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).

Connective Tissue Disorders

A common cause of flat feet is a connective tissue disorder. The phrase “connective tissue” refers to the framework of the body, protecting the organs and binding together the different tissues of the body. Collagen, which is well-known for being used as a lip injection in order to provide fuller lips, is the most common connective tissue in the body. Connective tissue can be thought of as the medium that binds and holds together the entire body.

These disorders may be inherited or they may be due to autoimmune processes. The inherited connective tissue disorders include Marfan’s Syndrome, Ehlers-Danlos Syndrome, and brittle bone disease. Those born with Marfan’s Syndrome have notably long limbs, long fingers and toes, and problems with their heart valves. The most serious side effect of Marfan’s Syndrome is a predilection for aneurysms of the aorta, which may rupture and cause death. Ehlers-Danlos Syndrome is a defect in collagen. As a result, individuals have very flexible joints. Patients with Ehlers-Danlos syndrome are able to flex and extend fingers and toes to a greater degree than normal individuals. Unfortunately, while such an ability may seem fascinating, those with Ehlers-Danlos have loose, unstable joints that are prone to sprain, dislocate, or sublux. Those with the disease often have flat feet, due to the fact that the connective tissue is unable to support the joints.

Connective tissue disorders may also be due to an autoimmune process. The immune system of these individuals is or active, producing extra antibodies and putting them out into the circulatory system. We are able to detect these circulating antibodies with a simple blood test. Autoimmune diseases of connective tissue include lupus, rheumatoid arthritis, and scleroderma. Lupus often mimics several other diseases, causing rashes, hair loss, joint pain, and kidney problems. It is very similar to rheumatoid arthritis in terms of joint pain, however, it is less disabling and usually does not cause severe destruction of joints. Those with lupus are often at risk of developing tuberculosis in the bones.

Because connective tissue is found throughout the body, manifestations may range from severe to minor. Like the individuals they affect, connective tissue disorders are unique in their severity and prognosis.

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).

Swimmer’s Itch

As the weather warms, many will take a weekend getaway to a lake or recreational areas. Children and adults alike wade in calm streams and lakes, enjoying the warm weather and tranquility of nature. Unfortunately, after a weekend of R & R, people may notice strange red bumps on their shins and feet. It may seem trivial to tell a doctor you were on vacation, but it is very important to detail any recent travels.

Simmer’s itch may result from wading in slow-moving fresh water bodies. Flatworm parasites use freshwater snails and water fowl as their hosts in their parasitic life cycle. In fresh bodies of water, larvae leave water snails and attempt to find their next host, a water bird. Sometimes, during this process, these larvae encounter humans. They attempt to burrow into human skin, and immediately die. The dead larvae cause an inflammatory reaction from the immune system, resulting in the red bumps.

It is very important to note that the parasites that give rise to the swimmer’s itch are different from the parasites that cause schistosomiasis. In schistosomiasis, the larvae do in fact invade the human body and burrow into different parts of the body, resulting in manifestations that include diarrhea, liver enlargement, genital sores, and fever.

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).

That Lump on Your Sole

Whenever we hear the word ‘lump,’ we are trained to immediately rule out any conditions such as cancer. Frequently, patients come in complaining of a lump at the bottom of their foot. The more information you can provide about the lump, the more it helps us in accurately diagnosing it. If you do notice a lump, there are a number of things you should note that will help us:

How long has the lump been there? It’s okay to estimate months/years if you have to. Is it getting bigger? If so, has it doubled in size? Tripled in size? Some of our patients actually measure the lump themselves, and if you can do this, it is greatly helpful for us. Do you smoke? Is there a history of cancer in your family?

Most of the time, the lump on the bottom of your foot is what we at Florida Foot Specialist refer to as a plantar fibroma. It is a thickening of the plantar fascia – the band of tissue that runs along the bottom of your foot. In some patients, this lump is painful, and they have difficulty walking.

Because we cannot see into the lump, we cannot definitely diagnose the lump as a fibroma without sending a sample of tissue in to the pathologist. We can perform ultrasound in office to actually see the fibroma Sometimes we may order an MRI Accommodative orthoses, injections to break up the tissue, and surgery are some treatment options that are available for this condition. What’s best for you is determined by location size and level of pain.

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).

What are Bone Cysts?

A bone cyst is something that normally occurs in the bones of the foot. A cyst is basically an area of bone that is filled with some kind of fluid. It may be filled with blood or serious fluid. They are generally asymptomatic, though sometimes cysts may be painful depending on which bone they occur in. Cysts are often an incidental finding on X-rays; we normally see them when we are looking for something else on X-ray. For example, sometimes if we are taking pre-operative X-rays for bunion surgery, we may notice a cyst near the site of the surgery.

So suppose you have a cyst that is troublesome? Then what is the next step? We may obtain an MRI or advanced imaging modality to help analyze the contents of the cyst. We may inject the bone cyst with a corticosteroid to help heal the cyst. There is some evidence that bone marrow aspirate may also facilitate bone cyst healing. Failing these options, surgery is always an option. We at Florida Foot Specialist will open the bone cyst and clean it out, kind of like scooping slushy ice cream out of a bowl.

If the cyst is small, that may be the only treatment; however, depending on the size and location of the cyst, we may need to pack it with bone graft, chips, or possibly some cement. When we pack the cyst, we are effectively stabilizing the bone it is in.

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).

Marjolin’s Ulcer

Marjolin’s ulcer, despite its name, is not actually an ulcer at all, but rather a form of squamous cell carcinoma. It generally occurs in an area that has been previously traumatized, scarred, or is chronically inflamed. Commonly associated conditions include chronic wounds (like ulcers) and burn injuries.

We often think of Marjolin’s ulcer as a possible diagnosis if we see a chronic ulcer that does not get better after a prolonged period of appropriate treatment. Typically, wounds either get better or worse with treatment. A wound that transforms into a Marjolin’s ulcer is painless and demonstrates slow growth. The cells of the chronic wound undergo a transformation into carcinoma cells. Malignant change, especially with Marjolin’s ulcer, occurs after a very long period of time (10-25 years).

If we suspect a patient has Marjolin’s ulcer, we will take a biopsy of the area and send the sample to pathology for evaluation. When we biopsy an area, we will make sure that we numb up the patient before taking the biopsy. Depending on the size of the lesion, we may need to take a couple of tissue samples in order to examine the entire lesion. Treatment, similar to squamous cell carcinoma, involves surgically removing the area of cancer. Overall, however, Marjolin’s ulcers have a very poor prognosis, especially if there is involvement of lymph nodes. The average 5-year survival rate is 40-60%.

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).

Zsa Zsa Gabor is currently fighting to keep her leg. According to the Associated Press, Gabor has a lesion on her leg that has grown from an inch to almost a foot. Varying reports call the lesion gangrenous or infected, and state this is the reason Gabor may lose her leg.

So what is really going on? The ‘lesion’ the press is referring to is likely an ulcer. Ulcers on the leg are most commonly due to venous insufficiency. Those with venous insufficiency are also more prone to develop blood clots in the legs, or Deep Venous Thrombosis. Risk factors of blood clots include overweight individuals, female sex, individuals over 40 years of age, recent surgery, immobility, trauma, burns, stroke, and use of birth control medications.

The gold standard for treatment of venous ulcers is compression; whether by machine, four-layer compression, or a soft cast, the leg must be compressed so that the blood in the leg can ultimately return to the heart. As people advance in age, like Gabor, their veins lose their strength and are less able to return blood to the heart. If the blood pools, the leg swells and the skin becomes fragile, breaking open and leading the way to ulceration. Compression is simply a method that we use to help the veins return blood to the heart.

Gabor’s ulcer likely became infected; unfortunately, once the infection travels to the bone, treating the infection becomes more difficult. The best treatment would be for a bone biopsy and culture to determine the specific bacteria causing the bone infection then placing a patient on the appropriate antibiotics. . Antibiotics, even ones delivered intravenously, can have difficulty adequately penetrating the bone to fight bone infection (osteomyelitis). The penetration of the antibiotics depends on circulation, size of ulcer or bone infected, and its location. Whether or not the antibiotics will successfully fend off the infection for Zsa Zsa Gabor remains to be seen. Regardless, our thoughts and prayers are with Ms. Gabor.

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).

The Case of the Neuroma

A neuroma refers to an over-grown or a tumor of a nerve. In podiatry, we commonly see neuromas between the 3^rd and 4^th toes. This particular neuroma is known as a Morton’s neuroma. Neuromas may also occur between other toes, but Morton’s neuroma is what we most commonly see. Patients suffering from neuromas have pain when they are on their feet; the pain is shooting, and there may be sensations of burning, numbness, and paresthesia.

Many other conditions can cause pain in a similar location of the foot, such as irritation of the capsule, irritation of the metatarsal bones, Freiberg’s disease, etc. When you come in to Florida Foot Specialist, it is very important that you describe your symptoms precisely. There are many treatment options for neuromas; orthotics may be given to help take the pressure off of the neuroma. Steroid injections are another option; these are given as a shot to the affected area. Physical therapy may also be given for neuromas.

Failing these options, surgery may be warranted to take out the neuroma. The process of removing the neuroma involves dissecting through the structures of the foot and cutting out the neuroma. The incision may be made on the top of the foot or bottom of the foot, depending on the surgeon’s preference. There are a number of different complications with the surgery; the neuroma may recur. The blood supply to the area may be compromised. In addition, if the tiny muscles between the toes are damaged, hammertoes may develop.

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).