fractures depends on the type and extent of the fracture, and may include rest, immobilization (casting or rigid shoe) and avoidance of offending activity. If the break is badly displaced or if the joint is affected, surgery may be necessary. Surgery often involves the use of fixation devices, such as pins or screws.

It is not true that if you can walk on it, it is not broken. Evaluation by a physician is recommended, therefore please call our office to schedule an appointment, 440-946-5858.

Back to School Shoe Shopping

The sounds of school bells, slamming locker doors and students clammering into classrooms are being heard once again. With the start of a new school year, parents are eagerly seeking a wide array of school supplies and new fashions for their children. One of the most important purchases on a parent’s back to school shopping list is a new pair of shoes. With the numerous styles and fashions of shoes, several important factors must be considered:

-Children’s feet change with age: Shoe and sock sizes may change every few months as a child’s feet grow.
-Never hand down foot wear: Just because a shoe size fits one child comfortably does not mean it will fill another the same way. Also, sharing shoes can spread athlete’s foot and nail fungus infections.
-Examine the heels of your child’s shoe. Children may wear through the heels of shoes quicker than out-growing shoes themselves. Uneven heel wear can indicate a foot problem that should be evaluated by a foot/ankle physician.
-Shoes that do not fit properly can aggravate the feet: Always measure a child’s feet before buying shoes and watch for signs of irritation.
-Always buy for the larger foot: Feet are seldom the same size.
-Buy shoes that do not need a “break-in” period: Shoes should be comfortable immediately. Also, make sure to have your child try on shoes with socks or tights, if that’s how they will be worn.

6 Tips to Protect Kids in Fall Sports

If your children are playing sports this fall, pay attention to six tips that could protect them from serious ankle injuries.

--Have old sprains checked by a doctor before the season starts. A medical check-up can reveal whether your child's previously injured ankle might be vulnerable to sprains, and could possibly benefit from wearing a supportive ankle brace during competition.

--Buy the right shoe for the sport. Different sports require different shoe gear.

--Children should start the season with new shoes. Old shoes can wear down like a car tire and become uneven on the bottom, causing the ankle to tilt because the foot can't lie flat.

--Check playing fields for dips, divots and holes. Most sports-related ankle sprains are caused by jumping and running on uneven surfaces. That's why some surgeons recommend parents walk the field, especially when children compete in non-professional settings like public parks, for spots that could catch a player's foot and throw them to the ground. Alert coaching officials to any irregularities.

--Encourage stretching and warm-up exercises. Calf stretches and light jogging before competition helps warm up ligaments and blood vessels, reducing the risk for ankle injuries.

If you would like more information please visit our website at www.drrobertrosenstein.com, or call our office at 440-946-5858 to set-up a consultation.

Sporting Activities and Big Toe Pain

Turf toe is a sprain of the big toe joint resulting from injury during sporting activities. This injury usually results from excessive upward bending of the big toe joint. The condition can be caused from either jamming the toe, or repetitive injury when pushing off repeatedly when running or jumping. Although this injury is most commonly reported in football players, participants in soccer, basketball, wrestling, gymnastics and dance also are at risk.

The name “turf toe” comes from the fact that this injury is especially common among athletes who play on artificial turf. When playing sports on artificial turf the foot can stick to the hard surface, resulting in jamming of the big toe joint.

The signs and symptoms of turf toe can include pain, swelling, and limited joint movement. If turf toe is caused by repetitive actions that cause injury, the signs and symptoms will usually begin slowly and gradually worsen. Turf toe can also be caused by a direct injury leading to damage of the bone beneath the cartilage. If direct injury is the cause, the signs and symptoms may begin suddenly and get worse over a 24-hour period.

Treatment of turf toe consists of controlling the inflammation of the joint capsule. The most important aspect of treatment is to rest the sore toe to allow the inflammation to subside and the joint capsule to heal. In addition to resting the toe, inflammation can be controlled by icing the area and elevating the foot, and anti-inflammatory medications.

Athletes diagnosed with turf toe should avoid their sport at least three weeks to allow the joint capsule to heal. Without doing so, the injury can progress, and can lead to an even longer recuperation. It is not uncommon for athletes to try to come back too soon, or to try to play through the injury. Unfortunately, this usually leads to a more chronic injury, and ultimately a longer recovery.

If you or someone you know is suffering from this condition, please contact our office for a consultation, 440-946-5858 or visit our website, www.drrobertrosenstein.com for additional information.

Surgeons Issue Warning on Dangers of Cosmetic Foot Surgery

"Foot facelifts” are a growing trend around the globe, a procedure that can help to narrow the feet so that they fit better in heels or smaller shoes. However, the American Orthopedic Foot and Ankle Society has issued a warning about these procedures, indicating that this type of surgery can cause extensive nerve damage and pain, and may lead to other problems.

Cosmetic foot surgery involves shortening the second toe so that it is not longer than the big toe. This makes it easier for the foot to accommodate high heels, and can reduce pain and discomfort when wearing heels for an extensive period of time. However, the procedure can cause a significant amount of pain and nerve damage in itself, and poses many risks. Complications of foot surgery include infection, corns, and chronic pain when walking. In some cases, the bones and tendons can become inflamed or may even shift, requiring more surgery.

The procedure is also known as restorative foot surgery, because it is designed primarily to enhance the physical appearance of the foot. Some procedures involve removing fat from the heels and around the sides of the foot, so that the foot looks better in high heels. Other procedures involve the injection of fat into the balls of the feet so that the individual has a more shapelier foot and feels more comfortable in heels. Some surgeons also perform bone restructuring procedures, or administer procedures that narrow the base or tip of the feet.

Please follow the Foot and Ankle Society’s recommendation and never have surgery performed to improve the appearance of the foot.

New Study Demonstrates Dramatic Impact of Podiatric Care

Patients with diabetes who receive medical and surgical care provided by a podiatrist are less likely to suffer hospitalization or amputation than patients who do not receive care from a podiatrist, according to a new study from Thomson Reuters. Thomson Reuters is an internationally respected research firm with expertise in the health-care market.

The study, sponsored by APMA (American Podiatric Medical Association), examined records for more than 32,000 patients with diabetes under 65 and matched health and risk factors for those who had podiatry visits to those who did not. Care by a podiatric physician, defined as at least one pre-ulcer visit, was associated with lower risk of hospitalization and amputation.

The dramatic results of this study demonstrate the important role of today's podiatrist. Podiatrists, make a significant impact on patient outcomes and health-care costs. As more diabetic patients receive high-quality medical care by podiatrists prior to developing ulcers, a greater reduction in cost and improvement in patients' quality of life will be seen.

If you or someone you know has diabetes and does not have a podiatrist, please contact our office for a consultation, 440-946-5858, to ensure proper quality of life.

Stiffness in Your Big Toe?

Each day, with every step you take, your big toe bears a tremendous amount of stress, a force equal to about twice your body weight. Most of us don't realize how much we use our big toe. We tend to take it for granted, unless a problem develops.

One problem that afflicts the big toe is called hallux rigidus, a condition where movement of the toe is restricted to varying degrees. This disorder can be very troubling and even disabling, since we use the all-important big toe whenever we walk, stoop down, climb up or even stand. If you have pain and/or stiffness in your big toe, you may have this condition.

Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the big toe and with time it gets increasingly harder to bend the toe. "Hallux" refers to the big toe, while "rigidus" indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis (a wearing out of the cartilage within the joint that occurs in the foot and other parts of the body).

Early signs and symptoms include pain and stiffness in the big toe during use (walking, standing, bending), difficulty with certain activities (running, squatting) and swelling and inflammation around the joint

As the disorder gets more serious, additional symptoms may develop, including pain, even during rest, difficulty wearing shoes because bone spurs (overgrowths) develop and limping, in severe cases

Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis—the kind that results from "wear and tear"—often develops in people who have defects that change the way their foot and big toe functions. In some people, hallux rigidus runs in the family and is a result of inheriting a foot type that is prone to developing this condition. In other cases, it is associated with overuse, especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often have to stoop or squat. Hallux rigidus can also result from an injury or an inflammatory diseases, such as rheumatoid arthritis or gout.

Treatment for mild or moderate cases of hallux rigidus may include one or more of these strategies. First, shoe modifications: Shoes that have a large toe box should be worn, because they put less pressure on the toe. Stiff or rocker-bottom soles may also be recommended. Second, orthotic devices: Custom may improve the function of your foot. Third, medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to help reduce pain and inflammation. Supplements such as glucosamine-chondroitin sulfate and some vitamins and minerals may also be helpful. Fourth, injection therapy into the affected toe can help to reduce the inflammation and pain. Lastly, physical therapy: Ultrasound therapy or other physical therapy modalities may be undertaken to provide temporary relief.

In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery that can be undertaken to treat hallux rigidus. These surgical procedures fall into two categories. The first category of procedures consists of reconstructing and "cleaning up" the joint. The arthritic damage from the joint as well as any accompanying bone spurs are removed, preserving and restoring the normal alignment and function of the joint, as well as reducing or eliminating pain. The second category of procedures consists of more aggressive procedures. These procedures include fusing the joint or removing part or all of the joint and replacing it with an implant, such as is done for the hip or knee.

If you or someone you know is suffering from this condition please visit our website, www.drrobertrosenstein.com for more information or contact our office, 440-946-5858 to schedule a consultation.

Arches Falling???

Treatment and prevention of adult flatfoot can reduce the incidences of additional foot problems such as bunions, hammertoes, arthritis and calluses, and improve a person’s overall health, according to research published in the July/August Journal of Foot & Ankle Surgery.

Overweight males in white-collar jobs are most apt to suffer from adult flatfoot disorder, a progressive condition characterized by partial or total collapse of the arch, according to the research. FootHealthFacts.org, the consumer website of the American College of Foot and Ankle Surgeons, notes that symptoms of adult flatfoot include pain, general aching or fatigue in the foot, swelling, flattening of the arch and an inward rolling of the ankle. Flatfoot is a progressive disorder by nature, therefore, the study suggests that neglecting treatment or preventive care can lead to arthritis, loss of function of the foot and other painful foot disorders.

Flatfoot disorder may gradually worsen to the point that many of the tendons and ligaments in the foot and ankle are simply overworking, often to the point where they tear and/or rupture. If this occurs, even simple walking and standing becomes increasingly painful, requiring much more energy.

In many cases, flatfoot can be treated with non-surgical approaches including orthotic devices or bracing, immobilization, physical therapy, medication and shoe modifications. In some patients whose pain is not adequately relieved by conservative treatments, there are a variety of surgical techniques available to correct flatfoot and improve foot function.

If you are someone you know is experiencing this condition please visit our website, www.drrobertrosenstein.com, for more information or contact the office, 440-946-5858 for a consultation.

Troublesome Lump on Your Foot or Ankle?

A ganglion cyst is a benign tumor, or lump that can occur anywhere on the body, but is most prevalent on the hands, but also very common on the feet. It is a sac filled with fluid that arises from either a joint (space between two bones) or from a tendon (structure that attaches a muscle into bone).

Ganglion cysts are also known as bible cysts or sometimes Gideon cysts because years ago the recommended treatment was to smash the growth with a book in order to break it up and even the poorest of families owned a bible.

Ganglion cysts vary in size and may get smaller or larger over time and may even disappear, only to possibly return later.

Ganglion cysts are more common in women with 70% of ganglion cysts occurring in people between 20-40 years of age. About 4% of all ganglion cysts occur on the feet.

Signs and symptoms associated with a ganglion cysts may include:
- A noticeable lump
- Tingling or burning, if the cyst is touching a nerve.
- Dull pain or ache, which may indicate the cyst is pressing against a tendon or
joint.

Ganglion cysts are usually caused by some type of injury. For example, a ganglion cyst might develop after something drops on the foot, if the foot was twisted while walking or after too much stress was placed on a joint or tendon.

Treatment options for a ganglion cyst include:
- Monitoring
If the cyst causes no pain and does not interfere with walking, it is best
to carefully watch the cyst over a period of time.
- Shoe modifications:
Wearing shoes that do not rub the cyst or cause irritation or placing a pad inside the shoe may
help reduce pressure against the cyst.
- Aspiration and injection.
This technique involves draining the fluid and then injecting a steroid medication into the mass.
More than one session may be needed.
- Surgery.
When other treatment options fail or are not appropriate, the cyst may need to be surgically
removed. While the recurrence rate associated with surgery is much lower than that
experienced with aspiration and injection therapy, there are nevertheless cases in which the
ganglion cyst returns.

If you or someone you know has this condition and would like additional information, please do not hesitate to give our office a call, 440-946-5858 or visit our website at www.drrobertrosenstein.com.

Skin Cancer and Your Feet

The next time you clip your toenails, take a closer look at the rest of your feet. An extra 60 seconds could save your life.

Routine self examinations of your feet are an important way to find skin cancer early, when it's easiest to cure. Half of the people who learn they have melanoma of the foot die within five years because the cancer had already spread throughout their body by the time it was diagnosed.

Nearly 60,000 people will learn they have melanoma this year. It's not known how many of those cases will involve the foot, but more than 8,100 melanoma patients will die, which is approximately one death every hour. If melanoma is detected in its earliest stages, 92 percent of patients are alive after five years.

Unlike many other types of cancer, melanoma strikes people of all age groups, even the young. Whites are 10 times more likely to develop melanoma than blacks. But studies suggest more than half of melanoma cases in blacks involve the foot, where late diagnosis leads to a higher death rate. Routine foot self exams increase the likelihood of noticing suspicious moles, freckles or other spots.

Routine foot exams should evaluate for the following ABCD findings in a mole, freckle or other lesion:

● Asymmetry – Is one half of the lesion different in shape from the other?

● Border – Does the lesion exhibit uneven or ragged borders?

● Color – Is there more than one color noted with the lesion or does the noted colors have an uneven distribution?

● Diameter – Is the lesion wider than a pencil eraser? Does the lesion exhibit signs of ulceration, craters, donut-shaped edges, bleeding or slow healing if the lesion is ulcerated?

If any of these signs are present on the foot, it is important to see a physician right away.

To help prevent melanoma please follow the general pre-cautions listed below:

● Use adequate sunscreen in areas that are unprotected by clothing or shoes. Be sure to apply sunscreen on the soles as well as the tops of feet.

● Wear water shoes or shoes and socks

● Inspect all areas of the feet daily

● If you wear nail polish, remove it occasionally so that you can inspect the skin underneath the toenails.

● Avoid UV radiation during the sun’s peak hours (10 a.m. to 4 p.m.), beginning at birth.

● Wear sunglasses that block 100% of all UV rays, both UVA and UVB.

Remember: Early detection is crucial with malignant melanoma. If you see any of the ABCD signs or if you have discoloration beneath a toenail that is unrelated to trauma be sure to visit your physician as soon as possible or given our office a call for consultation, 440-946-5858.

Bunionette

Tailor’s bunion, also called a bunionette, is a prominence of the fifth metatarsal bone at the base of the little toe. The metatarsals are the five long bones of the foot. The prominence that characterizes a tailor’s bunion occurs at the metatarsal “head,” located at the far end of the bone where it meets the toe. Tailor’s bunions are not as common as bunions, which occur on the inside of the foot, but they are similar in symptoms and causes.

Tailor’s bunion is most frequently caused by an inherited faulty mechanical structure of the foot resulting in the fifth metatarsal bone starting to protrude outward, while the little toe moves inward creating a bump on the outside of the foot that becomes irritated with shoe gear. Another cause for a tailor's bunion is a bony spur (an outgrowth of bone) on the side of the fifth metatarsal head.

Symptoms associated with a tailor’s bunions can include redness, swelling, and pain to the site of the enlargement. These symptoms tend to worsen with shoes that rub against the enlargement, irritating the soft tissues underneath the skin and producing inflammation.

Treatment for tailor’s bunion typically begins with non-surgical therapies, which may include:

• Shoe modifications. Shoes with a wide toe box. Avoid shoes with pointed toes or high heels.
• Padding. Pads placed over the area may help reduce pain.
• Oral medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.
• Injection therapy. Injections of corticosteroid may be used to treat the inflamed tissue around the joint.
• Orthotic devices.
  

Surgery is often considered when pain continues despite the above approaches. Surgery can include many different procedures or combination of procedures based upon x-ray findings, age and activity level.

If you or some one you know is suffering from a tailor's bunion, please do not hesitate to give our office a call for further information or to set-up a consultation, 1-440-946-5858.

Burning, Tingling and Numbness in Your Feet?

If you are experiencing burning, tingling and/or numbness to your foot, you might have a neuroma. A neuroma is thickening of nerve tissue. The most common neuroma in the foot is a Morton’s neuroma, which occurs between the third and fourth toes. It is sometimes referred to as an inter-metatarsal neuroma. “Inter-metatarsal” describes its location in the ball of the foot between the metatarsal bones.

The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.

Anything that causes compression or irritation to a nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box or high-heeled shoes that cause the toes to be forced into the toe box. Other causes include certain foot deformities, such as bunions, hammertoes, flatfeet, or more flexible feet. Other potential causes include activities that involve repetitive irritation to the ball of the foot, such as running or court sports.

Common symptoms that you might experience if you have a neuroma include:

-Tingling, burning, or numbness
-Pain
-A feeling that something is inside the ball of the foot
-A feeling that there’s something in the shoe or a sock is bunched up

Non-surgical treatment options may include:

-Padding: Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
-Orthotic devices: Custom orthotic devices provide the support needed to reduce pressure and compression on the nerve.
-Activity modifications: Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
-Shoe modifications: Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
-Medications: Oral non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
-Injection therapy: Treatment may include injections of cortisone, local anesthetics or other agents.

Surgery may be considered if your symptoms have not responded adequately to non-surgical treatments.

If you would like further information please visit our website, www.drrobertrosenstein.com or give the office a call, 440-946-5858 to schedule a consultation, 440-946-5858.

Hammertoes

Hammertoes occur when the smaller toes of the foot become bent and prominent. The four smaller toes of the foot are much like the fingers in the hand. Each has three bones (phalanges) which have joints between them (interphalangeal joints). Normally, these bones and joints are straight. A hammertoe occurs when the toes become bent at the first interphalangeal joint, making the toe prominent. This can affect any number of the lesser toes. In some cases, a bursa (rather like a deep blister) is formed over the joint and this can become inflamed (bursitis). With time, hard skin (callous) or corns (condensed areas of callous) can form over the joints or at the tip of the toe.

What causes hammertoes?

There are many different causes but commonly it is due to shoes or the way in which the foot works (functions) during walking. If the foot is too mobile and/or the tendons that control toe movement are over active, this causes increased pull on the toes which may result in deformity.

In some instances trauma (either direct injury or overuse from walking or sport) can predispose to hammertoes.

Patients who have other conditions such as diabetes, rheumatoid arthritis and neuromuscular conditions are more likely to develop hammertoes.

What are common symptoms?

• Deformity/Prominence of toe


• Pain


• Redness around the joints


• Swelling around the joints


• Corn/Callous


• Difficulty in shoes with deformity of the shoe upper


• Difficulty in walking


• Stiffness of the joints of the toe

What can be done to reduce symptoms?

There are several things one can do to try and relieve symptoms:

• Wear proper fitting shoes with a deep toe box


• Avoid high heels


• Use a toe prop to straighten the toe if it is still mobile


• Wear a protective pad over the toe


• See a podiatrist

How can a podiatrist help?

A podiatrist can offer other options, if simple measures do not reduce symptoms. These include:

• Advise on appropriate shoes


• Advise on exercises if the toes are still mobile


• Instruction on how to properly strap the toe in a corrected position


• Providing of a splint or protection


• Advise on surgery


• Prescribing of custom orthotics




• The way in which your foot loads during walking can place increased stress on the ball of the foot and cause increased toe activity. Orthotics can help to control foot movement.


• These are unlikely to resolve established deformity, however can help reduce discomfort to the ball of the foot.

How can I cure the deformity?

The only effective way of correcting the deformity is to have surgery.

What does surgery for this deformity entail?

There are a number of different surgeries. However, the most common procedures are:

• Tendon transfer




• Tendon transfers involve taking the tendon from under the toe and re-routing it to the top of the toe so that the toe is pulled down.


• Digital arthroplasty


• Digital arthrodesis

Digital arthroplasty and arthrodesis involve the removal of bone from the bent joint to allow correction. An arthroplasty removes half the joint and leaves some mobility whilst an arthrodesis removes the whole joint leaving the toe rigid.

In more severe cases, the tendon on the top of the toe and the joint at the ball of the foot may need to be released to allow the toe to straighten. If there is severe stiffness at this joint, the metatarsal may need to be shortened using a Weil osteotomy.

If you are suffering from hammertoes and would like more information please visit our website for more information, http://www.drrobertrosenstein.com/ or call the office, 440-946-5858, to schedule a consultation.