October Articles 2013

Nerve Disorders of the Foot and Ankle

Similar to well known nerve disorders in the hands, such as carpal tunnel syndrome, nerve disorders that affect the foot and ankle occur in patients for reasons ranging from stress to genetics. Nerve disorders of the foot should be addressed right away because they may be immobilizing in serious cases. Two of the most common nerve disorders of the foot and ankle are Interdigital Neuroma and Tarsal Tunnel Syndrome.

Interdigital Neuroma is caused by localized inflammation of one of the nerves that controls toe sensitivity in the frontal area of the foot. This inflammation is generally only found in the second or third interspace, and any other symptoms similar to Neuroma on other digits should be checked against other disorders. Symptoms include chronic burning or tingling sensations between the affected toes which can, at times, migrate to the toes themselves. This pain is often increased by walking, running, or by wearing shoes that compress the toes, such as high heels. A doctor should be consulted if this pain is chronic and if the symptoms get worse.

Typical examinations to determine the presence of Neuroma include radiographs, MRIs, and even bone scans of the affected area. Bone scans are only required if degeneration of bone is suspected, however. Surgery is often not required to alleviate the symptoms of Neuroma, and in many cases functional orthotics can be used to alleviate the stress of constant weight on the affected toes. Surgery is recommended for those patients that suffer from symptoms for 6 months or more, so reporting symptoms early can increase the rate of non-surgical recovery.

Tarsal Tunnel Syndrome, a condition that is less common than Interdigital Neuroma, is similar to Carpal Tunnel Syndrome in that it is caused by a compression of the nerve caused by any number of factors (mostly associated with excess pronation). Typically seen in those that have either flatfeet or valgus heel positions, Tarsal Tunnel Syndrome has patients complaining of moderate to severe ankle pain that starts along the bottom of the foot and often proceeds to the calf. Some more extreme cases occur with partial numbness and even atrophy of the foot and surrounding muscles.

If there is a good chance that someone has Tarsal Tunnel Syndrome, an EMG test is often used to diagnose the condition.  If the diagnosis is positive, an MRI can be used to identify the compression of the nerve. Treatment with NSAIDS, functional orthotics, and rest off of the feet is often prescribed, but again, long standing symptoms require surgery, as do exacerbated symptoms caused by lesions present between nerves.


Flat Feet

Flat feet is a foot condition in which the arch of the foot either drops or is never developed. While it is common in babies and small children, it can become a problem if the arch never develops. For adults, the development of flat feet can be brought upon by injury, or may even be a result of pregnancy due to the increased elasticity; however, in adults the flat footedness is usually permanent.

The wet footprint test can be an indicator to diagnosing flat feet. In this test, the individual would place a flat foot on a surface in order to show a footprint. If there is no indentation or indication of an arch, that person may have flat feet. In all cases, it is best to consult a podiatrist if flat feet is suspected or noticed.

Once flat feet has been diagnosed, it can be treated by walking barefoot in beach-like terrain, or wearing insoles. There are two types of flat feet; one being rigid, where the feet appear to have no arch even when the person is not standing, and the other being flexible where the person appears to have an arch while not standing, but once standing the arch goes away. In the case of flexible flat feet, unless there is pain caused by the condition, there is no need for treatment. However, if it causes pain or in the case of rigid flat feet, exercises and orthotic insoles may be prescribed in order to help the arches develop.

In some cases when the condition is severe and all other methods have been exhausted surgery may be required but this is normally avoided due to a lengthy recovery time and high cost.


Solutions for Cracked Heels

Cracked heels can be embarrassing, and can make life frustrating when sandal season comes around. But not only are they an aesthetic problem – they can also tear stockings, socks and even wear out shoes faster at the back, and when severe may cause pain and infection.

Cracked heels are a problem for many who walk a lot, who are athletic, and who have especially dry skin. Those who are using certain kinds of medication that will dry the skin, who swim a lot, wear certain kinds of shoes, and those who are diabetic may also have trouble with cracked heels. Seniors may have more trouble with cracked heels than others, since the skin’s production of oils decreases with age. There is no one way to get cracked heels, and there is no one cure for them.

Today there are numerous products on the market that have a variety of ingredients to promote healing. Some of these products are over-the-counter and some come from a physician’s prescription pad--especially for those who have chronic dry feet and heels.

Some doctors recommend for those with rough skin to wear socks at night when they sleep. This helps promote healing of the skin on the heels and helps any creams put on the feet stay on longer and better sink into the skin.

Using moisturizers both day and night is one way to help alleviate the dryness that causes cracked heels. Making sure that the skin is clean and dry at all times is another way. Using a pumice stone to remove dead skin before applying a moisturizer can also help, as many times cracked heels will not respond to moisturizers unless the thick outer layer of skin is first removed through exfoliation. Lotion or ointment applied after exfoliation will be absorbed by the skin much more easily.

Eating a well-balanced diet with foods that promote body healing and balance can also help the skin – from within. Whatever is put into the body can either help it or hurt it and foods that give the body staying power will permeate throughout, especially through the first line of protection--the skin. Taking supplements of omega-3 fatty acids and zinc may also help cracked heels.

Not all products that say they will help cracked heels actually work. See a professional for foot care if nothing being tried is working. A podiatrist or a dermatologist should be able to give information and advice to help with the problem.


How to Prevent Running Injuries

Many common running injuries are caused by overuse and overtraining. Several common injuries can occur due to running. When the back of the kneecap starts wearing away and starts causing pain in the knee, this is commonly referred to as runner’s knee. Runner’s knee can occur because of decreased strength in the quadricep muscles or shoes that do not offer proper support to the inside of the forefoot. Runner’s knee usually is treated with strengthening exercises focusing on the quad muscle and sports orthotic. To prevent runner’s knee, efforts should be focused on hip strengthening. Physical therapy is also beneficial in helping to learn the best exercises to heal runner’s knee. To prevent runner’s knee, strengthen the quad muscles to keep the kneecap aligned.

Overtraining is one cause of a common running injury called iliotibial band syndrome, which occurs when the iliotibial band gets irritated, causing pain and discomfort to the outside knee area. Another common running injury is known as plantar fasciitis, which occurs when the bone in the foot becomes inflamed and irritated. This injury primarily causes pain in the foot. Causes can include a high arch, incorrect footwear, tight muscles and flat feet. The best way to avoid plantar fasciitis is stretching and proper footwear.

Stress fractures are a common injury for runners. These fractures can occur because of overtraining, lack of calcium or running style. In runners, it is common for stress fractures to occur in several locations including the inner bone of the leg, the thighbone, the bone at the base of the spine and the toe bones in the foot. The best approach to preventing stress fractures are proper footwear maintenance and running on a surface with enough “give” to absorb some of the shock produced during running.

Besides overtraining, other causes of these common running injuries are poorly fitting footwear, irregular biomechanics, and lack of flexibility and strength. The best way to avoid running injuries is to prevent them. Fortunately, each of these common running injuries can be prevented. To avoid running injuries it is highly recommended to wear only footwear that fits properly and that suits your needs. Running shoes are the only protective gear that runners have to safeguard them from injury; therefore, choosing the correct footwear for running is important. It is important, too, to think about other aspects of your running routine like training schedules, flexibility and strengthening, and tailor them to your needs in order to minimize the possibility of injury. Regular stretching before and after running should be considered also when trying to avoid running injuries. Stretching keeps muscles limber resulting in greater flexibility.


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