Foot and Ankle Doctor Blog Space

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My Toe is Crossing Over

The second toe is the most common toe to dislocate in the forefoot. The plantar plate at the second metatarsophalngeal joint can become unstable and rupture causing pain, swelling and subluxation or dislocation of the toe. The plantar plate attaches the bottom of the metatarsal (long bone in the foot) to the base of the proximal phalanx (toe bone) and prevents motion in the sagittal plane and absorbs shock while ambulating. It is a major stabilizing structure and when damaged can lead to a crossover toe.

Plantar plate tears are caused by trauma, inflammatory arthropathy, and repetitive hyperextension commonly caused by excessive wear of high heels.

Patients often complain of pain and swelling on the bottom of the toe. Without treatment the deformity can progress and the second toe can cross over the big toe making it difficult to wear shoes.

Our physicians at

Foot& Ankle Doctors, Inc

will perform an anterior draw test, which is pathognomonic for an unstable metatarsal phalangeal joint. Ultrasound, x-ray and MRI are other diagnostic tests that may be ordered to determine the severity. Conservative treatment includes:

-Rest

-Ice

-NSAIDs

-Taping the toe in a plantarflexed position

-Accommodative padding to reduce pressure under the affected toe

-Stiff-soled shoe or rocker-bottom shoe

-Custom orthotics

In severe cases the plantar plate may need to be surgically repaired. The plate itself may need to be sutured or a metatarsal osteotomy performed to shorten the second metatarsal.

If you are having pain in your toes, come see us at

Foot& Ankle Doctors, Inc

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Giants Tight End Fells Tackled by Small Bug

New York Giants tight end, Daniel Fells may loose his foot after suffering from a serious MRSA infection. MRSA is a type of staphylococcus infection that is resistant to methiciliin antibiotics. It is a common superbug and is contagious spreading from one person to another. The Giants have taken precaution to prevent the spread of the bug to other players by complying with infection-control protocols. MRSA can enter through a break in the skin barrier causing infection that may enter the bloodstream and affect major organs or bones.

Fells reportedly received a cortisone injection for a toe injury that may have inoculated the bacteria into his body. Anytime a foreign object such as a needle is placed into the body, there is a risk of infection. The risk is low, but there is always a risk. Fell has undergone multiple surgeries to stop the infection and save his foot. If the infection has spread to the blood, Fells will need a course of IV antibiotics.

MRSA often presents as a skin infection and can be mistaken for a pimple or spider bite. The skin will become red, swollen, painful to the touch, and filled with pus. It may be accompanied by a fever, and has the potential to become a life-threatening infection if left untreated.

All of us at Foot & Ankle Doctors, Inc. wish Fells a full recovery.

Dr. Nejad

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Chronic Ankle Pain – Os Trigonum Syndrome

Ballet dancers, soccer players and individuals who frequently plantarflex their foot (point their toes downwards) may experience chronic ankle pain located at the back of their ankle. Os trigonum is an accessory bone located on the lateral process of the talus – the back of the ankle. Most individuals are unaware they have an os trigonum until it becomes symptomatic. Severe plantarflexion can cause the accessory bone to become crushed between the ankle bone and the heel bone. This motion results in injury to the ligamentous attachments of the accessory bone leading to pain and swelling. Individuals complain of a deep aching pain at the back of their ankle when walking or when pointing their foot.
Conservative treatment options include:

  • Rest to allow the inflammation to subside

  • Immobilization with an ankle support/brace/ boot

  • Ice to decrease swelling

  • NSAIDs such as ibuprofen to help reduce pain and inflammation

  • Corticosteroid injection to reduce inflammation and pain

If conservative treatment fails to alleviate symptoms, surgical excision of the os trigonum may be necessary.

If you or a loved one is experiencing chronic ankle pain, come see us at Foot & Ankle Doctors, Inc.

Dr. Dardashti

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Is This Foot Pain from Gout?

Patients suffering from gout often complain of severe pain that is 10/10 on a visual analogue scale for pain (VAS). Gout commonly affects the big toe. Patients are in so much pain they can’t even let their bed sheets touch their foot without jumping. The usual presentation is that the patient wakes up with a swollen red hot painful foot and cannot recall any injury or trauma. An acute gout attack can be excruciating that some people go to the emergency room for relief of their pain.

Gout is a systemic condition caused by increased levels of uric acid in the blood. The big toe is the most common joint to collect excess uric acid. Excess uric acid will start to crystallize in the joint and your body reacts to the uric acid by becoming inflamed, swollen, red, warm and painful.

Diet and avoiding foods rich in uric acid such as red meat, seafood and alcohol can help prevent a gout attack. It can also be managed through medications.

If you are unsure if your foot pain is from a gout attack, come visit us at Foot & Ankle Doctors, Inc.

Dr. Dardashti

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Don’t Be Flip-Flopping Around This Summer

At Foot & Ankle Doctors, Inc. we understand that flip-flops are a summer staple, and have become so popular that some companies have created flip-flops with a built in bottle opener. Although flip-flops and sandals are comfortable and fashionable, they aren’t the best footwear for you.

Flip-flops have little to no arch support, they have minimal cushioning and shock absorption and can lead to foot pain if worn all day long. Common foot injuries associated with flip-flops include: blisters, stress fracture of the metatarsals, plantar fasciitis, ankle sprains and tendonitis. It’s okay to wear flip-flops when running a few errands, at the beach, or at a public pool, but they should not be worn when walking long distances, doing yard work and playing sports.

Patients with diabetes should avoid flip-flops because they expose your feet and increase your chances of lacerations and puncture wounds leading to serious infections.

What to look for in a summer sandal:

  • High quality material such as soft leather that will not irritate the skin
  • A sturdy pair that will not fold in half when bent
  • Built in arch support

It’s important to remember that the sun can easily damage the skin on the feet and sunscreen should be applied to protect them from sun damage

Dr. Nejad

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Athlete’s Foot

Athlete’s foot can be an embarrassing problem, despite its name anyone can contract athlete’s foot. It is caused by fungal infections and is easily contracted when wearing damp socks in tight shoes or walking barefoot in public locker rooms and shower areas.

Symptoms include cracked, scaling, itchy red skin between the toes and on the bottom on feet. In some cases blisters or ulcers may form. Athlete’s foot is contagious and it is best to avoid scratching or picking the affected areas on the feet.

Over the counter medication can be used to treat Athlete’s foot, however if your symptoms do not get better in a few weeks come see us at Foot & Ankle Doctors, Inc. If we cannot diagnose your symptoms classically as Athlete’s Foot a small shave biopsy will be taken and sent to the lab to be examined under a microscope before topical or oral anti-fungual medications will be dispensed.

  • To avoid Athlete’s Foot:
  • Keep your feet dry
  • Change your socks regularly
  • Don’t walk around barefoot in public places
  • Wear well ventilated shoes
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OATS for your Ankle Pain

Young adolescents complaining of ankle pain, joint popping or locking with decreased range of motion of the ankle and swelling and tenderness are signs of osteochondritis dissecans (OCD). OCD most often occurs in athletic males between the ages of 10 and 20. A small piece of cartilage becomes loose and can detach in some cases. If the fragment of cartilage migrates and gets stuck in the ankle joint, surgical intervention is required. OCD can increase your chances of developing osteoarthritis of the ankle joint.

Imaging

Physicians at Foot & Ankle Doctors, Inc. will take x-rays of your ankle and stage the severity of the injury from 1 to 4.

Treatment

Treat of early stages of OCD involve immobilization of the ankle joint in a non-weight bearing cast to avoid stress on the ankle. Physical therapy is important to increase range of motion and strengthen muscles that support the ankle joint. If conservative treatments fail after 3 months or a fragment of bone is caught in the ankle joint, surgery is required.Surgical intervention includes arthroscopic treatment to clean the ankle joint of debris. Osteoarticular Transfer System (OATS) surgery is another treatment that replaces damaged cartilage relieving pain and resorting movement. Small plugs of healthy cartilage are taken from another area of the ankle joint and transferred to damaged area. Patients will be on crutches for 6 to 12 weeks after surgery and long term physical therapy is necessary to restore range of motion and relieve pain.

For more information visit us at Foot & Ankle Doctors, Inc.

Dr. Nejad

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Bone Spurs in the Big Toenail

If you notice a soft pink mass on the tip of your big toe or sensitive area under the nail plate that is protruding and is painful when pressure is applied you may have a subungal exostosis. A subungual exostosis is a benign bone growth that arises from the dorsal surface of the distal phalanx (a small bone at the end of the toe) and causes pain and deformity of the nail.

Common causes for subungual exostosis include trauma, narrow shoes, previous nail surgery and certain biomechanical deformities such as a Hallux limitus.

At Foot & Ankle Doctors, Inc. x-rays of the foot will be taken to examine the bony growth and its involvement of the big toe. Differential diagnosis include: osteochondroma, Nora’s lesion, and osteosarcoma.

Conservative treatment includes purchasing a wider shoe and continuing with routine podiatric care.

Surgical removal is the recommended course of action. There are various surgical approaches and incisions that can be used to remove the bony prominence depending on its severity. In most cases the big toenail is removed to gain access to the bony prominence, which is then cut out. A surgical shoe will be dispensed and should be worn for 1-2 weeks.

Dr. Dardashti

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Puncture Wound

Stepping on a thumbtack, nail or piece of glass is something that shouldn’t be taken lightly. Most people try to treat themselves at home, however any object that penetrates the skin can lead to an infection especially if the object is not clean.

A puncture wound can lead to cellulitis, an infection caused by streptococcus or staphylococcus bacteria. Cellulitis will cause swelling and redness to the skin. The infected area will be warm and painful to the touch and you may develop a fever. If the bacteria enter the bloodstream the infection can spread to the rest of the body and sometimes lead to a life threatening infection know as necrotizing fasciitis.

If you step on a nail, seek medical attention immediately. If your tetanus shots are not up to date, your physician will administer a tetanus shot to protect you against lockjaw, an infection that can cause your muscles to painfully contract.

Treatment
Come see us at the Foot & Ankle Doctors, Inc
. within 24 hours after injury. We will remove the foreign object and take x-rays to ensure no pieces remain in the foot. We will clean the wound and monitor your progress during healing. In some cases antibiotics may be prescribed.

Complications
Infection is always a concern after a puncture wound. Signs of infection include warmth, redness, swelling, soreness and sometimes drainage. If the object penetrated to bone, a bone infection may occur. In some cases a painful scar or hard cyst may develop.

Dr. Farshid Nejad

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Acute Compartment Syndrome in the Foot

Compartment syndrome is a painful condition that occurs from an increase in pressure within the muscles. Increase in pressure above normal levels can decrease blood supply to the muscles and nerves in that area which can result in permanent tissue damage.

Acute compartment syndrome is a medical emergency. It is usually caused by trauma such as a crush injury, a fracture or a constricting bandage or cast.

Chronic compartment syndrome is not a medical emergency. It is usually caused by repetitive physical activity such as running.

There are 9 compartments in the foot and each compartment has a fascia covering to keep the tissues in place. This fascia does not stretch easily and following an injury, swelling or bleeding can occur, resulting in increased pressure within the compartments. If the pressure is not released, permanent tissue damage can occur.

Symptoms – The 6 P’s of Compartment Syndrome

  • Pain out of proportion and not relieved by narcotics
  • Pulselessness
  • Parasthesia
  • Paralysis
  • Pallor
  • Poikilothermia

If you experience these symptoms, seek medical advice immediately

Diagnosis
A wicker catheter is a device that is used to measure compartment pressures. Normal compartment pressure in the foot is between 0-8mmHg. A compartment pressure measuring >30mmHg or 10-30mmHg below diastolic pressure is concerning and emergent fasciotomy may be needed.

Treatment
Depending on which foot compartments are affected incisions are made over the compartments to relive pressure. Fasciotomy incisions are left open 5 days to allow edema and swelling to dissipate. After the pressure has been adequately reduced the surgical sites are closed.

Acute compartment syndrome is a surgical emergency and if not treated immediately permanent damage and tissue death can occur. For more information on acute compartment syndrome come see one of our physicians at Foot & Ankle Doctors, Inc

Dr. Dardashti

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