Foreign bodies made in America

Most foreign bodies we see in our center are not incredibly too foreign. In fact, most of these objects tend to be naturally occurring debris from the oceans and lakes in Florida. Shells, stingray barbs, and even an occasional brackish water stone laceration to the plantar foot. If these injuries are not treated  in emergent fashion, this may lead to subsequent infection.  In the case above, this patient was running in a bonfire for some odd reason, and apparently one of the sharper wooden shards punctured the foot and simultaneously burned it, leaving him with second degree deep tissue burns. This was not immediately treated until 3 days later, and he ended up needing surgery to clean the wound and remove dead tissue within the area. He also requires IV antibiotics and several weeks of protected weight to the area with crutches until it all heals. We will see this during the "seasonal time" here mainly because more vacationing residents will be on the beaches, or wherever and they will not wear shoes. A foot injury like this is usually easily prevented just by wearing a sandal or sneaker at all times while outside. Most times, our feet are not well equipped to deal with the amount of sharp and dangerous objects that may lie waiting for unsuspecting tourists to walk on them. If you suspect you have stepped on something, don't wait. Come to see us at the FFLC, so we may rapidly diagnose, treat, and remove any foreign object from the foot before infection and need for hospitalization may occur. We can remove the foreign object right in office, and are well equipped to obtain cultures from the area, perform ultrasound guided removals, and even identify radio opaque material with use of radiography.

Green Bay Packers season in peril on account of a foot injury

The season looks dire so far in 2012 for any Green Bay fan, as first we lost a game on a call which was undoubtebly the most controversial and ridiculous call in NFL history to the Seahawks and now we lose to the Colts with a rookie quarterback and with that we also lose 3 more starters on both sides of the ball due to significant injuries. Not to mention that both the Bears and Vikings are winning every week now. We were 15-1 last year, and this year we probably will not make the playoffs as we are already 3rd place and have a 2 game deficit to both teams ahead of us with the Texans coming up next week who will likely demolish the Packers.

After losing to the otherwise rebuilding Colts, another unfortunate injury may have been partly responsible. The Packers have had a mediocre running game as it is this year with Benson, but now we have to struggle further without him. Maybe there is a good practice squad runner that nobody knows yet who can step it up and have a "next man up" mentality a la 2 years ago with our playoff run with an unknown running back. To make things even worse, with the loss of Cedric Benson, a running back who was supposed to be main addition to an offense that has had little trouble scoring points through the air last season, and give this team another dimension to confuse defenses and give Aaron Rodgers some help with the ground game, his ability to cut and balance and jump may have been permanently altered because of his foot injury. Teams will sit in zone defense and blitz packages knowing fully that we have no ground game to use and this will be a long year for certain.

Now, not only can we not pass the ball very consistently because the offensive line cannot block anyone, but we really will be left unable to run the ball as well, and Rodgers will continue to get sacked 5 or more times a game and potentially sustain another concussion, and we have nobody on reserve as a quarterback, because we let him go to Seattle in the offseason!! Fire Dom Capers too, because our defense cannot hold a three score lead against the COLTS!!

Anyhow...

Benson has suffered a midfoot sprain. This injury has been relatively common this year, with both Benson, and Santonio Holmes of the Jets suffering this injury already this year. Last year the Texans had a quarterback who also had a Lisfranc injury.
A most devastating injury, which can sideline a player for 2 months, and may lead to longterm pain and need for fusion if arthrosis and degenerative joint disease ensues. Football requires quick changes in direction, jumping, and running with quick stops and starts. All of these motions are difficult when a player has sustained such an injury. Longterm, we have noticed a number of patients who have likely had such an injury in the past and was not diagnosed or treated properly and are left with a change in the position and alignnment of the midfoot. This may lead to rockerbottom foot deformity in extreme cases, and most likely will lead to chronic recalcitrant pain in many cases. Ideally the bones should be reduced as soon as possible in cases of initial instability to their anatomic position, but this is often times not done on account of lacking evidence of fractures, or poorly obtained radiographs which do not show the alignment concerns from this injury secondary to the patient being unable to stand on the foot in order for the films to demonstrate the instability. Regardless, once the swelling has diminished with non weight bearing and casting, a flat film with the patient standing should be obtained to see if any instability has occured, otherwise the patient may be placed under anesthesia in order to use an active xray machine to stress the midfoot in order to demonstrate any need for fixation.

Turf the "Turf Toe" Injury

Often around this time of the year, football injuries become more prevelant in our practice with high school and junior leagues. The great toe will get hyper-extended for a brief moment, and this leads to pain and inability to return to sport. Sometimes this injury can lead to chronic instability of the toe joint which may lead to arthritis and eventual need for surgery if not treated properly with initial presentation. This injury is typically treated incorrectly with coritsone injections, and this may actually lead to further damage to the joint capsule and even the ligament between the sesamoid bones. Treatment for this condition starts with proper evaluation, detailed history and physical examination, and sometimes with foot blockade of local anesthetic or even arthrogram, we can diagnose and give a prognosis to return to the field in 1 visit. This treatment may consist of casting, immobilization, PRP injections, or even surgery for progressively more unstable joints or specific findings from MRI examination. Ultimately, athletes can expect a minimum of 2 weeks off, followed by gentle passive range of motion exercises, and finally we may allow return to the field for practice and eventual playing time. Most athletes will not return to the field if they are unable to dorsiflex the great toe joint at least 50 degrees without pain. If a patient has progressive deviation or valgus deformity becomes evident, surgery is most likely indicated. If the pain improves after proper immobilization and therapy driven rehabilitation, many will not require surgery.  Ultimately it is decided based on timely diagnosis, treatment, and therapy driven rehabilitation. Notable players who have had Turf Toe injury include Deion Sanders and Ray Lewis. Sometimes this injury will end the professional player's career.