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.