High Heels are Worse than We Thought !

The New York Times recently ran a story on the scientific look at the dangers of high heels.  (http://well.blogs.nytimes.com/2012/01/25/scientists-look-at-the-dangers-of-high-heels/)

As podiatrist we see the changes that happen to women’s feet from long term wearing of high heel including worsening bunion, hammertoes, metatarsalgia, ankle equinus, and Achilles tendinitis pathology.  In this research it was demonstrated that when women that rarely wore heels walked, their tendons (for example the Achilles tendon) elongated and stretched as expected, whereas in the group of women that regularly wore heels, their tendons were not as engaged but rather the muscle belly attached to the same tendon. This leads to more rigid function which can progress to tendinitis and potential abnormal pull.  Previous research has shown the greatest strength and efficiency of the muscle/tendon unit occurs when the muscle stays relatively the same length and the tendon lengthens.  This also happened when the heel wearing women walked barefoot.  The alteration of the muscle function puts these women at higher risk for tendinitis, especially when wearing tennis shoes and flats when more stretch is required by the tendon to place the heel on the ground.

The recommendation was not to stop wearing heels, but rather to slowly lower the heel height worn and to reserve the extra high heels for 1-2 times a week.

We can show you a dynamic ultrasound which can demonstrate this in the ACHILLES tendon right in the office.

- Dr TIMM 

Minimal Invasive Flatfoot Surgery Being Recognized in the Literature

Journal of Foot and Ankle Surgery
Volume 52, Issue 4 , Pages 432-443, July 2013

Plantar Pressure Distribution in a Hyperpronated Foot before and after Intervention with an Extraosseous Talotarsal Stabilization Device—A Retrospective Study

Plantar pressure measurements have long been used by clinicians to provide information regarding potential impairments and disorders of the foot and ankle. Elevations in peak plantar pressures or a poor distribution of these pressures can be an indication of pathomechanics in the foot. Lower extremity deficits such as sensory impairment, foot deformities, limited joint mobility, and reduced plantar tissue thickness have been associated with high plantar pressures. The total pressures, pressure distribution, and peak pressures provide useful information to evaluate the abnormal functioning of the talotarsal joint. Instability of the talotarsal joint can result in excessive forces exerted on the joints and surrounding tissues in the foot that can then lead to dysfunction of the proximal musculoskeletal kinetic chain. In the present study, we performed a retrograde analysis of the pre- and postoperative measurements of the peak plantar pressures, peak forces, and area of contact between the foot and the ground during each phase of the gait cycle for 6 patients (12 feet) who had undergone a bilateral extraosseous talotarsal stabilization procedure using a type II extraosseous talotarsal stabilization device. After the procedure, a significant reduction was seen in the peak pressures (42%) over the entire foot and a significant increase in the contact area (19.7%) between the foot and the floor. This could imply that the extraosseous talotarsal stabilization procedure was effective in stabilizing the talotarsal joint complex, thus eliminating abnormal hindfoot motion and restoring the normal biomechanics of the foot and ankle complex, as indicated by a reduction and realignment of the peak plantar pressures and forces.

In essence, from a surgical standpoint, as well as from a patient recovery standpoint, utilization of the HYPROCURE implant may improve function and redistribute abnormal forces in the foot which may  lead to reduced symptoms in appropriate patient populations with faster recovery and improved biomechanical function.

- Dr Timm

Weight Gain is Related to Diet Soda Consumption

New data gleaned from five years of studies have shown that artificial sweeteners can lead to weight gain as the body forgets how to process real sugar.

Sweet taste without the guilt — this has long been the promise of diet sodas.

But researchers at Purdue University have found by reviewing studies done over the past five years that diet soda and other artificially sweetened products could cause the same health problems as regular soda. In review, Susan E. Swithers, a Purdue professor of behavioral neuroscience, discovered that with consuming artificial sweeteners like sucralose, aspartame and saccharin, the body loses its ability to process real sugar, which could result in weight gain.

With real sugar, messages are released to the brain and the gullet via hormones that regulate digestion and intake of food, blood sugar levels, and even perception of fullness and satisfaction from the food consumed. However, with no actual calories to process with artificial sweeteners, the body doesn't know how to react.

"You've messed up the whole system, so when you consume real sugar, your body doesn't know if it should try to process it because it's been tricked by the fake sugar so many times," says Swithers to CNN.

The end result, says Swithers, is that the body's metabolic system stops reacting to real sugars and doesn’t release the hormones that say, “That was delicious, I’m full.” This can cause an endless cycle of feeling hungry and wanting more sugar.

It has also been shown that people who regularly drink diet soda have a higher risk of weight gain, obesity and type 2 diabetes and heart disease.

However, representatives of the American Beverage Association disagree and argue that low-calorie products can be effective tools for weight control, calling the study “an opinion piece,” in a released statement, according to CNN.

Theresa Hedrick, nutrition and scientific affairs specialist for the Calorie Control Council lobbying group, told WebMD, "I think it's important to remember that low-calorie sweeteners are one aspect of a multifaceted approach to health or obesity prevention. ...They aren't magic bullets."

Weight gain is a major contributor to all foot and ankle problems, and our patients need to understand that weight loss therefore will directly impact the reduction of most foot and ankle pain. Ask us about your weight loss options today, or at your next appointment.

- Dr Timm

YOU MAY BE DAMAGING YOUR ANKLE WITH EACH STEP

Ankle sprains are a common injury after a fall, sudden twist or blow to the ankle joint. Approximately 40 percent of those who suffer an ankle sprain will experience chronic ankle pain, even after being treated for their initial injury.

A review article published in the May 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) explains that tendon injuries to the ankle can be a possible cause for this chronic pain. In some cases, the condition is untreated or overlooked which prolongs the pain and the problem. "When patients injure their ankles, the injury may not seem serious at first," explains Terrence Philbin, DO, lead author of the article and Fellowship Director of the Orthopedic Foot and Ankle Center in Columbus, Ohio. "People may not seek medical attention and they can think it will just get better on its own. I think that is why this condition often goes undiagnosed." The authors of the article describe how in some cases chronic ankle pain may actually be the result of injuries to the peroneal tendons. The peroneal tendons are located behind the outside portion of the anklebone (called the fibula). The tendons help to stabilize the foot and ankle. Tendon injuries can include tendonitis or swelling around the tendons. In more severe cases, the peroneal tendons can actually tear or there can be a swelling of the tendons behind the fibula bone. This can cause the ligament that holds the tendons together to stretch out and tear, or even rupture. Symptoms associated with peroneal tendon injuries can include: Ankle pain that is not responding to treatment Swelling and tenderness around the outside of the ankle Pain behind the anklebone Pain that transmits from the ankle down into the foot The use of magnetic resonance imaging (MRI) or ultrasound can be helpful when identifying and diagnosing peroneal tendon injuries and disorders. "These imaging techniques offer a more complete look at the peroneal tendons," noted Philbin. "One might consider getting an MRI or ultrasound especially if you have chronic ankle pain." If the condition is caught early, non-operative treatment options can include: Rest, ice and elevation Anti-inflammatory medication Immobilization in a cast or brace Physical therapy More serious injuries of the peroneal tendons, including tears or ruptures, will very likely require surgery. Peroneal tendon injuries can happen suddenly or can develop over time. The injury is most common among athletes involved in sports that require repetitive ankle motion and in individuals who have high arches of the foot. A proper diagnosis is essential in order to treat peroneal tendon injuries correctly and to help alleviate chronic pain. Philbin reminds patients, "If you have ankle pain and it is not getting better, do not ignore it. Get it evaluated by a physician who has experience treating foot and ankle injuries."

We can try a variety of measures to reduce pain and swelling and disability from this condition. PRP injections, low profile bracing, and physical therapy are excellent nonsurgical options. Ultimately surgery would be considered pending the nature and severity of the problem, and how you respond or fail to respond with nonsurgical management.

- DR TIMM

Walking on Anchors

The Tampa Bay Rays superstar Evan Longoria is one who can vouch for the trouble that heel pain can cause. In essence, the heel is anchoring him from doing what he is usually able to do on the field. IF he were to read this, as you all do, he would be coming in as well for an immediate consultation and high energy shock wave treatment. This has been shown in many cases to effectively remove heel pain and pressure within 6 weeks post treatment. We would augment this with a platelet rich plasma injection under ultra sound guidance to enhance the healing of the distraught fascia. This is going to otherwise hold him at bay for months to come during the season, and frankly the Rays cannot afford this length of reduced productivity from him.  Get into our office as soon as possible to reduce the length this anchor has it's grips on your feet, causing you to reduce your exercise frequency and increase your weight. It is a spiral that most people can do without.

DR TIMM

An Arizona mother has found herself under fire after posting a video online showing her daughter breaking her feet while jumping off a roof on a dare in a bid to raise money for the injured teen.

Carrie Yunker, of Peoria, created a page on the popular crowdfunding site gofundme.com, asking the online community to help her raise $4,200 that will be used to cover her daughter Nicole Easton's everyday expenses for the next several of months while she recovers from her injuries. 

In a post on the fundraising site, Yunker explained that her daughter just graduated from high school, had a good job and had recently moved into her first home 'as an adult' when disaster struck.

In her online plea for help, Yunker explained that while her daughter did not have health insurance, her father was able to add her to his plan.

The accident landed the girl in a wheelchair, and she is expected to be disabled for the next six weeks, according to her mother. 

Yunker then went on to explain that her daughter not being able to work for a while means that she would be unable to cover her share of the rent and bills, which could result in her losing her home. 

The mother gave a breakdown of her daughter's expenses, writing that she will need $1,800 for rent for half a year and $2,400 for expenses like food, toiletries, phone and utilities.

This is a foolish stunt which could leave this poor unfortunate teen with chronic pain and debilitating arthritis with potentially the need for a triple arthrodesis in the future for both sides. This likely resulted in a calcaneal fracture to both feet, which is perhaps one of the more debilitating injuries sustained from a fall from a height. She was most fortunate to not sustain a spinal injury as well, which could have left he in a wheelchair for much longer than 6 weeks. Any time you are dared to attempt any stunt that could significantly injure yourself, keep in mind you may only get to make a foolish mistake once, with lengthy and difficult longstanding consequences, so you should think before you act.  

We deal primarily in foot and ankle problems, and this sort of pain and arthritic sequelae are commonplace for us to manage. We have a detailed protocol for varying pathology, and are able to manage this post traumatic OA with a variety of modalities until surgery is absolutely required. 

At FFLC we are regularly seeing patients who fall from a height, and most of these individuals are roofers, construction workers, and others with on the job injury. However, if you fall like this Arizona teen, you may be left with significant medical expenses and difficulties walking the remainder of your life.  She may benefit from arthrodesis procedures in her early 20's if the damage is significant, otherwise she may be unable to run, which may or may not impact her for years to come. Life lesson here: Be safe and think before you act. 

MonaVie is HERE!!

Delivering a wide array of antioxidants, vitamins, and phytonutrients, as well as other beneficial ingredients like Wellmune®, plant-derived glucosamine, and plant sterols, every serving is guaranteed to be as efficacious as it is delicious.

Take a stand against free radicals. MonaVie Essential® is a mouthwatering blend of 19 body-beneficial fruits and AçaVie™—the purest, most potent form of açai available. Scientifically formulated to support your body’s nutritional needs, this efficacious juice defends against the effects of aging while improving your overall health. Put the power of antioxidants to work for you by drinking MonaVie Essential today.

Get your body in motion. MonaVie Active® is a delicious fusion of 19 body-beneficial fruits and scientifically validated glucosamine, which targets joint mobility and flexibility. Formulated with AçaVie™—the purest, most potent form of açai available—this advanced juice also offers protection against cellular oxidation. Promote healthy joints and get moving with MonaVie Active today.

Drink to your heart’s content. MonaVie Pulse™  is a heart healthy blend of 19 fruits, resveratrol, and plant sterols,* which have been clinically shown to help lower cholesterol. Featuring AçaVie™—the purest, most potent form of açai available—this cardioprotective juice supports optimal cell health and healthy cholesterol levels. Do something good for your heart and enjoy MonaVie Pulse today.

Optimize your body’s natural defenses. MonaVie (M)mūn™ is a body-beneficial blend of 19 fruits and Wellmune®, which has been clinically shown to strengthen your body’s immune defenses. Formulated with AçaVie™—the purest, most potent form of açai available—this scientifically advanced juice combats cellular oxidation while helping protect your body year round. It’s your daily defense for a healthier life.

Recharge your body and mind with a boost of sustained energy. MonaVie EMV and MonaVie EMV Lite feature a proprietary blend of antioxidant rich fruits, including the Brazilian superfruits açai and maqui, and natural sources of energy. Great tasting and lightly carbonated, these healthy formulas increase performance, endurance, and concentration by kicking up your energy level and keeping it there—without a subsequent crash. Finally, two healthy solutions to your body’s everyday energy needs.†

Delivers potent antioxidants and essential nutrients to your body. MonaVie Kosher™ is a mouthwatering fusion of the Brazilian açai berry—one of nature’s top superfoods—and 18 other beneficial fruits. Incorporating a Balance-Variety-Moderation approach to nutrition, this free radical fighting, kosher certified formula nutritionally supports your body’s overall health.

* Foods containing at least 0.4 grams per serving of plant sterols, eaten twice a day with meals for a daily total intake of at least 0.8 grams and as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease. Two servings (4 ounces of juice or 2 packets of gel) of MonaVie Pulse contain 0.8 grams of plant sterols.

†These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.