www.alaskapodiatry.com
Monday, November 29, 2010
Ganglion Cyst
What is a ganglion?
Ganglion Cysts are a benign fluid-filled lump (cyst) that can occur in many areas of the body, but is most common on the hands and feet. They typically arise over a joint or tendon. Although the exact causes are not known, a ganglion likely occurs due to a weakness in the covering of the tendon or joint space. Direct injury or everyday minor trauma can potentially be a cause. Motions of a tendon over a bony prominence or pressure from a shoe on a tendon or joint are examples of minor trauma. Weakness in the covering with a subsequent swelling of liquid into a confined space causes the lump to form. The growth is usually very firm but may be somewhat soft, depending on the fluid content. The fluid itself is usually similar in appearance to a thick clear jelly. Diagnosis
A diagnosis of ganglion cyst is usually made on clinical examination based on location of the growth and pertinent history. An x-ray may be taken to rule out a bone spur as the aggravating factor behind the formation of the cyst. If there is any question as to the extent of the growth, an MRI may be ordered for a more detailed evaluation.
Treatment
Proper treatment is based on pain, size, location and aggravating factors. Once a mass is diagnosed as a ganglion cyst it may be left alone, untreated, if it is not painful or causing problems with shoes. Occasionally these growths will spontaneously disappear. Cysts can be drained by needle aspiration followed by a cortisone injection in an effort to prevent the cyst from filling again. Once drained, a compression dressing is worn over the site for a period of time in an attempt to reduce recurrence. Over half of the cysts will refill with this form of treatment, but the upside is that the procedure can be repeated again if needed. If the growth is a source of pain or irritation and drawing fluid out (aspiration) has failed, then surgical excision may be necessary. Although surgical excision reduces the chance for recurrence ganglions will sometimes come back. Surgical excision is an outpatient procedure. Crutches and non-weight bearing are not usually needed. A surgical shoe is usually worn for 2 to 3 weeks during the time that the incision is healing. There really is no preventative care for ganglion cysts due to their spontaneous nature.
It is important to be evaluated by a foot and ankle specialist to ensure proper diagnosis. More information can be found on our website, alaskapodiatry.com.
Tuesday, November 16, 2010
Wednesday, November 10, 2010
Hammer Toes
Thanks to Randy for posting a question, hope this helps.
A hammertoe is a contracture—or bending—of one or both joints of the second, third, fourth, or fifth (little) toes. This abnormal bending can put pressure on the toe when wearing shoes, causing problems to develop. Common symptoms of hammertoes include:
• Pain or irritation of the affected toe when wearing shoes.
• Corns (a buildup of callus skin) on the top, side, or end of the toe, or between two toes. Corns are caused by constant friction against the shoe. They may be soft or hard, depending upon their location.
• Calluses (another type of skin buildup) on the bottom of the toe or on the ball of the foot.
Corns and calluses can be painful and make it difficult to find a comfortable shoe. Even without corns and calluses, hammertoes can cause pain because the joint itself may become dislocated or arthritic.
Hammertoes usually start out as mild deformities and get progressively worse over time. In the earlier stages, hammertoes are flexible and the symptoms can often be managed with noninvasive measures. But if left untreated, hammertoes can become more rigid and will not respond to non-surgical treatment. Corns are more likely to develop as time goes on—and corns never really go away, even after trimming. In more severe cases of hammertoe, open sores may form. Because of the progressive nature of hammertoes, they should receive early attention.
Causes of Hammertoes
The most common cause of hammertoe is a muscle/tendon imbalance. This imbalance, which leads to a bending of the toe, results from mechanical (structural) changes in the foot that occur over time in some people. Hammertoes are often aggravated by shoes that don’t fit properly—for example, shoes that crowd the toes. In some cases, ill-fitting shoes can actually cause the contracture that defines hammertoe. For example, a hammertoe may develop if a toe is too long and is forced into a cramped position when a tight shoe is worn. Occasionally, hammertoe is caused by some kind of trauma, such as a previously broken toe.
Treatment:
Non-Surgical Approaches
There are a variety of treatment options for hammertoe. The treatment your foot and ankle surgeon selects will depend upon the severity of your hammertoe and other factors.
A number of non-surgical measures can be undertaken:
• Trimming and padding corns and calluses.
• Changes in shoewear. Avoid shoes with pointed toes, shoes that are too short, or shoes with high heels—conditions that can force your toe against the front of the shoe.
• Orthotic devices. A custom or OTC orthotic device placed in your shoe may help control the muscle/tendon imbalance.
• Medications
When Is Surgery Needed?
In some cases, often when the hammertoe has become more rigid, surgery is needed to relieve the pain and discomfort caused by the deformity. Your surgeon will discuss the options and select a plan tailored to your needs. Among other concerns, he or she will take into consideration the type of shoes you want to wear, the number of toes involved, your activity level, your age, and the severity of the hammertoe.
One type of surgical procedure performed to correct a hammertoe is called arthroplasty. In this procedure, the surgeon removes a small section of the bone from the affected joint. Another surgical option is an arthrodesis. Arthrodesis is a procedure that involves fusing a small joint in the toe to straighten it. A pin or other small fixation device is typically used to hold the toe in position while the bones are healing.
It is possible that a patient may require other procedures, as well— especially when the hammertoe condition is severe. Some of these procedures include tendon/muscle rebalancing or lengthening, small tendon transfers, or relocation of surrounding joints. Often patients with hammertoes have bunions or other foot deformities corrected at the same time. The length of the recovery period will vary, depending on the procedure or procedures performed. For more information please visit our website alaskapodiatry.com.
Thursday, October 28, 2010
Professional Pictures
Monday, September 27, 2010
Gout
Gout is caused by an elevation of uric acid within your blood. Uric acid is a natural substance in your body that is a breakdown product of proteins. Gout occurs in people who either make too much uric acid, eat too many foods that are high in uric acid, or in people who cannot get rid of excess uric acid in their blood. Gout medicines focus on helping your body produce less uric acid, or helping your body eliminate excess uric acid.
Where does Uric Acid come from?
You naturally produce most of the uric acid in your body, but there is a percentage (up to 20%) of uric acid that comes into your body through diet. Adjusting your diet by avoiding foods high in uric acid can help reduce your chances of repeat gout attacks. In addition, keeping yourself very well hydrated with water is helpful. Some medications can make a gout attack more likely, including some blood-pressure pills (water pills). Your doctor may adjust these medications if gout becomes a problem.
In addition to medicine, you can help avoid future gout attacks by following the following diet guidelines:
Eliminate the following:
Liver Kidney Anchovies Sweetbreads Sardines Brains Heavy gravies Heart Fish roes Mussels Herring Beer / Wine Meat extracts, consommé
Reduce the following foods to no more than one serving per day:
Meats Beans Fowl Peas Cauliflower Mushrooms Other seafood Lentils Spinach Yeast Asparagus Whole grain cereals Fish (except noted above)
These foods do not cause gout:
Fruits Milk Cheese Eggs Refined cereals Nuts Spices (including salt) Sugars & Sweets Vegetable soups (clear) Vegetables
Diagnosis & Treatment
A blood test may be used to test the uric acid level. It is common; however, that the blood level of uric acid may be normal even while a person is having a gout attack. If the diagnosis is in question, a sample of joint fluid may be taken and tested for gout crystals. Most cases of gout affect the big toe joint but other areas can also be affected. The pain can be quite severe and result in joint swelling and redness. Walking may be difficult and pressure of a shoe or even bed covers can be painful. Treatment for the acute, severe pain may include anti–inflammatory medications (such as indomethacin or colchicine) or injections near the area. A sandal or surgical shoe may be useful to relieve pain as well.
Tuesday, September 21, 2010
Peripheral Neuropathy
Peripheral neuropathy
Peripheral neuropathy refers to disorders of the nerves which are outside of the central nervous system (nerves which are away from the brain and spinal cord). Unfortunately, this problem is all too common. Peripheral neuropathy can have various causes and produce many different symptoms.
Symptoms that involve the feet may include burning, tingling, numbness, or shooting pains. Numbness often affects the bottom of the toes and balls of the feet. Peripheral Neuropathy affects the longest nerves in the body first, which are the nerves that start from the bottom of the spinal cord and extend to the toes. It is not uncommon for the big toe to be involved first. If symptoms progress, the hands can become involved as well. Some experience a sensation as if a band was around the foot or that a stocking was on when it is not. At times the feet may be overly sensitive. Even common sensations can be irritating such as the wearing of shoes, walking on carpet, etc.
Causes of Neuropathy
There are many causes of peripheral neuropathy. It is quite common, however, that an exact cause cannot be discovered. Poor circulation is usually not the cause of numbness. So, numbness does not necessarily mean you are at risk as a result of poor blood flow! Your health care provider will check your circulation to be sure it is adequate.
Known causes of peripheral neuropathy include:
¨ Diabetes (the most common cause)
¨ Alcohol toxicity
¨ Thyroid abnormalities.
¨ Nutritional deficiencies such as inadequate Vitamin B-12 or the inability of the body to utilize vitamins and nutrients.
¨ Illnesses such as Guillian-Barre.
¨ Inherited conditions that affect nerves.
¨ Entrapment of nerves can occur with back problems, sciatica, or tarsal tunnel (a pinched nerve near the inside of the ankle similar to carpal tunnel).
¨ Growths that press on nerves.
¨ Injury to nerves.
Drugs used in the treatment of cancer, HIV/AIDS, and other conditions
Treatment of Neuropathy
Treatment for peripheral neuropathy depends on the cause. Blood tests or nerve conduction studies may be used to check for various causes. If an underlying cause can be identified, such as diabetes, then treating that cause is important. Injections or even surgery in some cases can relieve a pinched nerve.
Though symptoms may sometimes improve, the sensations such as numbness do not always go away. If pain is associated with neuropathy, then your health care provider may recommend trying a cream such as capsaicin which is available without a prescription. Your health care provider may also recommend the use of oral medications to treat neuropathic pain. The types of medication often used to treat neuropathy are for other conditions such as seizures or depression. Common medications that may be prescribed are Neurontin, Lyrica, or Cymbalta to name a few. Many individuals find that neuropathy is most irritating or painful when trying to go to sleep as there are no distractions from the irritation. Occasionally, neuropathy medications are combined with pain medications, such as Ultram, to help patients through the initial period as the Neuropathy medications may take some time to reach their maximum benefit. The important point to remember is there is treatment available, which is tailored to fit each individual patient. Check out our website www.alaskapodiatry.com. Also see us on twitter (alaskapodiatry), and become a fan on facebook (Alliance Foot and Ankle).
Hallux Rigidus/Limitus
Hallux Limitus/ Rigidus
Hallux Limitus/ Rigidus is a condition where the big toe joint degenerates and becomes stiff and arthritic. The hallux (big toe) needs to flex upward and downward at the first metatarsal phalangeal joint (big toe joint) to function normal. Due to certain conditions such as trauma/ injury, genetic predisposition to faulty structure, generalized (whole body) arthritic conditions or prior surgery, the big toe joint may start a process known as degenerative joint disease. This progressive condition leads to wearing out of the articular cartilage (the pearl white shinny tissue seen where two bones form a joint), and the big toe joint starts to become stiff and painful to move. Once the body recognizes that this process is occurring extra bone is laid down around the joint (bone spur) to begin a process of fusing the joint solid thus no motion, no pain. While this process is occurring pieces of the extra bone can break off into smaller fragments and cause pain to the joint.
Hallux limitus is more common in men than women but plenty of active women are diagnosed with the condition. It consists of four stages. Most people are unaware of any symptoms in stage one other than possible progressive joint stiffness. Many present for treatment in stage two as the joint becomes more painful to move and fracture fragments may start to jam the joint. If left untreated as one progresses toward stage four the joint becomes very stiff and bulbous as the body places bone around the joint in an attempt to fuse it (no motion, no pain). Small amounts of motion though stiff occurs and the poor quality of this motion combined with extensive bone spur development (some pieces may even be fractured) can lead to extreme pain with ambulation.
Treatment is patient specific depending on age, activity level, type of employment, stage of condition, prior treatment, shoe choices, and expectations. Hallux limitus is progressive over time and is not reversible. Non-surgical treatments may alleviate pain and slow progression. Stiff sole shoes with an appropriate orthotic (shoe inlay) may off load the great toe joint and support the transverse and longitudinal arch of the foot. Anti-inflammatory medications and injections into the joint can temporarily ease symptoms. Self-directed or formal physical therapy may help improve function, decrease swelling, and increase local blood flow. As the condition progresses with increased pain and decreased function, surgical options are usually considered. If it is possible, an attempt is made to reconstruct the degenerative joint to reduce the stage of the condition. This preserves ones natural joint and although far from perfect may function pain free for many more years. As one advances to stage three or four, reconstructing ones joint may not be possible and joint destructive procedures such as a joint implants or surgical fusion need to be considered. Joint implants may be limited to a select type of person. Joint fusion (arthrodesis) is a very powerful procedure to eliminate pain and still allow for a high level of activity. Joint fusion requires a committed rehabilitation and understanding that adjacent joints can be affected in the future.
Subscribe to:
Posts (Atom)