Foot and Ankle Doctor Blog Space

Category: Foot Injury

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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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Fracture Healing

All broken bones in the body undergo a natural healing process. Bone healing is a slow process and can take up to 8 weeks. Immobilization and compression is necessary for optimal bone healing.

There are four phases of bone healing

  • Inflammation: occurs within the first 48 hours. Swelling can help provide stability
  • Soft callus: occurs during the first two months. Fibrous tissue and cartilage tissue develop at the ends of the fracture site
  • Hard Callus: occurs during the 3rd and 4th month. The soft callus is replaced with bone and is visible on x-ray
  • Bone remodeling: Lasts for several months. The bone continues to return to its normal shape. Bone can regenerate back to 100% of its strength after a fracture

At Foot & Ankle Doctors, Inc we like to immobilize patients with fractures. Immobilization is an important part in promoting bone healing. Depending on the type of fracture a surgical shoe or boot may be used. In more severe cases surgery may be needed to fixate the fracture site with screws, plates or wires. A cast will be applied afterwards and physical therapy recommended once the bone is adequately healed.

Factors that Impair Bone Healing

  • Early weight bearing
  • Smoking
  • Fracture ends greater than 1cm apart
  • Poor nutrition
  • Certain medications

If bone healing is slow or delayed, our physicians can provide a variety of treatments to enhance bone growth such as bone stimulators, use of bone growth proteins and bone grafts.

Dr. Dardashti

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Extensor Hallucis Longus Tendon Injury

We all have our clumsy moments where we accidentally drop something on our foot. The top of the foot lacks a lot of fat or padding to protect vital structures such as arteries, nerves and tendons which makes dropping a piece of glass, metal or plastic worrisome. Pain, swelling, bruising and bleeding are common symptoms of injury to the foot. If you notice the inability to move your big toe up towards the ceiling you may have severed your extensor hallucis longus (EHL) tendon and should come to see one of our physicians at Foot& Ankle Doctors, Inc.

 

Severing the EHL can be treated conservatively or surgically depending on the severity of the injury. If the EHL tendon ends are close enough to each other conservative care would include a non-weight bearing cast for 6 weeks. This would allow the two torn tendon ends to heal together.

 

If the tendon ends are far apart surgery will be required to sew the two ends together or a tendon graft may be necessary to bridge the gap and restore tendon alignment and function.

 

Dr. Dardashti

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Toe Injuries Are Not Just For High Athlete Performers

Athletes involved with high impact sports will often suffer from toe injuries. Sports fans will remember when Pierre Garcon and Taylor Martinez both suffered from a plantar plate tear. Although a lot of us are not professional athletes we too can suffer from plantar plate tears.

The plantar plate is a ligament located on the bottom of the toes. It is responsible for cushioning the ball of the foot when walking and running and prevents hyperextension of the toes. With repeated overuse the ligament can stretch and tear and lead to a predislocation syndrome also known as a crossover toe deformity or a floating toe syndrome. Plantar plate tears most commonly affect the second toe.

Symptoms of a plantar plate tear:

  • Persistent pain at the ball of the foot

  • A toe that is changing position – lifting up or crossing over

  • Swelling

Plantar plate tears can be difficult to diagnose. Common misdiagnoses include a neuroma, tuff toe or a stress fracture. If you were given one of these diagnoses and you are unresponsive to treatment, ask your doctor about the possibility of a plantar plate tear.

At Foot& Ankle Doctors, Inc we will first offer conservative treatment options:

  • Rest

  • Ice

  • Anti-inflammatory medication

  • Accommodative padding to alleviate pressure from the ball of the foot

  • Plantarflexion strapping of the digit to hold it in place

  • Orthotics and stiff soled shoe or rocker-bottom shoes may be recommended

If conservative treatments fail, surgery may be required to repair the ligament.

 

Dr. Dardashti

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Stiff Painful Big Toe – Hallux Limitus

A stiff big toe that is painful to move is a sign of degenerative arthritis and is known as hallux limitus. It can be a disabling condition preventing patients from walking normally and performing their daily activities. Hallux limitus is a progressive condition that gets worse overtime and can eventually lead to a “rigid” toe that patients describe as a “frozen big toe.”

Hallux limitus can be caused by:

 Abnormal foot structure or biomechanics

 Overuse or wear and tear of the joint

 Trauma

 Inflammatory diseases – ex. Rheumatoid arthritis, Gout

Symptoms and treatment of hallux limitus vary depending on the stage of the condition. Early stage symptoms include pain and stiffness when walking, standing for extended periods of time or squatting. Later stages present with swelling of the big toe, difficulty wearing shoes, formation of a bump on top of the toe as well as stiffness.

Treatment options include the use of nonsteroidal anti-inflammatory medications, custom orthotics, shoe modifications and corticosteroid injections. In some cases surgery may be an option to reduce pain. Surgical options include:

 Cleaning the joint and removing pieces of bone that limit motion

 Fusing the big toe to prevent further degeneration of the joint

 Replacing the joint of the big toe with an implant

If you are experiencing pain or stiffness in your big toe come see our physicians at the Foot & Ankle Doctors, Inc.

Dr. Nejad

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Turf Toe.. More Serious Than You Think

Turf toe sounds like a minor injury that only involves a single toe, however it can be a career ending injury like it was for Deion Sanders. It commonly occurs in athletes who play sports on artificial turf, hence the name “turf” toe. This injury occurs when athletes bend their big toe beyond its normal flexibility. Cleats often get stuck in divots in artificial turf leading to hyper extension of the toe. Hyper extension of the big toe can take place every time the athlete pushes off with their toes to start running. This motion occurs multiple times during every game and practice eventually over time the big toe becomes sprained.

The severity of the injury is graded from 1 to 3

Grade

Injury

Treatment

1

Mild sprain

  • RICE – rest, ice, compress, elevate

  • Taping the toe to restrict movement

  • Non-steroid anti-inflammatory medication

2

Partial tear of the capsule and ligaments

  • Same as Grade 1 + walking boot to immobilize the big toe joint

3

Complete tear of the capsule and ligaments

  • Same as Grade 1 + walking boot or cast for immobilization

 

Physical therapy should also be implemented to prevent stiffness in the joint and gain adequate range of motion. Surgery is often not needed, but is an option for some cases.

Foot& Ankle Doctors, Inc recommend athletes who return to sports should have their shoes modified with a steel shank or stiff insoles to restrict hyper extension of the toe.

Dr. Nejad

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Kevin Durant suffers from a Jones fracture

We are sad to hear that Kevin Durant is suffering from a Jones fracture. A Jones fracture is a common fracture of the 5th metatarsal (a long bone on the outside of the foot that connects to the little toe) commonly caused by an inward twisting injury of the foot.

Durant most likely experienced pain, swelling and tenderness along the outside of his foot, had difficulty walking and may have had some bruising. It was crucial that Durant was diagnosed and treated immediately because the 5th metatarsal has a poor blood supply that impedes the healing process.

Nonsurgical treatments for Durant includes resting and icing, immobilizing his foot with a cast and avoiding placing any weight on his foot. Jones fractures can take 6 weeks to heal and another 2-3 weeks of rehabilitation to build up muscle strength and range of motion.

Most professional athletes opt to treat a Jones fracture operatively with a screw or plate placed across the fracture site to avoid the possibility of delayed healing or non-unions, which are frequent with Jones fractures. It could be 8-12 weeks before Durant returns to the court if he decides to have surgery.

All of us at Foot & Ankle Doctors, Inc. are wishing Durant a speedy recovery.

 

Dr. Dardashti

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