Wound Care Haiti Receives Pledge From Anodyne Therapy
The nonprofit Wound Care Haiti I have started, received a pledge from Anodyne Therapy on proceeds from future sales on their new product line. Wound Care Haiti is still waiting on 501 c(3) status. I will be in Port-Au-Prince, Haiti for World’s Diabetes Day. We will be lecturing to doctors, nurses and pedicurits for 18 hours of total lectures. We will be doing diabetic foot screenings and surgeries at the University Hospital. We are working in conjunction with FAHDIMAC on establishing a wound care center in Haiti. A study done by FAHDIMAC shows the diabetes rate to be higher in Haiti than the US. The need in Haiti is great, by saving a leg we can save a life. I will post about the conference over the next week, please check back.
By Patrick A. DeHeer, DPM
Is Your Doctor Really Doing The Ponseti Method?
Training with Dr. Ponseti at the University of Iowa
The Ponseti method has become the standard of care for newborns with clubfoot, but is your doctor really doing the Ponseti method? Many claim to use the Ponseti method, but at a recent meeting in Washington, DC for the Bone and Joint Decade Meeting International Clubfoot Symposium this problem was discussed in detail. There are a few tips that you as a parent can use to evaluate your child’s care.
1. Casting should be above the knee
2. Plaster material should be used – sometimes on older children fiberglass may be used to reinforce the plaster
3. The cast should be changed every 5-7 days
4. Cast should not be removed right before application of a new cast
5. The first cast will look almost worse as the front part of the foot and the back part of the foot have to be put on the same plane – This is called the “Magic Move”
6. Achilles tendon release in done in 85% of the cases – This is a minimally invasive procedure
7. The last cast should be left on for 3 weeks and bracing should be ordered during this time
8. Recurrence rates without bracing is 80%, but with bracing is 6%
9. Do not stop bracing until advised by your doctor
10. A study from the University of Iowa had a mean bracing time of 49.5 months
11. Ponseti International Website provides a list of recommended providers – use this list, do not just rely on a referral
12. The doctor treating your child should be putting on the cast, not a technician
On a final note, Dr. Ponseti recently passed away but his legacy will continue on. I had the honor of learning this treatment from him directly and it was an amazing experience. There are very few real heroes in the world, Dr. Ponseti was a true hero. He was a man of vision, compassion, bravery and perseverance.
By Dr. Patrick A. DeHeer, DPM
Common Foot Disorders
Your feet take a pounding every day from walking, standing, exercise, working and shoes. When you add a foot disorder to the equation, each painful step reminds you of how much stress your foot takes. A recent study by the American Podiatric Medical Association showed that there is a 75% chance of you having some type of foot aliment during your lifetime. While there are numerous foot conditions, some conditions are much more common than others. Understanding these conditions and what you can do to help yourself can be the first step back towards a pain-free lifestyle.
1. Heel Pain – Watch out for that first step in the morning.
- Heel pain is the most common foot disorder; it is a combination of plantar fasciitis with or without a heel spur. Plantar fasciitis is an inflammatory condition of the arch ligament that runs from the heel to the ball of the foot and helps to maintain the arch structure.
- With continued strain, this can lead to the development of a heel spur. It is a common misconception that a heel spur requires surgery or is a more serious condition; this is inaccurate.
- There is a direct correlation to body mass index (being over-weight) and the occurrence of heel pain. Other causes of heel pain include: Foot structure, high activity level or a change of activity level, shoe gear, the type of surfaces you stand on, injury, and arthritic conditions.
- Symptoms usually include a bruised feeling of the heel, which is often worse in the morning or after sitting. This is due to contracture of the plantar fascia while off the foot and a resultant stretch when first getting back on your foot.
- You can be actively involved in your treatment with a few simple steps. The first goal is to get the inflammation under control, followed by long-term prevention of recurrence.
- Start with stretching, appropriate shoe gear, RICE therapy, over-the-counter arch support and anti-inflammatory medication – Foot Care Tips.
- If you do not see a resolution of symptoms, consult a professional.
2. Bunions – Why is my big toe crooked?
- Bunions (Hallux Abducto Valgus) are a boney deformity of the big toe joint in which the great toe moves towards the second toe and a large bump develops on the joint. The joint subsequently does not move through a normal range of motion.
- Bunions are most often related to foot structure and foot function. Shoes can play a factor in development of bunions as can arthritis, injury, neuromuscular disorders, and congenital disorders.
- Symptoms may include any of the following: Arthritis, pain and swelling, limitation of motion, redness, calluses or corns.
- Treatment should be initiated with progression of the deformity or symptoms.
- Start by going to a wider shoe with good arch support.
- Consider an over-the-counter arch support.
- Take an anti-inflammatory medication per package instructions if you experience pain or swelling.
- If these measures do not alleviate your symptoms consult a professional.
3. Hammer Toes – Why is my toe rubbing on my shoe?
- Hammer toes are contracture of the toe, usually the middle joint on the toe, but may also involve the end joint of the toe or the joint where the toe attaches to the foot.
- Hammer toes are the result of a tendon imbalance due to foot mechanics or structure. Other causes include shoes, neuromuscular disorders, congenital disorders, and injury.
- Hammer toes are progressive and become more rigid with time, which can result in corn formation and pain. With progression this can lead to redness, swelling and sores.
- There are few self-treatment options for this condition, but here are a few things you can try on your own to help.
- First try to get a wider toe box shoe.
- If you have corns or skin irritations consider non-medicated padding.
- Over-the-counter orthotics can help with the mechanical or structural deformities.
- If symptoms or deformities progress, seek professional care.
4. Morton’s Neuroma – Why are my toes burning?
- Morton’s neuroma is a pinched nerve that is typically located between the third and fourth toes.
- The cause of this is unknown, but shoes are contributory as are certain activities like running.
- The symptoms can be varied, but normally they include burning, numbness, pain, and a full feeling in the ball of the foot. These symptoms are often made worse with dress shoes.
- Here are a few steps you can take to initially treat you neuroma.
- Start with a wider shoe and avoid dress shoes if possible, this helps stop the pinching effect of shoes.
- Try a cushioned over-the-counter arch support.
- Take an anti-inflammatory medication per package instructions.
- If symptoms do not resolve, consult professional care.
Do You Need a Podiatrist?
Pain in your foot is not normal and the difficulty comes in trying to decide when you can treat yourself and when you should seek treatment by a Podiatrist . You can start with RICE therapy (rest, ice, compression, elevation). Anti-inflammatory medications can help with pain and swelling, which should be taken according to package directions. Proper shoe gear, fitted by a professional, is helpful for several painful conditions. Another consideration for self treatment is an over-the-counter arch support to relieve pressure and support the foot. Here are some situations where you should seek podiatric care.
- If you experience pain that increases with activity, this could be a stress fracture or tendon injury. Both of these conditions require immediate care to prevent more serious problems.
- Injuries that prevent you from putting weight on your foot due to significant swelling and pain require attention as soon as you can be seen by a podiatrist. This may mean going to the emergency room to be seen by the podiatrist on call.
- Severe pain that lasts more than 24 hours can be the result of several conditions; therefore professional care is vital for diagnosis and treatment.
- Open wounds or sores that are slow to heal on the foot should be seen by a podiatrist. If you have diabetes or poor circulation, you should seek immediate care within 24 hours of noticing the wound. The longer a wound is present, the higher the risk of infection.
- If you have moles or other skin lesions on your feet that are irregular in shape or color, are painful, become open sores, or have changed appearance; you should have a biopsy of the lesion to confirm a diagnosis and help generate a treatment plan once those results have been obtained.
- Growths on the foot are not uncommon, but when they change or become painful, they should be examined.
- Pain that wakes you up at night or when your legs are elevated, and is relieved by walking or dangling your feet; is a common sign of poor circulation. Seeing a podiatrist is a good place to start. After an examination and possibly some simple vascular testing, your podiatrist can make recommendations for further treatment and referrals as needed.
- If you notice flattening of one arch, which may or may not be painful, you should seek care to determine the cause and subsequent treatment.
- Changes in color of your foot or lower leg compared to the other side can indicate poor circulation (white discoloration), venous conditions (purple or blue discoloration), infection or gout (red discoloration). These conditions vary in severity, but should be evaluated.
- An ingrown toenail that is causing pain or becomes red and swollen requires a simple in office procedure to permanently remove the ingrown portion of the toenail.
- Thickening and discoloration of your toenail which becomes painful or spreads to other nails can be treated by either topical or oral medications.
- A foot deformity that is progressively getting worse should be evaluated and your treatment options reviewed.
Five Tips to Fix Your Aching Feet
Your feet are often the most neglected and ignored part of your body, until they hurt. Then each step or minute of standing reminds you how much you depend on your feet. Foot pain is not normal, and often signifies an underlying problem. You can take some simple steps on your own initially for your pain, but if these fail to help you should seek professional care.
- 1. Proper Shoe Gear
Shoes are a very important initial treatment if you are experiencing foot pain. Here are some suggestions about shoes for aching feet:
- Get your foot measured by a qualified shoe fitter for both length and width, preferably at the end of the day.
- Wear the correct type of shoe for the type of activities you are doing. For everyday walking, consider a cross trainer or running shoe if possible. If you must wear dress shoes, visit a good shoe store for recommendations and make sure you try on several pairs.
- Replace worn shoes.
- 2. Arch Support and Shock Absorption
Arch support and shock absorption can go a long way to decrease foot pain. However, this can be confusing due to the abundance of products available. Here are some tips to consider for an over-the-counter arch support:
- A support that is entirely soft acts as a cushion only and does not provide any support.
- Look for something costing in the range of $25 – 75; anything more is not worth the extra money and you would be better off with a custom made device from a professional.
- Look for an arch support that is multi-layer, with soft shock absorbing materials on the top and bottom with some type of supportive plastic material in the middle.
- 3. Stretching
Tightness of the Achilles tendon (heel cord) is a common cause or component of several foot conditions. Stretching of the Achilles tendon is very helpful, but must be done correctly:
- Start facing a wall with one leg in front of the other and the toes pointing straight ahead.
- Lean into the wall with both hands against it.
- Bend the front knee and keep the back knee straight.
- As you lean forward, you should feel a slight stretch in your calf; hold this for 10 seconds.
- Come back out of the stretch. This counts as one stretch.
- Perform this 10 times on the back leg.
- Switch legs and perform 10 times on the other leg.
- 4. RICE Therapy
RICE therapy is commonly used for acute conditions and simply stands for Rest, Ice, Compression and Elevation.
- Rest: You may need to discontinue any activities that aggravate your foot pain.
- Ice: 20 minutes three to four times a day. Should be avoided if you have poor circulation or are diabetic.
- Compression: Ace wrap or compression type of bandage. Should be avoided if you have poor circulation or are diabetic.
- Elevation: Elevate the affected area, when possible, to heart level.
- 5. OTC Anti-inflammatory Medication
Consider taking an over-the-counter anti-inflammatory medication according to package instructions and precautions if you are able. If there is a question about this, please consult your physician.
