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.