3 Things you Need to Know about Neuromas

1. WE ARE ALL AT RISK.
We all have the propensity to form them. These lesions of the digital nerves on the bottom of the foot are directly related to environmental causes, such as tight fitting shoes, long hours on your feet every day, and even lack of tactile stimulation (such as massages). That being said, we are certain that everyone who walks on their feet are at risk to form this annoying and painful scenario. Therefore, you need to know if you actually have a neuroma in order to decide if treatment is in order. Pain, feeling of bunched up stocking, tingling and numbness to the toes. Worse in closed shoes. Feels better with massage. This sounds like a neuroma.

2. SURGERY IS NOT NEEDED.
All too often patients are deterred to see their doctor for reasons of fear. Fear drives the most powerful decisions, and is responsible for most things that are avoided. I can assure anyone reading this article that surgery is not needed for most neuromas. In fact, we are able to use a variety of ablation techniques, such as neurolytic injections, and radiofrequency ablation without an incision. These techniques help patients to avoid surgery, and can lead to excellent pain relief, with the replacement of numbness to the painful area. This is normal and is a good trade off for patients who are dealing with very symptomatic neuromas.

3. DIAGNOSIS IS PAINLESS.
Pain and discomfort are never acceptable. In fact, these are two of the sensations we try to avoid on a daily basis. Most times, whenever you seek aide from a physician, there are painful tests to be undertaken. At FFLC, we are able to calmly and painlessly diagnose many foot and ankle conditions, and have the equipment necessary to fully enhance the likelihood of a correct and timely diagnosis. Ultrasound, radiography, fluoroscopic imaging, and physical examination are readily accurate means to assure that we are correctly receiving the necessary information to treat your condition. Even if you want to delay any interventions at the time of your initial encounter, we can deliver a timely diagnosis so when it becomes more painful or if things need to become more invasive, we are ready to deliver the necessary treatments. So there are no reasons to avoid seeking an appointment today.


-Dr Timm

3D Images of High Heels you MUST SEE.

The 3D scan that will shock every high heel loving woman

• by: STEPHEN ADAMS
• From: Daily Mail
 
• August 19, 2013 10:07AM

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The high heel pedCAT scan. Picture: Screengrab, YouTube

THE first 3D scan of a female foot in high heels has highlighted the painful price fashion- conscious women may pay for tottering around in towering Christian Louboutins or Jimmy Choos.

Consultant orthopaedic surgeon Andy Goldberg says all the body weight gets forced on to the front of the feet, eventually causing unsightly clawed toes that can become arthritic.

Wearing stilettos pushes and twists bones out of line, resulting in knobbly bunions and other painful conditions.

The picture above was taken with a new $340,000 scanner at the Royal National Orthopaedic Hospital in North London. The PedCAT machine, the first of its kind in the UK, does a 360-degree scan of the patient's feet in just 60 seconds.

Doctors can then view the resultant 3D image from every angle, spinning it around to view the foot from above, below and the side. It also takes 600 2D views of the foot.

Mr Goldberg, a foot and ankle specialist, said the technology was a major advance over traditional 2D X-rays, which could lead to misdiagnoses.

"The scanner gives us much more information"' he said.

'It shows the deformity caused by wearing high heels is much more complicated than we previously thought.

"With high heels, the toes are squashed inside the shoe. The more stiletto-shaped they are, the worse it is. The toes not only get squashed, but they become clawed too." The base of the big toe becomes 'deviated outwards', forming a bunion, while the scanner also shows how these bones can become 'rotated and dropped'.

Pea-shaped bones under the base of the big toe - called sesamoids - get dislodged by the immense pressures put on them.

"There's nothing wrong with being in this high heel position temporarily - it forms a part of your normal stride. And if you wear heels for an hour or two at an evening party, it's not a problem" Mr Goldberg said.

"But if you wear them for eight hours a day for years on end, you will develop problems."

Before the high heel pedCAT scan. Picture: Screengrab, YouTube

It wasn't just middle-aged women who suffered, he said. "It's not uncommon for me to see teenage girls in my clinic. They are usually accompanied by their mothers, who tell them, 'Look, the doctor says you should be wearing sensible shoes!' But I try not to get involved with family politics too much.

"If you have got a family history of high heel wearers and you wear them a lot, you are pretty much guaranteed to develop bunions," he said.

"If you are not genetically predisposed, wearing high heels may accelerate bunions.

"Foot and ankle problems affect your walking and take over your life. There's a saying that if you want to take someone's mind off a problem, put them in tight shoes."

A survey of patients at the hospital's foot and ankle clinic found that 57 per cent had experienced severe pain as a result of wearing uncomfortable shoes such as high heels.

And 86 per cent claimed they found it difficult finding comfortable shoes. In truth, the internet is now awash with firms which offer sensible footwear in fashionable shades.

"People don't like doctors like me saying, 'Your shoes are a problem.' If I suggest they buy themselves some comfy shoes, I'm liable to get punched in the face." Mr Goldberg added. He also claimed some patients exaggerated the pain their bunions caused to get them surgically removed - so they could then continue to squeeze their feet into fashionable shoes.

Mr Goldberg said the damage caused by high heels was nothing new: "We have always been slaves to fashions that have led to deformity.

"But what we should be doing is fitting people's shoes around their feet, rather than the other way around.

"If a fashion icon such as Victoria Beckham designed a range of shoes that really fitted our feet, then that would be a real game-changer."

Victoria Beckham attends party to celebrate 40th anniversary of Range Rover. Picture: Supplied.

A HIGH PRICE TO PAY: HOW THE DEFORMITY AND PAIN DEVELOPS

- Prolonged 'hyper- extension' of these toe joints, under intense pressure, causes pain.

- High heels force women to throw their weight on to the front of the foot. Toes get squashed together and clawed up, eventually becoming rigid and arthritic.

- Big toe bones become pushed out, forming the trademark bunion of many high-heel slaves.

- Pea-shaped sesamoid bones are drawn underfoot and out of position, affecting how the foot bends and resulting in pain

We've indirectly known much of what this is saying but we are now exclusively certain the perils that feet are subjected to with regards to high heeled shoewear. These 3 dimensional scans give us an exact orientation to the deforming forces that women are subjecting their foot to on a daily basis, and it can give significant biomechanical insight to the resulting deformities and symptomatology associated with them. 

-DR TIMM

Is it a Bunion or Something Else?: How to Tell

"Is it a Bunion or Something Else?: How to Tell"

 

Many times, we will see a patient who is absolutely convinced they are suffering from pain related to a condition called a "bunion" deformity. Sometimes they are correct, other times we need to adjust this diagnosis.  Bunions typically are formed from biomechanical stresses which progress and lead to joint deviation and sometimes dislocation. This is accompanied by pain with motion and may lead to the need for surgery.

 

 

When the prominence is on TOP of the toe joint, it is not necessarily the same condition. We often refer to this as a "Dorsal bunion" or hallux limitus/rigidus. This is Latin for restriction of motion of the first toe joint. This is a very localized form of osteoarthritis and requires a different approach. Bunions tend to improve with padding and wider shoes. These sorts of issues are more likely to improve with coritsone injections and specific orthotics in the shoes. Other times it may require either a fusion, or an implant of the joint to maintain motion in specific cases. These are also progressive, and lead to limited motion and increased pain secondary to the arthritis in the joint space. We have a variety of holistic joint preservation techniques such as supplementation, PRP injections, and anti inflammatory cremes available to quell acute symptoms and maintain joint motion

 

This radiograph shows the excellent straight appearence of the toe joint, but also shows the absence of a joint space which can be an indication of severe degenerative joint disease (osteoarthritis). 

Observe the giant "lump" on top of this patients foot. Painful and inflamed this can be a source of debilitation and may require a cortisone injection for relief initially. 

 

 

One must be aware of the problem and it's nature, in order to obtain an excellent solution. Therefore, if there are any concerns or questions about what specifically is occurring in the foot and ankle, you should promptly be seen by your foot and ankle surgeon.

 

 

Brian Timm, DPM, AACFAS, DABLES
Board Certified by the American Board
of Lower Extremity Surgeons in
Reconstructive Foot and Ankle Surgery

3 Secrets you MUST KNOW to AVOID FRACTURE COMPLICATIONS AFTER SURGERY

This situation may occur even in the most skilled surgeon's care. Most of these problems can be avoided with 3 very important factors to be considered:

1) REMAIN NON WEIGHT BEARING
When the doctor tells you that you are not supposed to place your foot on the ground, that is NON NEGOTIABLE. Most patients will be in some form of a cast, which they believe will absorb all the forces when they are resting the foot on the floor. This is partially correct. Non weight bearing means that you must think of an antigravity chamber. This is where the foot does not touch the ground under any circumstances. If you are really efficient at this, a nonunion is much less likely to occur. Your bone will take less time to heal, and the position and fixation used will be less likely to fail. This includes keeping the area free of water, as this could also lead to infections.

2) VITAMIN D
Most patients who I see here are not even aware they have a vitamin D deficiency. If a nonunion occurs, we often will obtain blood-work to assure there are no further metabolic conditions which may preclude healing of bone. Most often we will have our patients on a vitamin D/ Calcium supplement to prevent this and enhance the healing. So if we tell you that you need Coral Calcium, we are only enhancing your chances to heal without complications.

3) PROTEIN
Often times, even in the most obese patients, we will see varying degrees of protein insufficiency. This can be troublesome, as most people attribute calcium as the most important supplement for bone healing. More studies are showing the importance of a balanced diet which includes high sources of protein, such as soy beans, chicken, and fish as keys towards normal bone healing metabolism. Protein shakes, bars, and natural sources in the diet will enhance bone healing.


- DR TIMM

Stress Fractures Affect Even Olympic Athletes

The most decorated Olympian of all time is dealing with a stress fracture in his right foot after a rather grueling round of golf.

Michael Phelps was seen wearing a walking boot while at a mural dedication in Barcelona, Spain. When asked about the boot, Phelps said he exacerbated a previous stress fracture during a round of golf.

“Golf really is a dangerous sport,” Phelps joked after the dedication. He said he thinks he may have injured his foot when he stepped into a hole, but added that the injury has some perks.

“The good thing is, I only have to pack one shoe.”

Phelps’ coach Bob Bowman believes the former Olympian made his stress fracture worse by walking on it throughout a golf tournament.

“He hit his foot somehow in the house and then he did that tournament when he walked about 20 miles and got a little stress fracture,” Bowman told the Associated Press.

A Closer Look at Stress Fractures
As Dr. Silverman concluded in his diagnosis of Derek Jeter’s fractured ankle, stress fractures occur because of mechanical overload to a bone that can’t compensate fast enough.

“Our bodies wear down each day as we take on weight-bearing activities. When you exercise, your body breaks down faster,” said Silverman. “If your body breaks down faster than it builds up, stress fractures occur.”

Stress fractures can also develop if a person has a foot condition that alters the way their foot displaces weight. Conditions like flatfeet, high arches, or improper gait can put increased stress on your bones. It’s uncertain if Phelps has any foot conditions that would make him more predisposed to stress fractures, but walking the 6,865-yard course last weekend definitely put added stress on his feet.

Phelps would have more than enough time address the underlying issues in his foot if he decided to come out of retirement to participate in the 2016 Olympics. He dodged a question by a reporter who asked if he was completely sure he was finished with the Olympics, saying “well, golf is definitely out.”

Source Yahoo Sports.