NFL reciever Nicks may return to line up tonight.

One of the more prolific pass catchers for the NFL New York Football Giants will return to his number 88 jersey possibly tonight after recovering from his fifth metatarsal fracture ORIF surgery from May 2012. He likely had a Jones fracture, which in most cases with athletic players a percutaneous screw was utilized in order to fascilitate healing. At FFLC, you are not required to be an NFL player to get this state of the art procedure if necessary, as we have successfully treated numerous athletic patients with this traumatic injury using this specific technique with minimal to no complications.

The main reason why surgery is likely required in these individuals with the fractured fifth metatarsal, stems from the nature of the amount of weight applied to the area with each step, as well as where the tendons insert at the most proximal aspect of the main fracture fragment, with each step the tendon pulls away this fracture from the main portion of the bone.  Sometimes a below knee cast is applied to stop all motion, but even this may not fully accelerate healing. The screw fixation eliminates all motion to the site, and by placing the screw, the surgeon is able to drill through the scar tissue and promote healing with placement of demineralized bone matrix proteins and collagen to enhance liklihood of healing the fracture.

So if you happen to catch the Patriots and Giants tonight, keep your eyes on number 88, as his cutting and route running is still going to be at a high level after his injury, because he had state of the art surgery in order to heal his fracture.

Chemotherapy and your feet.

Some of our patients are undergoing chemotherapy to treat various cancers, and this may cause some patients to experience painful scaling skin on the palms and soles of their feet and hands. Here is some general information to guide you towards improving this condition. Please come and see me if any problems or concerns arrise.

- Dr Timm

Hand-Foot SyndromeOther terms: Palmar-Plantar Erythrodysesthesia; PPE What is hand-foot syndrome?Also called hand-foot syndrome or hand-to-foot syndrome, Palmar-Plantar Erythrodysesthesia is a side effect, which can occur with several types of chemotherapy or biologic therapy drugs used to treat cancer. For example, Capecitabine (Xeloda^{®), 5-Flurouracil (5FU), continuous-infusion doxorubicin, doxorubicin liposomal (Doxil®), and high-dose Interleukin-2 can cause this skin reaction for some patients. Following administration of chemotherapy, small amounts of drug leak out of very small blood vessels called capillaries in the palms of the hands and soles of the feet. Exposure of your hands and feet to heat as well as friction on your palms and soles increases the amount of drug in the capillaries and increases the amount of drug leakage. This leakage of drug results in redness, tenderness, and possibly peeling of the palms and soles. The redness, also known as palmar-plantar erythema, looks like sunburn. The areas affected can become dry and peel, with numbness or tingling developing. Hand-foot syndrome can be uncomfortable and can interfere with your ability to carry out normal activities.}
Things you can do if you suspect hand-foot syndrome (Palmar-Plantar Erythrodysesthesia):
Prevention: Prevention is very important in trying to reduce the development of hand-foot syndrome. Actions taken to prevent hand-foot syndrome will help reduce the severity of symptoms should they develop.This involves modifying some of your normal daily activities to reduce friction and heat exposure to your hands and feet for a period of time following treatment (approximately one week after IV medication, much as possible during the time you are taking oral (by mouth) medication such as capcitabine). Avoid long exposure of hands and feet to hot water such as washing dishes, long showers, or tub baths. Short showers in tepid water will reduce exposure of the soles of your feet to the drug. Dishwashing gloves should not be worn, as the rubber will hold heat against your palms. Avoid increased pressure on the soles of the feet or palms of hands. No jogging, aerobics, power walking, jumping - avoid long days of walking. You should also avoid using garden tools, household tools such as screwdrivers, and other tasks where you are squeezing your hand on a hard surface. Using knives to chop food may also cause excessive pressure and friction on your palms. 　Cooling procedures:
Cold may provide temporary relief for pain and tenderness caused by hand-foot syndrome.
Placing the palms or bottoms of your feet on an ice pack or a bag of frozen peas may be very comforting. Alternate on and off for 15-20 minutes at a time.
Lotions:
Rubbing lotion on your palms and soles should be avoided during the same period, although keeping these areas moist is very important between treatments.
Emollients such as AMLACTIN, Aluvea,Aveeno®, Lubriderm®, Udder Cream®, and Bag Balm® provide excellent moisturizing to your hands and feet.
Pain relief:
Over the counter pain relievers such as acetaminophen (Tylenol®) may be helpful to relieve discomfort associated with hand-foot syndrome. Check with your doctor.
Vitamins:
Taking Vitamin B6 (pyridoxine) may be beneficial to preventing and treating Plantar-Palmar Erythrodysesthesia, and should be discussed with your doctor.
Drugs/treatment changes that may be prescribed by your doctor:
Chemotherapy treatments may need to be interrupted or the dose adjusted to prevent worsening of hand-foot syndrome.
When to call your doctor or health care professional:
If you notice that your palms or soles become red or tender. This most often occurs before any peeling, and recommendations for relief of discomfort can be given. If you are on chemotherapy pills, you may be asked to hold treatment, or need your dose adjusted to prevent worsening of symptoms.

Pain in the Achilles !!

So many of our patients suffer from what we in the medical field call "Tendonopathy". This is a vague term which encompasses a vast array of varying pathologic conditions, in both acute and chronic presentations.

Probably one of the main contributers to the more common tendonopathy that we see is the pressence of a large spur behind the heel which is associated near the insertion of the most important tendons in the foot and ankle - ie the Achilles tendon.

Numerous treatments in the literature have been described, and the main thing to consider in these situations, is that there are viable nonsurgical options available for this disorder. Many patients hesitate to present in the office of a physician with lumps and bumps on their extremities for fear of needing surgery. This is a problem, because most of the time these anxieties allow the pathologic process to worsen, and eventually by delaying treatment you are nearly obligating yourself to undergo the one treatment you were trying to avoid.  Surgery is always a last option for posterior heel pain, as this can require 3 months or more to recover from depending on the nature of the pathology and extent of procedures required to rectify the conditions. Many times, we can identify the extent of the pathology and at least rule out tearing or masses with the use of ultrasound technology which is readily available in the office. Often, we require MRI images to plan should nonsurgical options fail to reduce symptoms.

We offer state of the art high energy shock wave therapy coupled with PRP injections to the posterior achilles for pain and thickening, and to reduce symptoms from protruding and prominent boney areas behind the heel that may be penetrating through the tendon in this part of the foot, thus causing tendonopathy pain. This treatment is more effective in less chronic cases, but is usually able to reduce the pain and edema from these conditions in most cases. Shoegear choices are also a factor here, as many ill fitting shoes may contribute to pain in areas of boney prominences.

Do not hesitate to make an appointment, as we may be able to reduce your pain without surgery !