Miami Heat Star’s Foot Injury

Most people down in South Florida know the name Dwayne Wade. He is a player for the Miami Heat. He is considered one of the big three, also including Lebron James and Chris Bosh. However, lately the Heat have been the big two and missing Dwayne Wade. This is due to a nagging foot injury that has kept Dwayne off the floor. Wade missed multiple games with the injury, which occurred on Dec. 28. Lingering soreness forced Wade to shut it down a week later.
At first Wade said that he could be dealing with plantar fasciitis, which can be a slow-healing injury. The Heat have been calling it a foot contusion. “I don’t know, it’s just hurting,” Wade said. “It could be three different things. It could be (plantar fasciitis), a bruise, or maybe it’s a combination of the two. I don’t know. I just know it’s in the area of plantar fascia. I know it’s bruised as well. Whatever it is, it’s just taking its course, taking its time to get healthy.”
Heel pain is one of the most common problems we see in our podiatry office. The most common cause of heel pain this plantar fasciitis. However, there are other causes and a full examination is necessary.
Plantar Fasciitis is an inflammation of the plantar fascia. The plantar fascia is a ligament that runs along the bottom of the foot from the heel to the ball of the foot and even has slips that go into the toes. The main job of the plantar fascia is to hold the arch up. As you walk and your arch falls it puts extra strain on the plantar fascia. This causes small tears and eventually thickening of the plantar fascia. The thickening causes pain on the bottom of the heel.
A second cause of pain in the bottom of the heel is a bone bruise or stress fracture of the heel bone. This bone is called the Calcaneus. With repeated stress from walking or running bruises or stress fractures may occur. The Calcaneus may also be fractured with injury, but this requires a significant amount of force. The fractures are usually caused by a fall. The pain of a bone bruise often feels as though it’s coming up the sides of the heel rather than pinpointed on the bottom. Bruises and stress fractures are more difficult to diagnose. Often they are not seen under normal x-rays. An MRI may be required to diagnose a stress fracture of the heel.
A third cause of pain in the bottom of the heel is entrapment of a nerve that comes around the inside of the ankle can be perceived as pain in the bottom of the heel. The disorder is called tarsal tunnel syndrome, and is similar to carpal tunnel syndrome. It is due to the collapsing of the arch of the foot, and pinching of the nerve to the bottom of the foot.
There are several other disorders which can cause pain on the bottom of the heel. Still the most common cause is plantar fasciitis. If you begin to have heel pain you should come to our office for an exam. There are many treatment modalities that may be used to resolve your pain and get you back to your normal activities.

New Pediatric Orthotics

A common problem that we as Podiarist seen in our office is children with flat feet. This can often be seen with the children intoeing or out-toeing. The flattening of the arch in a child’s foot can cause pain, incoordination, fatigue, and a decrease in activity level.
A flatfoot deformity as well as intoeing and out-toeitng is easily recognized. Watching the child walk will demonstrate that the arch in the middle of the foot disappears, or in the case of intoeing in out-toeing the feet are deviated to the inside or out. The difficult aspect is diagnosing the cause of flattening, intoeing or out-toeing. The deformity can occur anywhere from the lower back to the hips and knees or to the foot and ankle itself. The other question arises in whether the problem will fix itself as the child grows. Children are not fully skeletally mature until their late teens. This means that the bones are constantly growing and changing their angular relationship. In some cases deformities are so severe that surgical intervention is required. However, in the majority of cases, simply bracing or having the child where orthotics will cure the problem.
Orthotics will keep the bones in the feet and proper alignment. As the child grows the bones will adjust and realign into a more normal alignment.
One concern when parents consider orthotics is that the child will grow out of them too quickly.In these cases there is an alternative. The recently developed ‘Little Steps’ are prefabricated orthotics for children. They come in seven sizes and accommodate children from toddlers to teenagers. We have started utilizing Little Steps in our practice and have had extremely good results. Along with correcting the deformities listed above the pediatric orthotics can increase coordination, decreased pain, and increased desire to play sports.

If your child begins to have a problem with his or her feet often times it can be solved very quickly. Children are very resilient and often by eliminating the causing force the child will feel immediate relief.

TurfToe
Ray Lewis is the first of many athletes to suffer an injury that by its name would seem minor, but in fact it has led to the end of many professional athletes careers. This injury is referred to as ‘Turf Toe’, and can be quite debilitating.
Turf toe is a hyperextension of the big toe joint in an upward direction. When the big toe joint is extended towards the top of the foot over approximately 80° it starts to tear the attachments on the bottom of the joint. These attachments include ligaments, tendons and two bones called the sesamoids. The tearing of these attachments causes severe pain in the joint and on the bottom of the foot. The slightest motion can become excruciating. In severe instances the joint becomes completely dislocated. In these instances often surgery is required to repair the damaged joint.
This injury has either ended or severely affected the careers of many professional athletes including: Deion Sanders, Jonathan Ogden, Shaquille O’Neal and many more. The most common sports for turf toe are football and soccer. The reason these sports are affected so much is that the athletes have to stop, plant their foot, and change to the opposite direction as quickly as possible. When the player puts their foot back they apply extreme amount of force to the first toe joint in an upward direction. They then use the big toe to push off and accelerate themselves in the other direction. This causes strains to the tendons and muscles, which weakens them.
When the New York Giants won the Super Bowl in 1987, tight end Mark Bavaro became known as one of the toughest players in football, a man capable of carrying tacklers on his back all the way to the end zone. It was a bittersweet season for Bavaro because he played with an agonizing ligament sprain of the metatarsophalangeal joint connecting the foot to the big toe, an injury more commonly known among football followers as turf toe.
After most games, Bavaro’s right big toe was so swollen and painful he could hardly stand up. Often he hopped to the training room to receive treatment. Day after day, for the final two months of the season, Bavaro put ice on the toe, kept it elevated and took the anti-inflammatory medication Ibuprofen, downing hundreds of milligrams of the stuff with each meal. Relief finally came after the Pro Bowl, when he underwent surgery to repair the two tiny fractured sesamoid bones in the ball of the foot.
Outside of surgery, the treatments for turf toe include rest, ice, anti-inflammatory medications, and strappings to immobilize the joint. Most players recover from this injury in 4 to 6 weeks. Ray Lewis is questionable to return Sunday.
Though I have discussed this injury in reference to professional athletes, it can also affect nonprofessionals. If it sounds like you could be affected by this injury. It would be advantageous for you to see a medical professional for treatment.

A NEW TREATMENT FOR PERIPHERAL NEUROPATHY

A common problem seen in our Podiatry offices that historically has had few treatments is peripheral neuropathy. Peripheral neuropathy is a condition in which the nerves of the feet and/or legs do not function properly. Common symptoms include tingling, numbness, sharp pains and/or burning pains to the affected parts of the body. There are over one hundred known causes of peripheral neuropathy. Treatments for peripheral neuropathy vary depending on its cause.

One cause of peripheral neuropathy is thiamine deficiency. Diabetics and non-diabetics alike may be thiamine deficient. Groups that have been shown to have a high incidence of thiamine deficiency are, among others, the elderly, people with diabetes, people who have had gastric bypass surgery, people who drink alcohol or patients on certain medications.

If you have tingling, numbness, sharp pains and/or burning pains to the feet, legs and/or hands you may be thiamine deficient. Reversing thiamine deficiency is a well known and often highly successful way to nutritionally manage peripheral neuropathy.

NeuRemedy may nutritionally manage peripheral neuropathy by delivering a highly bioactive form of the micro-nutrient thiamine to where it is needed, the nerve cells. In a very real sense, NeuRemedy works by nourishing the nerves. Some people are helped within a few days of taking NeuRemedy. Some need to take NeuRemedy for as long as two months to determine if the nutritional management provided by NeuRemedy is effective for them.

Neuremedy, also called the ‘Nerve Vitamin’ is available only in doctors offices. If you are experiencing any of the symptoms listed above you should contact your Podiatrist to see if they have it available in their office.

Barefoot Running or Minimalist Running

As a Podiatrist that has a special interest in sports medicine, and a triathlete in my spare time I have taken special notice of the debate over barefoot running versus contemporary running. Barefoot or minimalist running has become trendy after a book was published called ‘Born to Run’. This book chronicles the reclusive Tarahumara Indians of Mexico’s deadly Copper Canyons, who have practiced barefoot running for hundreds of years.
The book starts with the author, who is having foot pain, trying to find another way of running that will decrease his pain. After spending a significant amount of time with these Indians he changes the way he runs and his foot pain resolves.
Barefoot running is completely different than contemporary running in that there is no heel strike. In normal running the heel strikes the ground first and force is transferred through the foot until the big toe is lifted off of the ground. In barefoot running the ball of the foot strikes first. This is followed by the heel coming down towards the ground, sometimes not touching the ground at all.
The benefits and risks of barefoot running have been studied recently. However, there are no long-term studies with respect to barefoot running. The advantages of barefoot running include better proprioception, or balance. This means that your body is in better control of all of the small movements made during running. This can decrease excessive motion at the ankle joints, knees, and hips. There is also less of an impact force on the heel with barefoot running. The adverse effects are extra strain on the plantar fascia (a ligament along the bottom of the foot), Achilles tendon, and leg muscles. A person with plantar fasciitis, Achilles tendinitis, or history of muscle strains should avoid barefoot running.
If you are considering switching to barefoot running, there are shoes called minimalist shoes that will give the same benefit of barefoot running while still protecting bottoms of your feet. Many of the large shoe companies have come out with minimalist shoes. It is also a good idea to follow a strict training regimen when transitioning to barefoot running. If you switch to quickly, you’re more than likely going to have an injury.
In summation, it remains to be seen whether barefoot running is here to stay or passing fad. It has shown benefits for some. However it is not for everyone. It’s important to transition slowly, to find out if barefoot running is really for you.

Achilles Tendon Ruptures in the NFL

As you may have seen reported recently there has been an increase in Achilles tendon ruptures since the NFL players started practicing again. There have been as many as 10 Achilles tendon ruptures over the past two weeks, which is a significant increase from this time last year.

The Achilles tendon is the tendon on the back of the ankle that is responsible for pushing the ball of the foot down. It is the largest/thickest tendon in the body. It is also responsible for pulling the most amount of weight of any tendon in the body. A rupture of the tendon requires a significant amount of force accompanied by a lack of elasticity of the tendon.

The majority of Achilles tendon ruptures occur in men after the age of 40. These men do not exercise all week then play sports on the weekend. These men are often called weekend warriors. Due to the lack of physical activity and stretching throughout the week the Achilles tendon is tight with decreased elasticity. Then when a significant force is applied to the tendon it ruptures rather than stretching and absorbing the tension.

The reason for the increase in the tendon ruptures can be explained by the NFL lockout. During the lockout the players were not allowed to practice at the team facilities under the direction of the training staff. This led to the players not conditioning themselves as much and in the proper fashion.

            Playing NFL football applies a significant amount of stress on all of the joints, muscles and tendons of the body. Due to the players not having the proper amount of preseason conditioning their Achilles tendons are tighter than last season. With the same physical demands being put on the players it is predictable that an increase in injuries would occur.

            Tendon ruptures in all people (athletes or not) require surgical repair, and a significant amount of rehab. It is important to remember to stretch before any athletic activities to prevent injuries.

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Alcohol and Your Feet?

Can alcohol affect your feet? Believe it or not, it can certainly affect a person’s feet! The condition is known as alcoholic (occasionally, malnutrition) neuropathy. However, this usually occurs in chronic alcoholics who have an inadequate intake of proteins and vitamins. What does alcohol do to the feet?

It is believed that a combination of the toxic effect of the ingested alcohol and the nutritional deficiency lead to nerve damage. Axons are the processes of the nerve cell that conduct nerve signals away from the nerve cell. You can think of them as a conducting wires; they are covered with a conductive material called myelin. Myelin serves to conduct the nerve signals faster along the nerve itself; nerves with a large amount of myelin are faster than nerves without myelin. In alcoholic neuropathy, there may be damage to the myelin, to the axon, or to both the axon and myelin.

Myelin is damaged in a number of neurological diseases; this is exactly what happens with alcoholic/malnutrition neuropathy. The myelin swells and fragments, resulting in slower signal conduction. If there is damage to the axon, the nerve impulses are slowed significantly. When there is damage to both the axon and the myelin, recovery is very slow.

So what happens to the patients? The development of symptoms is usually slow, taking weeks to months to manifest. It can occur over a few days. The first symptoms experienced by patients are pain and numbness in the hands and feet. The most common sensation is a burning sensation. Weakness in the legs and changes in walking patterns follow the abnormal sensations.

If the condition is not recognized and treated, paralysis may occur in the legs and weakness will spread to the upper extremities and to the trunk. Once paralysis sets it, it may take months to fully treat the patient.

To treat the condition, one must remove the underlying cause; the patient must stop drinking and must be placed on a well-balanced diet. Supplements (especially of B-vitamins) may be given and the patient may be sent to physical therapy. It is important to be honest to your doctor about any alcohol, tobacco, or drug use; we at Florida Foot Specialist are here to help you, and our help is only as good as the information you give us!

Questions? Concerns? Please email us at support@floridafootspecialist.com or visit us at any of

our locations in Okeechobee, Jupiter, Fort Pierce, Clewiston, Vero Beach, and surrounding areas

of Palm Beach Gardens, Tequesta, Juno Beach, Port St. Lucie, and Stuart for more information!

You may call us at 1-877-763-FOOT (1-877-763-3668).

Cerebral Palsy

Cerebral palsy is a disability that results from a brain lesion. It is a non-progressive disease that affects body movement and muscle coordination. Unlike other neurological or musculoskeletal disorders, cerebral palsy is not caused by muscle or nerve problems. Abnormalities within the brain itself affect the brain’s ability to control movement and posture.

So why would we at Florida Foot Specialist care about cerebral palsy? Cerebral palsy patients often have severe problems in their feet and legs.

Cerebral palsy was first identified by Dr. Little in the 1860s, who postulated that it was possibly caused by asphyxiation in childbirth. Sigmund Freud later speculated that a difficult birth was not the cause, but rather a symptom of cerebral palsy. However, for many decades, it was believed that birth complications for the cause of cerebral palsy. This became a source of many lawsuits. In the 1980s, scientists analyzed data from thousands of newborns and their mothers. It was discovered that complications during birth and labor only accounted for less than 10% of infants born with cerebral palsy. In most cases, there was no single cause of the disease.

Children who are born with cerebral palsy may display a number of symptoms. These include lack of muscle coordination, stiffer tight muscles, walking on toes, excessive drooling, difficulty swallowing or speaking, and difficulty with precise movements. Cerebral palsy is not heritable, and it has no known cure. Babies with very low birth weight have a high chance of having cerebral palsy.

These symptoms vary between patients; disabilities are inconsistent from one patient to the next. Mental retardation occurs in 40% of those with paraplegia and about 70% of those with quadriplegia. So, in other words, not all with cerebral palsy are mentally retarded.

There are many different types of cerebral palsy, each with their own set of problems. The most common is called the spastic type. Those with the spastic cerebral palsy may experience muscle tightness and spasticity. It is very important for these individuals to follow up with their podiatrist because of the deformities that typically develop in the feet; we at Florida Foot Specialist will help minimize these deformities with the appropriate combination of devices and physical therapy. It is important to keep the muscles from contractures, where they are permanently tight and fixed.

Questions? Concerns? Please email us at contact@floridafootspecialist.com or visit us at any of

our locations in Okeechobee, Jupiter, Fort Pierce, Clewiston, Vero Beach, and surrounding areas

of Palm Beach Gardens, Tequesta, Juno Beach, Port St. Lucie, and Stuart for more information!

You may call us at 1-877-763-FOOT (1-877-763-3668).

Plantar Plate Tear

There’s a thick ligament that runs across the balls of your feet, connecting them together. This ligament is known as the plantar plate. It holds the toe joints together when you walk, allowing your toes to bend at the balls of your feet. As with all ligaments, the plantar plate is capable of being injured.

So what causes the plantar plate to tear? Sometimes, patients will report having some kind of injury to the site. Other times, patients may become more active, putting more stress on the bottoms of their feet. Some patients will report a recent increase in physical activity. Tears may have symptoms similar to neuromas, and the two may be easily confused. There are a number of other conditions that can cause pain in the same location, such as rheumatoid arthritis, osteoarthritis, or bursitis.

The ball of the affected toe or toes may be swollen and painful to the touch. It is important that you seek medical attention if the pain persists. Do not continue excessive physical activities. We at Florida Foot Specialist will evaluate your condition and discuss it with you. We will also treat the condition appropriately.

In the case of the plantar plate tear, what treatment options are available? At Florida Foot Specialist, we will start by ordering x-rays of your foot. An MRI may also be ordered to evaluate the joints at the balls of your feet. Another common imaging study that podiatrists order is called an arthrogram. Contrast dye is injected into the ball the foot, allowing the physician to see whether or not there is a tear in the plantar plate.

Sometimes, the tear is minimal and will respond to conservative treatment. Padding and taping help stabilize the tear. Modified shoes may also be prescribed in order to help stabilize the tear. Sometimes steroid injections are given; NSAIDs will be given to help with the acute pain. A consult for physical therapy may be placed. Conservative treatment allows the body to heal the tear itself; it is important for you to follow your doctor’s instructions.

In some cases, the tear warrants surgical correction. We at Florida Foot Specialist will discuss the appropriate surgical procedure if it is needed in your case. Sometimes, it’s simply a matter of sewing the plantar plate together. Other times, a fusion may be needed. Healing time following surgery depends on which procedure was performed.

Questions? Concerns? Please email us at support@floridafootspecialist.com or visit us at any of

our locations in Okeechobee, Jupiter, Fort Pierce, Clewiston, Vero Beach, and surrounding areas

of Palm Beach Gardens, Tequesta, Juno Beach, Port St. Lucie, and Stuart for more information!

You may call us at 1-877-763-FOOT (1-877-763-3668).