Stay warm this winter and protect your feet from prolonged exposure to the cold and wet snow. Frostbite occurs with exposure to subfreezing temperatures below 32°F. There are four phases of frostbite injury:

• Prefreeze phase: The arteries in the foot vasoconstrict, while the veins dilate causing leaking of fluid from the cells
• Freeze-Thaw Phase: crystals start to form within the cell membrane and can result in rupture of cell membranes. Damage at this phase is still reversible
• Vascular Stasis Phase: Tissue is deprived of oxygen
• Ischemic Late Phase: The injured tissue is dead and damage to nerves occurs at this point

If frostbite is caught at an early stage rapid rewarming with circulating water at 104-108°F for 20 minutes can reverse the process. Rewarming is a painful procedure and it is recommended that you seek medical attention for appropriate pain medication. It is important to avoid smoking and caffeine as they can cause vasoconstriction of the arteries. Blood thinners such as Aspirin or Heparin can be administered to increase delivery of blood flow to distal parts of the foot, such as the toes.

Frostbites in later stages cannot undergo rapid rewarming. Instead, these injuries will be left to demarcate until a debridement or amputation will be performed. In the meantime, local wound care with Betadine, Dakin’s, or Silver Sulfadiazine may be applied to the wound depending on its severity.

Frostbite is a serious injury that can lead to amputation if left untreated.  For more information come see us at Foot& Ankle Doctors, Inc.

Dr. Dardashti

Bone biopsy and culture is the gold standard for diagnosis of osteomyelitis. Bone biopsy is indicated when clinical examination, laboratory findings and radiographic changes are suspicious for osteomyelitis. Chronic osteomyelitis can lead to longstanding wounds that can undergo malignant transformation into squamous cell carcinoma, and are termed Marjolin’s ulcer. Non-healing chronic wounds should also undergo a bone biopsy as well.

Bone biopsies can be obtained either from surgical debridement or percutaneously. At Foot& Ankle Doctors, Inc percutanous biopsies are performed in clinic in the following steps:

1. Local anesthetic is injected in the area of skin to be biopsied
2. A small incision is made over the desired area of biopsy site
3. Blunt dissection is performed to the level of the bone
4. A trephine biopsy needle is inserted into the area of desired bone
5. Specimen sent for culture and pathology

If bone biopsy comes back positive for osteomyelitis, IV antibiotics can be started for 6 to 8 weeks. In some cases bone surgery to remove the infected bone is needed.

Dr. Nejad

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

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

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

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

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