Advancements in Treatment of Big Toe Arthritis

There has been a great advancements in the treatment of great toe arthritis, also known as hallux limitus and/or hallux ridigus. The terms commonly used refer to the latin term for limited to no motion, which is the main complaint that patients will have when they present for this condition. There is no clear understanding of the cause of hallux limitus/rigidus, but the main understanding is it may be due to trauma or chronic mechanical overload of the joint with abnormal weight bearing. The limited motion in the great toe joint is due to bone spurring and arthritis of the joint which causes jamming and pain.

Presenting symptoms for this include, but are not limited, to stiffness/pain/swelling/limited motion and cracking and/or grinding of the great toe joint.

Patients who present initially with mild complaints are often treated with shoe modifications and orthotics or custom insoles. Patients will often state that this improves their pain because they are not placing as much weight through the great toe region. However, over time, a certain number of patients will get increasing pain as the arthritis gets worse. This diagnosis is made through examination and x-rays of the foot to see the level of arthritis and joint damage to the great toe. It is rare but in some cases of local cartilage damage of possible cartilage lesions of the great toe, an MRI may be performed.

In most cases, surgical treatment of bone spurs and great toe arthritis is necessary. As the arthritis gets worse, the surgery is more difficult and requires more invasive options.

Advancements in surgical options for hallux limitus/rigidus are growing and getting better and better, offering a multitude of treatment options based upon the patient's needs. These procedures can include cheilectomy of bone spur removal, osteotomy for realignment and joint decompression, midfoot fusion for 1st metatarsal repositioning, hemi base implant joint resurfacing and great toe fusion

In general, early cases of spurring with limited joint damage do well with cheilectomy. As the problem proceeds, less cartilage is avaliable to work with, therefore an implant or great toe fusion is required If the 1st metatarsal bone is very loose and seems to be drifting upwards resulting in jamming of the great toe joint, then a fusion of the metatarsal at the base is a good option to realign the first metatarsal and prevent the jamming at the great toe joint.

For more information or to schedule an appointment, please call our office at, 440-946-5858.

Can Your Feet be Trying to Tell You Something?

Fungal Nail
Reason: Trauma or infection to the nail that makes it thickened, discolored, loose or deformed. Often caused by the spread of athlete’s foot, but may also be an indication of conditions such as diabetes or arthritis.
Response: Medications, such as Ker¬alac Gel and Lamasil tablets, have proven effective treatment.

Tendonitis
Reason: Overuse due to increase in physical activity, such as an increase in walking time or distance. May also be caused by wearing worn out or improperly-fitted shoes.
Response: Rest and ice, however in some cases, over-the-counter arch supports or anti-inflam¬matories may be indicated.


Blisters
Reason: Friction from shoes that don’t fit right or are too stiff.
Response: Instruct patients to keep feet dry and wear socks with properly-fitted shoes. Additionally, instruct them never to pop a blister and if painful, to seek medical attention.

Ingrown Toenails
Reason: Improper trimming or too much pressure on feet in tight-fitting shoes, resulting in redness, pain or swelling around the nail. Can also result from poor foot structure, heredity, trauma or foot deformities.
Response: Instruct patients to avoid tight-fitting shoes and socks and inspect nails daily. Additionally, instruct patients to trim nails straight across using toenail clipper.

Bromohydrosis (Foot Odor)
Reason: Increased perspiration from the more than 250,000 sweat glands in the foot due to increased body temperature.
Response: Instruct patients to rub corn starch or spray anti-perspirant directly onto the soles of the feet and spray Lysol into shoes daily. Additionally, instruct patients to keep shoes and socks dry and change shoes regularly.

Bunion (Hallux Abducto-Valgus Deformity)
Reason: A bump at the base of the big toe that is swollen, tender or painful when in the shoe, often caused by misalign¬ment of the joints. Ill-fitting shoes, heredity, trauma, biomedical abnormalities, neuromuscular disorders, inflammatory joint disease, congenital deformities or arthritis can also be culprits.
Response: Instruct patients to avoid pointy and narrow shoes or shoes with stitching or seams that rub bony areas of the foot. If painful, bun¬ions can be surgically removed by a podiatrist.

Plantar Fasciitis
Reason: Excessive weight gain resulting in pain on the bottom of the heel or in the arch. May also be caused by bony overgrowth on the heel, muscle imbalance, high or low arched feet, improper shoe gear, exces¬sive activity or trauma.
Response: Instruct patients to exercise, stretch their feet daily and wear strong, supportive shoes that don’t put undue stress on the ball or heel. If these measures are unsuccessful in relieving pain refer to a podiatrist for further examination and treatment.

If you are experiencing any of the above conditions, please do not hesitate to call and/or schedule an appointment at our office, 440-946-5858.

Keep Your Feet Safe at the Gym in the New Year

In the New Year, don’t forget to keep your feet in tip-top shape while following through with your resolutions to get fit. Follow the tips provided below to ensure heatlhy feet and maintenance of your resolutions:

Start new workouts gradually— Increase your stamina and the length of your workouts gradually to avoid overuse injuries such as stress fractures or tendon strains and sprains. Stretching your muscles before and after workouts also helps prevent these types of injuries. If you do feel you’ve sprained your ankle, be sure to seek treatment right away: Untreated or repeated ankle sprains may lead to chronic ankle instability, a condition that causes persistent pain and a ‘giving way’ of the ankle.

Wear the right shoe and sock— Wear well-fitting athletic shoes designed for the exercise or sport. Shoes that don’t support the arch of the foot and provide cushion for the heel can cause heel pain (plantar fasciitis). Shoes that are too small can also cause a neuroma, or a thickening of the nerve tissue, in the foot and may require injections, medication or physical therapy. Wearing cotton or non-slip socks are also key to help avoid painful blisters, which can become infected and cause more serious issues.

Use good technique— Improper exercise techniques can result in injury to the tendons or ligaments in your feet and ankles. Incorrect posture or misuse of exercise equipment can cause decreased stabilization in the foot and ankle, leading to joint sprains and muscle strains.

Gym Safety- Protect yourself from bacteria—Sweaty shoes, public showers, exercise equipment and the pool deck at the gym are breeding grounds for fungus, viruses and bacteria, including drug-resistant strains like MRSA (methicillin-resistant Staphylococcus aureus) which has become increasingly more common. Never go barefoot while in public areas; water shoes can provide a great barrier between your feet and the wet surfaces. “It’s also best to cover cuts and cracks in the skin or ingrown toenails since these minor tears in the skin’s surface can act as entry points for bacteria. If you have a cut or scrape that becomes red or swollen and is not healing in a timely manner, don’t hesitate to call our office for an appointment.

Above all, it’s important to listen to your body. If you experience an injury or pain, call our office at 440-946-5858 for an evaluation immediately!

Snow and Ice Can be Dangerous for Many Women

As a female, I too, like to wear fashionable shoes or boots, however with the onset of snow and ice after the 1st big snow storm hitting 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, so please don't hestiate and come into the office for evaluation.

Are you Prepared for Winter Sports?????

For many athletes and weekend exercise warriors, winter is a time to enhance their cardiovascular health. Many partake in winter sports such as sledding, skiing, snowboarding, rough-and-tumble ice hockey or casual ice skating. Winter sports offer a fast track for fun, but expose the body to injuries, especially foot and ankle injuries.

Some common winter and snow sports injuries related to the foot and ankle include:

• Frostbite: The symptoms of frostbite include skin-color changes, from blue to whitish, and a feeling of burning or numbness.
• Blisters: Friction in winter sports footwear often causes blisters.
• Neuromas: Enlarged benign growths of nerves between the toes are caused by friction in tight footwear and can result in pain, burning, tingling, or numbness. Neuromas require professional
treatment, including an evaluation of skates and boots.
• Sprains and strains: The stress of skiing and skating can result in sprains and strains of the foot and ankle. They can be treated with rest, ice, compression, and elevation (RICE). If pain persists, seek medical attention.
• Subungual hematoma: Pressure in the toe box of a ski or skate
can cause bleeding under the toenail known as a subungual hematoma. This condition should be treated immediately to prevent the loss of a toenail.

With adequate preparation and proper equipment, you can prevent most injuries common to winter and snow sports:
• Maintain an adequate fitness level all year round. Being fit is the best way to avoid many sports-related injuries in winter.
• Find a buddy who enjoys your sport. Never participate in winter sports alone.
• Warm up thoroughly before activity. Cold muscles, tendons and ligaments are vulnerable to injury. Make sure to cool down thoroughly afterwards, as well.
• Wear several layers of light,loose, waterand-wind-resistant clothing for warmth and protection.
• Wear proper footwear that is in good condition and keeps feet warm and dry. Footwear should provide ample ankle support, as well.
• Wear appropriate protective gear, including goggles, helmets, gloves, and padding.
• Wear a blended sock that “wicks” sweat away from the skin.
• Drink plenty of water before, during, and after your sports activity.
• Move to a warm, dry environment if your feet get wet. The skin tissues of wet, cold feet are in danger of freezing (frostbite).

If you sustain any type of injury during a winter activity please contact our office, 440-946-5858, for an appointment. Happy Holidays!!!

Frostbite can lead to many problems within the winter months

As we enter the cold weather season, many of us will be skiing,sledding, and shoveling snow. Many people will get cold feet as well as wet feet. Having “Jack Frost nipping at your nose” sounds great when Nat King Cole sings it, but it’s no fun when frostbite strikes your feet. Extreme exposure of your feet to cold over a prolonged period can lead to a serious condition called frostbite. However, you do not necessarily need to be exposed to extremely cold temperatures to get frostbite. Even cool temperatures coupled with wet socks can induce frostbite.

Symptoms include pain and a burning sensation in the exposed areas, numbness in the toes or feet, and changes in skin color, from pale or red to bluish-gray or black. Children, the elderly, and people with diabetes are more prone to frostbite because of the size of their extremities or poor circulation. People who live or work outdoors also have higher likelihood of contracting frostbite because of their increased exposure to the cold.

There are various degrees of frostbite with frost nip (first degree) being the most commonly encountered by people who live in very cold climates or do a lot of outdoor activity in the winter. Skin may feel stiff to the touch, but the tissue underneath is still warm and soft.

Superficial frostbite (second degree) and deep frostbite (third degree) are serious medical conditions that must be treated by a trained medical professional. Skin will feel hard and frozen to the touch and blistering will happen. In some severe cases, doctors may have to amputate frostbitten limbs to prevent severe infection.

Mild frostbite initially can be treated by getting out of the cold and moving to a warm environment. Keep the feet dry and warm; warm the skin gradually by using warm compresses or immersing the feet in warm water (101° to 104° F) until sensation
returns. Do not use direct heat such as heating pads or fire, and do not disturb any blisters.

Frostbite is very serious, and if you suspect that you have it, please call our office, 440-946-5858, for prompt diagnosis, proper treatment and to save your toes!

Prepare for Winter Sporting Season

From the rush of downhill snow skiing to cross country skiing to ice skating, cold weather sports provide a fast track for fun and cardiovascular heath, but the colder temperatures and exhilarating speeds attained during such sports can expose your foot and ankles to debilitating injuries.

Healthy feet and ankles act as accelerators, brakes and shock absorbers in winter sports and help keep the body upright and out of the line of danger. Therefore, avoiding foot/ankle problems is key to full enjoyment during theses activities.

To ensure an injury–free winter season follow the tips provided below:

● Keep feet warm and dry - Proper footwear, insulated, waterproof boots or shoes, and thick cotton socks, to wick away moisture is as important as coats, hats and gloves during cold weather activities.

● Proper fitting footwear - Single most important factor in safe and successful skiing and ice skating. Without a snug and accurate fit, the pressure exerted from constant forward motion and lateral movement of skiing and quick turns of skating can result in discomfort and injury. Additionally, boots or skates that are too big can cause irritation in the toes due to excess motion or ones that are too small can inhibit circulation to the toes and cause cold feet.

● Stretch before and after participating in winter sports - Stretching the lower extremity prevents muscle pulls and tears and prepares the muscles for the movements required in the sports. Some simple stretches, such as a knee to chest, ankle/foot-soleus and ankle/foot-gastro with each being held for 60 seconds can aid in proper warm-up of tendons and ligaments.

Follow the tips listed above and enjoy the upcoming cold, snow-filled weather.

If you have sustained an injury during a winter sporting activity please give our office a call, 1-440-946-5858 for an appointment. Happy Holidays!