Friday, November 23, 2012

Take the 'fire' out of ant bites


The time has come for many of our patients to wear sandals and even more patients to walk around outside without shoes. Most people in Florida already do this, but with all of our seasonal residents returning, the number of people doing this will triple. This may often lead to exposure of your exposed foot and ankle to fire ant bites. These can be relatively nasty and may sting and burn for extended periods of time. Sometimes they may become infected and lead to abscess formation in patients with diabetes or vascular disease. It is important to have this looked at by a physician if the area becomes more red and swollen than the above picture shows, or if a fever or chills begin to occur. Even drainage and bleeding after 3 days time should be reported to the physician immediately. FFLC physicians are always ready and able to treat any foot and ankle emergency, and will often have immediate appointments available at one of the three locations.

  • General Treatment Guidelines
  • Local stings: Cool compresses and oral antihistamines are recommended for mild reactions as first line treatment at home. Sometimes the physician will administer corticosteroids which may be used topically or intralesionally injected for anti-inflammatory effect.
  • Multiple stings: Systemic corticosteroid use is controversial in patients with extensive lesions who do not have systemic allergic reactions or generalized skin reactions.
    • Large doses of corticosteroids and intravenous fluids may complicate the treatment of patients with preexisting cardiovascular disease.
    • Sometimes, the immunosuppressive effect of corticosteroids may predispose patients to secondary infection.
    • Oral antihistamines and topical corticosteroids are recommended in most cases; nevertheless, some practitioners still use prednisone or other systemic steroids to treat patients with numerous lesions.
  • Anaphylaxis: Acute management of fire ant anaphylaxis is identical to treatment of anaphylaxis from other causes. Subcutaneous epinephrine is used and repeated every 10-15 minutes as needed to reverse the symptoms. This may occur rapidly, and requires 911 and EMS for life saving efforts in some cases. 
Always remember that any red swollen area or lesion of any kind which is not improving after 5-7 days should be evaluated by a physician. 

Monday, November 12, 2012

Many Roads Lead to Foot Pain

Reflexology Chart, used for demonstrative purposes only. This is not a Pro-Reflexology article.


If you browsed through medical textbooks that explain different diseases, you'd find that many conditions can lead to harmful changes in the feet, including foot pain.
For example, if your thyroid — a gland in your throat that makes crucial hormones — is not working properly, associated problems with your nerves can affect the sensation in your feet. Or if you have degenerative changes in your lower back, the nerves coming off your spinal cord may become irritated, which could also affect the health of your feet, he says.
Here's a look at three common conditions that may result in foot pain and unhealthy feet.
Peripheral Arterial Disease
About 8 million Americans have peripheral arterial disease (PAD), according to the American Heart Association. In PAD, a fatty substance called plaque that builds up in the arteries in your legs, reducing the flow of blood to your lower legs and feet.
PAD can cause the muscles in your calves and other parts of your legs to cramp while you're moving around. The condition can also lead to foot pain and poorly healed foot wounds. While the foot and leg-related symptoms of PAD are usually quite obvious, the disease is also associated with hidden damage to the heart and brain — which places those with PAD at much higher risk of heart attack and stroke.
Not surprisingly, other risk factors for heart disease and stroke, such as smoking, diabetes, high cholesterol, and high blood pressure, also increase your risk of PAD.
Medications can be used to manage PAD, but changes in diet and lifestyle (like quitting smoking) are very important as well.
Rheumatoid Arthritis and Gout
According to the Arthritis Foundation, 46 million Americans have arthritis or other chronic problems affecting their joints. For patients with rheumatoid arthritis — which affects 1.3 million Americans — about 90 percent will develop symptoms in the foot and ankle.
Rheumatoid arthritis (RA) develops when the body's natural defense system against disease, the immune system, mistakenly attacks your joints, causing them to become painful and swollen. The symptoms of RA may include severe foot pain. When the condition affects your feet, pain usually begins in your toes and later spreads to the rest of your feet and ankles. The joint damage caused by RA can eventually change the shape of your toes and feet. In some people, foot symptoms are the first hint that they even have RA. Once diagnosed, RA can often be treated effectively with medications, exercise and, in some cases, surgery.
Another type of arthritis that is known for causing foot pain is gout. This condition occurs when a substance called uric acid accumulates in your body. Deposits of uric acid collect in the joints — particularly in your big toes — and can cause intense, episodic pain. Uric acid can also lead to kidney stones if too much of it builds up in the kidneys.
Doctors can treat gout with nonsteroidal anti-inflammatory drugs (NSAIDs) and other medications including steroids. Getting regular exercise, drinking lots of water, avoiding certain medications, and staying at a healthy weight can help prevent gout attacks, too.
Foot Pain Health Problems: Diabetes
Roughly 24 million Americans have diabetes — and 6 million of them don't even know it yet. If you have this health problem, the glucose or blood sugar that your body normally uses as fuel can build up in your blood. This excess sugar can damage nerves and blood vessels in the feet — eventually leading to decreased sensation and compromised blood flow.
As a result, symptoms of high blood sugar include numbness or tingling in your feet as well as severe foot infections. Diabetes is a major cause of foot problems in the United States and can lead to the surgical removal of a toe or even more of your foot or lower leg.
Fortunately, diabetes and its associated foot complications can be managed with medication and regular foot exams by your doctor. It is also important for diabetics to quit smoking, wear supportive shoes, and avoid being barefoot to prevent unnecessary foot trauma.
After a long day of standing at work, it's common to experience some foot discomfort, but if you notice severe foot pain that seems out of proportion to your physical activity, tell your doctor. What starts as a minor foot problem could indicate a more serious medical condition.

Friday, November 2, 2012

After hurting my ankle, now what?


Ankle Rehab Exercises: Improving Your Strength

A good ankle rehabilitation program should focus on ankle rehab exercise to improve the strength of the muscles of the ankle.  This is the most common focus for ankle rehabilitation, and rightly so.  Without a good strengthening program, you cannot get back to your normal pain - free life and sports.
Whether you are going through rehab in a clinic with an athletic trainer or physical therapist, or you are doing your own rehab at home, your strengthening program needs to focus on several specific areas.

The following are examples of ankle rehab exercises to help improve your strength.

The Calf

Ankle Rehab Exercises - Heel Raises
The calf muscles, including the gastroc and soleus are important during ankle function. They are the muscles that are responsible for you being able to point your toes, lift your heels up, walk, run, and jump. They also help control a lot of the movements that you perform during sports.

Strengthening of the calf can be accomplished with lots of different exercises. My favorite is the simple heel raise against the wall with forward support. 

Initially, you will want to do the heel raises on both feet at the same time, but as your ankle heals, you will be able to do single leg heel raises. 

Another way to strengthen the calf is with theraband exercises. Lunges, step ups, and balancing activities will also help to strengthen the calf muscles.

The Peroneals

The peroneal muscles are the stabilizers of the ankle. Located on the outside of the leg, they help the ankle maintain a neutral position when you are putting weight on your leg.

Try balancing on one foot for a few seconds. Watch what your ankle does while you are balancing.
Peroneal Strengthening
Notice how your foot rolls in and out and adjusts to keep you balanced? The peroneal muscles help to keep your foot neutral while you are balancing, as well as when you are walking, running, jumping, and landing. 

Strengthening of the peroneals can be done with theraband exercises. This type of ankle rehab exercise will isolate these muscles, and can be helpful in the early stages of your rehabilitation. 

Once you are stronger, more advanced exercises like lunges, step ups, and other balancing activities will help improve the peroneal's strength.

The Posterior Tibialis Tendon and Muscle

Posterior Tibialis Strengthening
The posterior tibialis is the medial stabilizing muscle of the calf. It helps to do the same thing as the peroneals, only on the opposite side. It works to keep the ankle and foot in a neutral position when you are bearing weight, and works with the peroneals to do this.

The posterior tibialis can also be strengthened with theraband exercises, and then more advanced exercises like lunges, step ups, and balancing.

Other Muscles

Functional Strengthening
There are several other muscles in and around the ankle that can be strengthened during ankle rehabilitation. The anterior tibialis, extensor digitorum, flexor digitorum, and other intrinsic muscles can all benefit from strengthening exercises.

It is important to remember though, that sports activities as well as daily life do not occur in isolation. So, ankle rehab exercises to improve your strength should also not occur in isolation.

In the early stages of rehab, some isolation is needed to retrain the muscles to be able to contract. This is very true if you have a lot of swelling. Theraband strengthening is a great way to work on isolated muscle activity.

After the first 1-2 weeks following initial rehabilitation, your program should progress to more multi-muscle exercises, like the lunges and step ups, and balancing activities discussed already. 

Ankle rehab exercises for improving strength should include the major muscle groups that produce the motions at the ankle as well as stabilize during activities. Your program should start out with simple exercises like theraband strengthening, and then progress to more advanced functional activities like lunges, step ups, and balancing.