Heel Pain - Podiatrist in Newburyport and Chelmsford, MA

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Heel Pain Treatment  - Podiatrist in Newburyport and Chelmsford, MA

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Heel Pain - Plantar Fasciitis

In our pursuit of healthy bodies, pain can be an enemy. In some instances, however, it is of biological benefit. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we've suffered.

When we sprain an ankle, for example, the pain warns us that the ligament and soft tissues may be frayed and bruised, and that further activity may cause additional injury.

Pain, such as may occur in our heels, also alerts us to seek medical attention. This alert is of utmost importance because of the many afflictions that contribute to heel pain.

Heel Pain

Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear; or being overweight.

The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel.

A common cause of heel pain is the heel spur, a bony growth on the underside of the heel bone. The spur, visible by X ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as "heel spur syndrome."

Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.

Plantar Fasciitis

Both heel pain and heel spurs are frequently associated with an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. The inflammation is called plantar fasciitis. It is common among athletes who run and jump a lot, and can be quite painful.

The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where it attaches to the heel bone.

The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.

Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.

Excessive Pronation

Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern.

As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation—excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.

Disease and Heel Pain

• Some general health conditions can also bring about heel pain.
• Rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint, can cause heel discomfort in some cases.
• Heel pain may also be the result of an inflamed bursa (bursitis), a small, irritated sack of fluid; a neuroma (a nerve growth); or other soft-tissue growth. Such heel pain may be associated with a heel spur, or may mimic the pain of a heel spur.
• Haglund's deformity ("pump bump") is a bone enlargement at the back of the heel bone, in the area where the Achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe, and can be aggravated by the height or stitching of a heel counter of a particular shoe.
• Pain at the back of the heel is associated with inflammation of the achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. The inflammation is called achilles tendonitis. It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.
• Bone bruises are common heel injuries. A bone bruise or contusion is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.
• Stress fractures of the heel bone also can occur, but these are less frequent.

Children’s Heel Pain

Heel pain can also occur in children, most commonly between ages 8 and 13, as they become increasingly active in sports activity in and out of school. This physical activity, particularly jumping, inflames the growth centers of the heels; the more active the child, the more likely the condition will occur. When the bones mature, the problems disappear and are not likely to recur. If heel pain occurs in this age group, podiatric care is necessary to protect the growing bone and to provide pain relief. Other good news is that heel spurs do not often develop in children.

Prevention

A variety of steps can be taken to avoid heel pain and accompanying afflictions:

• Wear shoes that fit well — front, back, and sides — and have shock-absorbent soles, rigid shanks, and supportive heel counters.
• Wear the proper shoes for each activity.
• Do not wear shoes with excessive wear on heels or soles.
• Prepare properly before exercising. Warm up and do stretching exercises before and after running.
• Pace yourself when you participate in athletic activities.
• Don’t underestimate your body's need for rest and good nutrition.
• If obese, lose weight.

Podiatric Medical Care

If pain and other symptoms of inflammation—redness, swelling, heat—persist, you should limit normal daily activities and contact a doctor of podiatric medicine.

The podiatric physician will examine the area and may perform diagnostic X rays to rule out problems of the bone.

Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physical therapy may be used in conjunction with such treatments.

A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting of the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery.

Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.

There has never been a better time for chronic heel pain sufferers than now. Extracorporeal Shockwave Therapy is now being offered by the physicians at Chelmsford Podiatric Associates. This new technology is noninvasive, and does not carry the potential risks or recovery period associated with conventional surgery. Learn more about treating heel pain and the Shockwave Treatment.

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Mortons Neuroma - Podiatrist in Newburyport and Chelmsford, MA

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Mortons Neuroma - Podiatrist in Newburyport and Chelmsford, MA

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 What is a Neuroma?

A neuroma is a painful condition, also referred to as a “pinched nerve” or a nerve tumor. It is a benign growth of nerve tissue frequently found between the third and fourth toes that brings on pain, a burning sensation, tingling, or numbness between the toes and in the ball of the foot.

The principle symptom associated with a neuroma is pain between the toes while walking. Those suffering from the condition often find relief by stopping their walk, taking off their shoe, and rubbing the affected area. At times, the patient will describe the pain as similar to having a stone in his or her shoe. The vast majority of people who develop neuromas are women.

Symptoms

• Pain in the forefoot and between the toes.
• Tingling and numbness in the ball of the foot.
• Swelling between the toes.
• Pain in the ball of the foot when weight is placed on it.

How Do You Get a Neuroma?

Although the exact cause for this condition is unclear, a number of factors can contribute to the formation of a neuroma.

Biomechanical deformities, such as a high-arched foot or a flat foot, can lead to the formation of a neuroma. These foot types bring on instability around the toe joints, leading to the development of the condition.

Trauma can cause damage to the nerve, resulting in inflammation or swelling of the nerve.

Improper footwear that causes the toes to be squeezed together are problematic. Avoid high-heeled shoes higher than two inches. Shoes at this height can increase pressure on the forefoot area.

Repeated stress, common to many occupations, can create or aggravate a neuroma.

What Can You Do for Relief?

• Wear shoes with plenty of room for the toes to move, low heels, and laces or buckles that allow for width adjustment.
• Wear shoes with thick, shock-absorbent soles and proper insoles that are designed to keep excessive pressure off of the foot.
• High heels should be avoided whenever possible because they place undo strain on the forefoot and can contribute to a number of foot problems.
• Resting the foot and massaging the affected area can temporarily alleviate neuroma pain. Use an ice pack to help to dull the pain and improve comfort.
• For simple, undeveloped neuromas, a pair of thick-soled shoes with a wide toe box is often adequate treatment to relieve symptoms, allowing the condition to diminish on its own. For more severe conditions, however, podiatric medical treatment or surgery may be necessary to remove the tumor.
• Use over-the-counter shoe pads. These pads can relieve pressure around the affected area.

Treatment by Your Podiatric Physician

Treatment options vary with the severity of each neuroma, and identifying the neuroma early in its development is important to avoid surgical correction. Podiatric medical care should be sought at the first sign of pain or discomfort; if left untreated, neuromas tend to get worse.

The primary goal of most early treatment regimens is to relieve pressure on areas where a neuroma develops. Your podiatric physician will examine and likely X-ray the affected area and suggest a treatment plan that best suits your individual case.

Padding and Taping:

Special padding at the ball of the foot may change the abnormal foot function and relive the symptoms caused by the neuroma.

Medication:

Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the neuroma.

Orthotic Devices:

Custom shoe inserts made by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the condition.

Surgical Options:

When early treatments fail and the neuroma progresses past the threshold for such options, podiatric surgery may become necessary. The procedure, which removes the inflamed and enlarged nerve, can usually be conducted on an outpatient basis, with a recovery time that is often just a few weeks. Your podiatric physician will thoroughly describe the surgical procedures to be used and the results you can expect. Any pain following surgery is easily managed with medications prescribed by your podiatrist.

Your Feet Aren’t Supposed to Hurt

Remember that foot pain is not normal, and any disruption in foot function limits your freedom and mobility. It is important to schedule an appointment with your podiatrist at the first sign of pain or discomfort in your feet, and follow proper maintenance guidelines to ensure their proper health for the rest of your life. The advice in this pamphlet should not be used as a substitute for a consultation or evaluation by a podiatric physician.

A New Neuroma Treatment called Sclerosing Injection Therapy

Morton's Neuroma

This condition was first described by T. G. Morton in 1876. He used the more vague terminology of "metatarsalgia" to describe a painful condition in the ball of the foot. Pain is caused by pressure on the digital nerves as they pass between the heads of the metatarsal bones, most commonly between the third and fourth toes, and secondarily between the second and third toes. Patients often feel cramping, tingling or burning and occasionally shooting pains in their forefoot or toes. Many feel the need to remove their shoe to massage the painful area.

Sclerosing Injection Therapy

Surgical excision (neurectomy) to remove a neuroma is frequently done when cortisone injections, foot inserts and anti-inflammatory medication fail. However, surgery should be considered as a last option due to the associated risks such as infection, scar tissue or recurrence. Sclerosing (sometimes called alcohol surgery) can be a wonderful alternative to surgical excision. Alcohol hampers the nerve's ability to transmit painful impulses. Alcohol injections affect the nerve by causing a "short circuit", desensitizing the painful area with mild numbness. This is exactly the same result that we aim for with surgery!

Sclerosing therapy can be done in the office and often produces the same level of relief without the risks associated with surgery. More importantly, there are no restrictions on activity after the injections, as there would be with surgery. Patients can expect good results, as success rates are between 70-80%. In rare cases where the therapy was not successful, surgery is still an option.

Neuroma sclerosis requires a series of weekly injections. After 3 injections, pre-treatment symptoms are reevaluated. If no improvement is noted, the series will be discontinued. However, if some improvement is noted, then the series will be completed, up to a total of 7 injections.

Note: Because injections have been given a "surgery code" by insurance companies, it will appear on your Explanation of Benefits as a surgery, even though you never approached an operating room.

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Foot Warts - Podiatrist in Newburyport and Chelmsford, MA

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Foot Warts  - Podiatrist in Newburyport and Chelmsford, MA

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What are plantar warts?
Warts are one of several soft tissue conditions of the foot that can be quite painful. They are caused by a virus, which generally invades the skin through small or invisible cuts and abrasions. They can appear anywhere on the skin, but, technically, only those on the sole are properly called plantar warts.

Children, especially teenagers, tend to be more susceptible to warts than adults; some people seem to be immune. 

Identification Problems

Most warts are harmless, even though they may be painful. They are often mistaken for corns or calluses—which are layers of dead skin that build up to protect an area which is being continuously irritated. The wart, however, is a viral infection.

It is also possible for a variety of more serious lesions to appear on the foot, including malignant lesions such as carcinomas and melanomas. Although rare, these conditions can sometimes be misidentified as a wart. It is wise to consult a podiatric physician when any suspicious growth or eruption is detected on the skin of the foot in order to ensure a correct diagnosis.

Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. Plantar warts are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black. It is important to note that warts can be very resistant to treatment and have a tendency to reoccur.

Source of the Virus

The plantar wart is often contracted by walking barefoot on dirty surfaces or littered ground where the virus is lurking. The causative virus thrives in warm, moist environments, making infection a common occurrence in communal bathing facilities.

If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of several warts; these are often called mosaic warts. Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, another route for spreading.

Occasionally, warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.

When plantar warts develop on the weight-bearing areas of the foot—the ball of the foot, or the heel, for example—they can be the source of sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.

Tips for Prevention

• Avoid walking barefoot, except on sandy beaches.
• Change shoes and socks daily.
• Keep feet clean and dry.
• Check children's feet periodically.
• Avoid direct contact with warts—from other persons or from other parts of the body.
• Do not ignore growths on, or changes in, your skin.
• Visit your podiatric physician as part of your annual health checkup.

Self Treatment

Self treatment is generally not advisable. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self treatment with such medications especially should be avoided by people with diabetes and those with cardiovascular or circulatory disorders. Never use them in the presence of an active infection.

Professional Treatment

It is possible that your podiatric physician will prescribe and supervise your use of a wart-removal preparations. More likely, however, removal of warts by a simple surgical procedure, performed under local anesthetic, may be indicated.

Lasers have become a common and effective treatment. A procedure known as CO2 laser cautery is performed under local anesthesia either in your podiatrist’s office surgical setting or an outpatient surgery facility. The laser reduces post-treatment scarring and is a safe form for eliminating wart lesions.

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*Article and pictures provided by the American Podiatric Medical Association.

Ingrown Toenails - Podiatrist in Chelmsford and Newburyport, MA

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Ingrown Toenails - Podiatrist in Chelmsford and Newburyport, MA

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Ingrown nails, the most common nail impairment, are nails whose corners or sides dig painfully into the soft tissue of nail grooves, often leading to irritation, redness, and swelling. Usually, toenails grow straight out. Sometimes, however, one or both corners or sides curve and grow into the flesh. The big toe is usually the victim of this condition, but other toes can also become affected.

Ingrown toenail may be caused by:

• Improperly trimmed nails (Trim then straight across, not longer than the tip of the toes. Do not round off corners. Use toenail clippers.)

• Heredity

• Shoe pressure; crowding of toes

• Repeated trauma to the feet from normal activities

• If you suspect an infection due to an ingrown toenail, immerse the foot in a warm salt water soak, or a basin of soapy water, then apply an antiseptic and bandage the area.

 

People with diabetes, peripheral vascular disease, or other circulatory disorders must avoid any form of self treatment and seek podiatric medical care as soon as possible.

Other "do-it-yourself" treatments, including any attempt to remove any part of an infected nail or the use of over-the-counter medications, should be avoided. Nail problems should be evaluated and treated by your podiatrist, who can diagnose the ailment, and then prescribe medication or another appropriate treatment.

A podiatrist will resect the ingrown portion of the nail and may prescribe a topical or oral medication to treat the infection. If ingrown nails are a chronic problem, your podiatrist can perform a procedure to permanently prevent ingrown nails. The corner of the nail that ingrows, along with the matrix or root of that piece of nail, are removed by use of a chemical, a laser, or by other methods.

 

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Podiatrist in Chelmsford and Newburyport, Mass - New England Foot and Ankle Foot Doctor

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Podiatrist in Chelmsford and Newburyport, Mass - New England Foot and Ankle Foot Doctor

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We are specialists in the care of the foot and ankle. Our patients include infants, children, teenagers, adults and the geriatric population. Dr. Fleishman, Dr. Downs, Dr. Gauthier and Dr. Coker spend quality time with each of their patients in order to better understand each individual patient's foot care needs, and to recommend the best course of treatment. We work closely with primary care physicians and other specialists to ensure the most effective treatment plan.

Our doctors, medical assistants, and office personnel are all dedicated to providing our patients with the finest medical, surgical and rehabilitative treatments for the foot and ankle. Our growth in the community is a direct result of the caring and personal treatment we give our patients.

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Fungal Toenails - Podiatrist in Chelmsford and Newburyport, MA

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Fungal Toenails - Podiatrist in Chelmsford and Newburyport, MA

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Fungal Nails - An Underreported Health Problem

Fungal infection of toenails is a common foot health problem. A majority of victims don't seek treatment, maybe don't even recognize the existence of a problem. Studies estimate that it afflicts three to five percent of the population; however, doctors of podiatric medicine think that because so many cases go unreported, the incidence is much higher than that (they treat perhaps 2.5 million people annually, but that's less than a quarter of the cases estimated by the studies).

Probably one reason that so many people ignore the infection is that it can be present for years without ever causing pain. Its prevalence rises sharply among older adults (20 to 30 percent, the studies say, though podiatric physicians think it's much higher). Because the older adults may be experiencing much more serious medical problems, it is understandable that fungal nails can be passed over as very minor, though it is anything but that.

Whatever the case, the disease, characterized by a change in a toenail's color, is often considered nothing more than a mere blemish -- ugly and embarrassing. It is apparently assumed that since white markings or a darkening of the nail are minor occurrences, the change represents something minor as well, even when the blemish spreads. It may be that cosmetologists see this condition as often as doctors. Nail polish is an easy solution for many women, rendering the problem "out of sight, out of mind."

In many cases, however, that change in color is the start of an aggravating disease that ultimately could take months to control. Fungal infection of the nails is known to podiatrists and other physicians as onychomycosis. It is an infection underneath the surface of the nail, which can also penetrate the nail. If it is ignored, its spread could impair one's ability to work or even walk. That happens because it is frequently accompanied by thickening of the nails, which then cannot easily be trimmed and may cause pain while wearing shoes. This disease can frequently be accompanied by a secondary bacterial and/or yeast infection in or about the nail plate.

What is a Fungal Nail?

Onychomycosis is an infection of the bed and plate underlying the surface of the nail, and is caused by various types of fungi, which are commonly found throughout the environment. Fungi are simple parasitic plant organisms, such as molds and mildew, that lack chlorophyll and therefore do not require sunlight for growth. A group of fungi called dermophytes easily attack the nail, thriving off keratin, the nail's protein substance.

When the tiny organisms take hold, the nail may become thicker, yellowish-brown or darker in color, and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails.

Because it is difficult to avoid contact with microscopic organisms like fungi, the toenails are especially vulnerable around damp areas where people are likely to be walking barefoot -- swimming pools, locker rooms, and showers, for example. Injury to the nail bed may make it more susceptible to all types of infection, including fungal infection. Those who suffer chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributory factors may be a history of athlete's foot and excessive perspiration.

Prevention

Because fungi are everywhere, including the skin, they can be present months before they find opportunities to strike, and before signs of infection appear. By following precautions, including proper hygiene and regular inspection of the feet and toes, chances of the problem occurring can be sharply reduced, or even put to a halt.

Clean, dry feet resist disease; a strict regimen of washing the feet with soap and water, remembering to dry thoroughly, is the best way to prevent an infection. Shower shoes should be worn when possible, in public areas. Shoes, socks, or hosiery should be changed daily. Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe. Use a quality foot powder -- talcum, not cornstarch -- in conjunction with shoes that fit well and are made of materials that breathe.

Avoid wearing excessively tight hosiery, which promotes moisture. Socks made of synthetic fiber tend to "wick" away moisture faster than cotton or wool socks, especially for those with more active life styles.

Artificial Nails and Polish

Moisture collecting underneath the surface of the toenail would ordinarily evaporate, passing through the porous structure of the nail. The presence of an artificial nail or a polish impedes that, and the water trapped below can become stagnant and unhealthy, ideal for fungi and similar organisms to thrive.

Always use preventive measures when applying polishes. Disinfect home pedicure tools and don't apply polish to nails suspected of infection on those on toes that are red, discolored, or swollen, for example.

Treatment

Depending on the nature of the infection and the severity of each case, treatment may vary. A daily routine of cleansing, over a period of many months, may temporarily suppress mild infections. White markings that appear on the surface of the nail can be filed off, followed by the application of an over-the-counter liquid antifungal agent.

However, even the best-over-the-counter treatments may not prevent a fungal infection from coming back. A fungus may work its way through the entire nail, penetrating both the nail plate and the nail bed. If an infection is not overcome, or continues to reappear, further medical attention is strongly recommended.

Laser Therapy GenesisPlus

Are you embarrassed by your discolored toenails? If so, New England Foot and Ankle can HELP!

New England Foot and Ankle is the only practice in the Merrimack Valley area to provide this breakthrough treatment Laser Therapy to treat toenail fungus. Our physicians at New England Foot and Ankle are at the forefront of laser nail care. Podiatric Medical Care

A podiatric physician can detect a fungal infection early, culture the nail, determine the cause, and form a suitable treatment plan, which may include prescribing topical or oral medication, and debridement (removal of diseased nail matter and debris) of an infected nail. Indeed, debridement is one of the most common foot care procedures performed by DPMs.

Newer oral antifungals approved by the Food and Drug Administration may be the most effective treatment. They offer a shorter treatment outlook (three to four months) and improved effectiveness, though DPMs advise that lengthier treatments, up to 12 months, may still be required for some infections. Current studies show that, for a small percentage of the population, there are some unwanted side effects with any oral antifungal.

In some cases, surgical treatment may be required. Temporary removal of the infected nail can be performed to permit direct application of a topical antifungal. Permanent removal of a chronically painful nail, which has not responded to any other treatment, permits the fungal infection to be cured, and prevents the return of a deformed nail.

Trying to solve the infection without the qualified help of a podiatric physician can lead to more problems. With new technological advances in combination with simple preventive measures, the treatment of this lightly regarded health problem can often be successful.

 

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Foot and Ankle Surgery - Podiatrist in Chelmsford and Newburyport, MA

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Foot and Ankle Surgery - Podiatrist in Chelmsford and Newburyport, MA

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Forefoot Surgery

When is Foot Surgery Necessary?

Many foot problems do not respond to “conservative” management. Your podiatric physician can determine when surgical intervention may be helpful. Often when pain or deformity persists, surgery may be appropriate to alleviate discomfort or to restore the function of your foot.

Bunions

A common deformity of the foot, a bunion is an enlargement of the bone and tissue around the joint of the big toe. Heredity frequently plays a role in the occurrence of bunions, as it does in other foot conditions. When symptomatic, the area may become red, swollen, and inflamed, making shoe gear and walking uncomfortable and difficult. If conservative care fails to reduce these symptoms, surgical intervention may be warranted. Your podiatric physician will determine the type of surgical procedure best suited for your deformity, based on a variety of information which may include X-rays and gait examination.

Hammertoes

A hammertoe deformity is a contracture of the toe(s), frequently caused by an imbalance in the tendon or joints of the toes. Due to the “buckling” effect of the toe(s), hammertoes may become painful secondary to footwear irritation and pressure. Corn and callus formation may occur as a hammertoe becomes more rigid over time, making it difficult to wear shoes. Your podiatric physician may suggest correction of this deformity through a surgical procedure to realign the toe(s).

Neuroma

An irritation of a nerve may produce a neuroma, which is a benign enlargement of a nerve segment, commonly found between the third and fourth toes. Several factors may contribute to the formation of a neuroma.

Trauma, arthritis, high-heeled shoes, or an abnormal bone structure are just some of the conditions that may cause a neuroma. Symptoms such as burning or tingling in the ball of the foot or in the adjacent toes and even numbness are commonly seen with this condition. Other symptoms include swelling between the toes and pain in the ball of the foot when weight is placed on it.

Those suffering from the condition often find relief by stopping their walk, taking off their shoe, and rubbing the affected area. At times, the patient will describe the pain as similar to having a stone in his or her shoe.

Your podiatric physician will likely X-ray the affected area to determine the size and severity of the neuroma and suggest a treatment plan. If conservative treatment does not relieve the symptoms, then your podiatric physician will decide, on the basis of your symptoms, whether surgical treatment is appropriate.

Bunionette (Tailor’s Bunion)

A protuberance of bone at the outside of the foot behind the fifth (small) toe, the bunionette or “small bunion” is caused by a variety of conditions including heredity, faulty biomechanics (the way one walks) or trauma, to name a few. Pain is often associated with this deformity, making shoes very uncomfortable and at times even walking becomes difficult. If severe and conservative treatments fail to improve the symptoms of this condition, surgical repair may be suggested. Your podiatric physician will develop a surgical plan specific to the condition present.

Bone spurs

A bone spur is an overgrowth of bone as a result of pressure, trauma, or reactive stress of a ligament or tendon. This growth can cause pain and even restrict motion of a joint, depending on its location and size. Spurs may also be located under the toenail plate, causing nail deformity and pain. Surgical treatment and procedure is based on the size, location, and symptoms of the bone spur. Your podiatric physician will determine the surgical method best suited for your condition.

Preoperative Testing and Care

As with anyone facing any surgical procedure, those undergoing foot and ankle surgery require specific tests or examinations before surgery to improve a successful surgical outcome. Prior to surgery, the podiatric physician will review your medical history and medical conditions. Specific diseases, illnesses, allergies, and current medications need to be evaluated. Other tests that help evaluate your health status may be ordered by the podiatric physician, such as blood studies, urinalysis, EKG, X-rays, a blood flow study (to better evaluate the circulatory status of the foot/legs), and a biomechanical examination. A consultation with another medical specialist may be advised by a podiatric physician, depending on your test results or a specific medical condition.

Postoperative Care

The type of foot surgery performed determines the length and kind of after- care required to assure that your recovery from surgery is rapid and uneventful. The basics of all postoperative care involves to some degree each of the following: rest, ice, compression, and elevation. Bandages, splints, surgical shoes, casts, crutches, or canes may be necessary to improve and ensure a safe recovery after foot surgery. A satisfactory recovery can be hastened by carefully following instructions from your podiatric physician.

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Rearfoot Surgery

Many Conditions Affect the Rearfoot

Many conditions can affect the back portion of the foot and ankle. Fortunately, many of these problems can be resolved through conservative treatments. However when pain persists or deformity occurs, surgical intervention can often help alleviate pain, reduce deformity, and/or restore the function of your foot or ankle.

Heel Surgery

Two common conditions that can cause pain to the bottom of the heel are plantar fasciitis and heel spur(s). Although there are many causes of heel pain in both children and adults, most can be effectively treated without surgery. When chronic heel pain fails to respond to conservative treatment, surgical care may be warranted.

Plantar fasciitis is an inflammation of a fibrous band of tissue in the bottom of the foot that extends from the heel bone to the toes. This tissue can become inflamed for many reasons, most commonly from irritation by placing too much stress (such as excess running and jumping) on the bottom of the foot.

Heel Spur(s) or heel spur syndrome are most often the result of stress on the muscles and fascia of the foot. This stress may form a spur on the bottom of the heel. While many spurs are painless others may produce chronic pain.

Based on the condition and the chronic nature of the disease, heel surgery can provide relief of pain and restore mobility in many cases. The type of procedure is based on examination and usually consists of plantar fascia release, with or without heel spur excision. There have been various modifications and surgical enhancements regarding surgery of the heel. Your podiatric physician will determine which method is best suited for you.

There are many other causes of heel pain, which has become one of the most common foot problems reported by patients of podiatric physicians. Many of them have a basis in heredity, as do a lot of other foot conditions. Among the causes are stress fractures and stress-fracture syndrome, entrapped nerves, bruises, bursitis, arthritis (including gout), deterioration of the fat pad on the heel, improper shoes, and obesity, just to name some. Most of these conditions will be treated nonsurgically, though surgery may be recommended in some instances.

Haglund's Deformity (pump bump)

 

This deformity is characterized by a bony enlargement on the back of the heel. Although not always painful, it may become so if bursitis develops near the Achilles tendon secondary to footwear irritation. If attempts at shoe modification and other medical treatments fail to improve this condition, surgical correction may be beneficial. Based on X-ray evaluation and other tests or examinations your podiatric surgeon will select an operative treatment to alleviate the condition.

Insertional Achilles Clarification/Spur

This deformity differs from Haglund's deformity, in that spur formation or calcification at the insertion of the Achilles tendon is the cause of pain. Often associated with Achilles tendinitis, this deformity can often be difficult to treat medically and therefore surgical treatment may be necessary in chronic cases. There are many causes of this condition, including arthritis, but the most common appears to be overuse syndrome, where trauma occurs where the Achilles tendon attaches to the heel bone. Surgical treatment includes removal of the bone spur and/or calcification, along with repair of the Achilles tendon.

Reconstructive Surgery

Reconstructive surgery of the foot and ankle consists of complex surgical repair(s) that may be necessary to regain function or stability, reduce pain, and/or prevent further deformity or disease. Unfortunately, there are many conditions or diseases that range from trauma to congenital defects that necessitate surgery of the foot and/or ankle. Reconstructive surgery in many of these cases may require any of the following: tendon repair/transfer, fusion of bone, joint implantation, bone grafting, skin or soft tissue repair, tumor excision, amputation and/or the osteotomy of bone (cutting of bones in a precise fashion). Bone screws, pins, wires, staples, and other fixation devices (both internal and external), and casts may be utilized to stabilize and repair bone in reconstructive procedures.

Preoperative Testing And Care

As with anyone facing any surgical procedure, those undergoing foot and ankle surgery require specific tests or examinations before surgery to obtain a successful surgical outcome. Prior to surgery, the podiatric surgeon will review your medical history and medical conditions. Specific diseases, illnesses, allergies, and current medications need to be evaluated. Other tests that help evaluate your health status that may be ordered by the podiatric physician include blood studies, urinalysis, EKG, X-rays, blood flow studies (to better evaluate the circulatory status of the foot/legs), and biomechanical examination.

A consultation with another medical specialist is sometimes advised by a podiatric physician, depending on your test results or a specific medical condition.

Postoperative Care

Surgery of the rearfoot requires close care following surgery. To assure a rapid and uneventful recovery, it is important to follow your podiatric surgeon's advice and postoperative instructions carefully. Rest, ice, compression and elevation of your foot/ankle postoperatively is often advised. The usage of bandages, splints, casts, surgical shoes, crutches, or canes may be necessary after surgery. Your podiatric surgeon will also determine if and when you can bear weight on an operated foot.

*Article and pictures provided by the American Podiatric Medical Association.

 

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Diabetic Foot Care - Podiatrist in Chelmsford and Newburyport, MA

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Diabetic Foot Care - Podiatrist in Chelmsford and Newburyport, MA

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Diabetes: Startling Statistics

Diabetes mellitus is a chronic disease that affects the lives of about 16 million people in the United States, 5.4 million of whom are unaware that they even have the disease. Every day, 2,200 new cases of diabetes are diagnosed, and an estimated 780,000 new cases are identified each year. The disease is marked by the inability to manufacture or properly use insulin, and impairs the body’s ability to convert sugars, starches, and other foods into energy. The long-term effects of elevated blood sugar (hyperglycemia) are damage to the eyes, heart, feet, kidneys, nerves, and blood vessels.

Symptoms of hyperglycemia may include frequent urination, excessive thirst, extreme hunger, unexplained weight loss, tingling or numbness of the feet or hands, blurred vision, fatigue, slow-to-heal wounds, and susceptibility to certain infections. People who have any of these symptoms and have not been tested for diabetes are putting themselves at considerable risk and should see a physician without delay.

Part of keeping your diabetes in control is testing your blood sugar often. Ask your doctor how often you should test, and what your blood sugar levels should be. Testing your blood and then treating high blood sugar early will help you to prevent complications.

The socioeconomic costs of diabetes are enormous. The costs have been estimated at $98 billion annually, about $44 billion of which are direct costs from the disease with $54 billion indirectly related. Diabetes is the sixth leading cause of death by disease in the United States, and individuals with diabetes are two to four times as likely to experience heart disease and stroke.

The growth of the disease worldwide is especially alarming. The World Health Organization (WHO) expects the number of new diabetes cases to double in the next 25 years from 135 million to nearly 300 million. Much of this growth will occur in developing countries where aging, unhealthy diets, obesity, and sedentary lifestyles will contribute to the onset of the disease.

• According to a recent survey, about 86,000 lower limbs are amputated annually due to complications from diabetes.
• Diabetes is the leading cause of end-stage kidney disease, accounting for about 40 percent of new cases.
• Diabetes is the leading cause of new cases of blindness among adults, age 20 to 74.

While there is no cure for diabetes, there is hope. With a proper diet, exercise, medical care, and careful management at home, a person with diabetes can keep the most serious of the consequences at bay and enjoy a long, full life.

How Do You Get Diabetes?

No one knows why people develop diabetes, but once diagnosed, the disease is present for life. It is a hereditary disorder, and certain genetic indicators are known to increase the risk of developing diabetes. Type 1, previously known as insulin-dependent diabetes mellitus or juvenile-onset diabetes, afflicts five to ten percent of diagnosed cases of diabetes. This type occurs most frequently in children and adolescents, and is caused by the inability of the pancreas to produce the insulin needed for survival. Type 2, previously called non insulin-dependent diabetes mellitus or adult-onset diabetes, affects the other 90-95 percent of all diagnosed cases of diabetes, many of whom use oral medication or injectable insulin to control the disease. The vast majority of those people (80 percent or more) are overweight; many of them obese, as obesity itself can cause insulin resistance.

Certain characteristics put people at a higher risk for developing Type 2 diabetes. These include:

• A family history of the disease
• Obesity
• Prior history of developing diabetes while pregnant
• Being over the age of 40
• Being a member of one of the following ethnic groups:
  • African American
  • Native American
  • Latino American
  • Asian American
  • Pacific Islander

African Americans are 1.7 times more likely to have diabetes than the general population, with 25 percent of African Americans between the ages of 65 and 74 diagnosed with the disease.

Hispanic Americans are almost twice as likely to develop type 2 diabetes, which affects 10.6 percent of that population group.

Native Americans are at a significantly increased risk for developing diabetes, and 12.2 percent of the population suffers from the disease. In some tribes, as many as 50 percent of its members have diabetes.

Of all the risk factors, weight is the most important, with more than 80 percent of diabetes sufferers classified as overweight.

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Diabetic Foot

The Role of Your Podiatric Physician

Because diabetes is a systemic disease affecting many different parts of the body, ideal case management requires a team approach. The podiatric physician, as an integral part of the treatment team, has documented success in the prevention of amputations. The key to amputation prevention in diabetic patients is early recognition and regular foot screenings, at least annually, from a podiatric physician.

In addition to these check ups, there are warning signs that you should be aware of so that they may be identified and called to the attention of the family physician or podiatrist. They include:

• Skin color changes
• Elevation in skin temperature
• Swelling of the foot or ankle
• Pain in the legs
• Open sores on the feet that are slow to heal
• Ingrown and fungal toenails
• Bleeding corns and calluses
• Dry cracks in the skin, especially around the heel

Wound Healing

Ulceration is a common occurrence with the diabetic foot, and should be carefully treated and monitored by a podiatrist to avoid amputations. Poorly fitted shoes, or something as trivial as a stocking seam, can create a wound that may not be felt by someone whose skin sensation is diminished. Left unattended, such ulcers can quickly become infected and lead to more serious consequences. Your podiatric physician knows how to treat and prevent these wounds and can be an important factor in keeping your feet healthy and strong. New to the science of wound healing are remarkable products that have the appearance and handling characteristics of human skin. These living, skin-like products are applied to wounds that are properly prepared by the podiatric physician. Clinical trials have shown impressive success rates.

Diabetic Wound Care

What is a Diabetic Foot Ulcer?

A diabetic foot ulcer is an open sore or wound that most commonly occurs on the bottom of the foot in approximately 15 percent of patients with diabetes. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication.

Diabetes is the leading cause of non traumatic lower extremity amputations in the United States, and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer have an amputation. Research, however, has shown that the development of a foot ulcer is preventable.

Who Can Get a Diabetic Foot Ulcer?

Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics and older men are more likely to develop ulcers. People who use insulin are at a higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.

How do Diabetic Foot Ulcers Form?

Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of feeling in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain and one may not even be aware of the problem. Your podiatric physician can test feet for neuropathy with a simple and painless tool called a monofilament.

Vascular disease can complicate a foot ulcer, reducing the body’s ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body’s ability to fight off a potential infection and also retard healing.

What is the Value of Treating a Diabetic Foot Ulcer?

Once an ulcer is noticed, seek podiatric medical care immediately. Foot ulcers in patients with diabetes should be treated for several reasons such as, reducing the risk of infection and amputation, improving function and quality of life, and reducing health care costs.

How Should a Diabetic Foot Ulcer be Treated?

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:

• Prevention of infection.
• Taking the pressure off the area, called “off-loading.”
• Removing dead skin and tissue, called “debridement.”
• Applying medication or dressings to the ulcer
• Managing blood glucose and other health problems.

Not all ulcers are infected; however if your podiatric physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

There are several important factors to keep an ulcer from becoming infected:

• Keep blood glucose levels under tight control.
• Keep the ulcer clean and bandaged.
• Cleanse the wound daily, using a wound dressing or bandage.
• Do not walk barefoot.

For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” Patients may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.

The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.

Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.

For a wound to heal there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels with noninvasive tests.

Controlling Blood Glucose

Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Working closely with a medical doctor or endocrinologist to accomplish this will enhance healing and reduce the risk of complications.

Surgical Options

A majority of noninfected foot ulcers are treated without surgery; however, when this fails, surgical management may be appropriate. Examples of surgical care to remove pressure on the affected area include shaving or excision of bone(s) and the correction of various deformities, such as hammertoes, bunions, or bony “bumps.”

Healing Factors

Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound. Healing may occur within weeks or require several months.

How Can a Foot Ulcer be Prevented?

The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrist on a regular basis. He or she can determine if you are at high risk for developing a foot ulcer and implement strategies for prevention.

You are at high risk if you:

• have neuropathy
• have poor circulation
• have a foot deformity (i.e. bunion, hammer toe)
• wear inappropriate shoes
• have uncontrolled blood sugar

Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose are important in the prevention and treatment of a diabetic foot ulcer. Wearing the appropriate shoes and socks will go a long way in reducing risks. Your podiatric physician can provide guidance in selecting the proper shoes.

Learning how to check your feet is crucial in noticing a potential problem as early as possible. Inspect your feet every day—especially between the toes and the sole—for cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality. Each time you visit a health care provider, remove your shoes and socks so your feet can be examined. Any problems that are discovered should be reported to your podiatrist as soon as possible, no matter how “simple” it may seem to you.

The key to successful wound healing is regular podiatric medical care to ensure the following “gold standard” of care:

• lowering blood sugar appropriate debridement of wounds
• treating any infection
• reducing friction and pressure
• restoring adequate blood flow

The old saying, “an ounce of prevention is worth a pound of cure” was never as true as it is when preventing a diabetic foot ulcer.

 

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Podiatrist in Chelmsford and Newburyport, Mass - Jerold Fleishman, DPM, FACFAS

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Podiatrist in Chelmsford and Newburyport, Mass - Jerold Fleishman, DPM, FACFAS - New England Foot and Ankle Foot Doctor

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Dr. Jerold Fleishman is originally from Marblehead, Ma and received his undergraduate degree from Northeastern University, Boston. He received his Doctorate from Temple University School of Podiatric Medicine and completed his surgical residency in Reconstructive Foot Surgery at St. Anne's Hospital in Chicago. Over the past 20 years, he has developed New England Foot & Ankle, P.C. into the premier podiatric medical practice in the Merrimack Valley. He is well known for his volunteer work with the Lowell Transitional Shelter, and is recognized for his appearances on local radio/TV programs.

Dr. Fleishman is Board Certified in Foot Surgery by the American Board of Podiatric Surgery and is a Fellow of the American College of Foot and Ankle Surgeons. He is an active member of the American Podiatric Medical Association, and is a Fellow of the American Academy of Podiatric Practice Management. Dr Fleishman is on staff at Saints Memorial Medical Center, Drum Hill Surgery Center, Anna Jaques Hospital, and Lowell General Hospital where he is a Corporator for the Board of Trustees.

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Podiatrist in Chelmsford and Newburyport, MA - Cathy Coker, DPM

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Podiatrist in Chelmsford and Newburyport, MA - Cathy Coker, DPM

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Podiatrist in Chelmsford and Newburyport, MA - Cathy Coker, DPM - New England Foot and Ankle Foot Doctor 

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Dr. Cathy Coker completed her Bachelor of Science degree from the University of Georgia in Athens, GA and received her doctorate from the New York College of Podiatric Medicine, New York, NY. She then completed a 3-year surgical residency in reconstructive foot and ankle surgery from Dekalb Medical Center in Decatur, GA.

Dr. Coker is a member of The Podiatry Institute, a nationally recognized non profit organization that is committed to developing, promoting and advancing podiatric medicine and surgery through ongoing education in the area of the foot and ankle. As a faculty member of the Podiatry Institute, she extensively lectures on disorders and various treatments of the foot and ankle.

Dr. Coker is a former Taekwondo kata title holder and remains physically active by participating in spinning, kickboxing and weightlifting. She enjoys spending time with her family and looks forward to becoming a New England resident.

She is an active member of the American Podiatric Medical Association and American Association for Women Podiatrists as well as being Board Qualified in Foot Surgery by the American Board of Podiatric Surgery. She is on staff at, Lowell General Hospital, Saints Medical Center, Anna Jaques Hospital, and Drum Hill Surgery Center.

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Bunions - Podiatrist in Chelmsford and Newburyport, MA

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Bunions - Podiatrist in Chelmsford and Newburyport, MA

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What Is a Bunion?
A bunion is an enlargement of the joint at the base of the big toe—the metatarsophalangeal (MTP) joint—that forms when the bone or tissue at the big toe joint moves out of place. This forces the toe to bend toward the others, causing an often painful lump of bone on the foot. Since this joint carries a lot of the body’s weight while walking, bunions can cause extreme pain if left untreated. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. Bunions– from the Latin "bunio," meaning enlargement–can also occur on the outside of the foot along the little toe, where it is called a "bunionette" or "tailor’s bunion."

Symptoms

• Development of a firm bump on the outside edge of the foot, at the base of the big toe.
• Redness, swelling, or pain at or near the MTP joint.
• Corns or other irritations caused by the overlap of the first and second toes.
• Restricted or painful motion of the big toe.

How Do You Get a Bunion?

Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This can lead to instability in the joint and cause the deformity. They are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk, and our inherited foot type, our shoes, or other sources.

Although bunions tend to run in families, it is the foot type that is passed down—not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type on to their children, who, in turn, are also prone to developing bunions. The abnormal functioning caused by this faulty foot development can lead to pressure being exerted on and within the foot, often resulting in bone and joint deformities such as bunions and hammertoes.

Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition.

Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women.

What Can You Do For Relief?

• Apply a commercial, non medicated bunion pad around the bony prominence.
• Wear shoes with a wide and deep toe box.
• If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
• Avoid high-heeled shoes over two inches tall.
• See your podiatric physician if pain persists.

Conservative Treatment For Bunion Pain

Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. Podiatric medical attention should be sought at the first indication of pain or discomfort because, left untreated, bunions tend to get larger and more painful, making non surgical treatment less of an option.

The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity. A podiatric physician may recommend these treatments:

Padding & Taping

Often the first step in a treatment plan, padding the bunion minimizes pain and allows the patient to continue a normal, active life. Taping helps keep the foot in a normal position, thus reducing stress and pain.

Medication

Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammations caused by joint deformities.

Physical Therapy

Often used to provide relief of the inflammation and from bunion pain. Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement.

Orthotics

Shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.

When early treatments fail or the bunion progresses past the threshold for such options, podiatric surgery may become necessary to relieve pressure and repair the toe joint.

Surgical Options

Several surgical procedures are available to the podiatric physician The surgery will remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.

A simple bunionectomy, in which only the bony prominence is removed, may be used for the less severe deformity. Severe bunions may require a more involved procedure, which includes cutting the bone and realigning the joint.

Recuperation takes time, and swelling and some discomfort are common for several weeks following surgery. Pain, however, is easily managed with medications prescribed by your podiatric physician.

 

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Sports Injuries to the Foot - Podiatrist in Chelmsford and Newburyport, MA

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Sports Injuries to the Foot - Podiatrist in Chelmsford and Newburyport, MA

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 Sports Injuries

Martial arts and kick boxing:

A variety of injuries can occur as a result of martial arts and kick boxing. These include plantar fasciitis, Achilles tendonitis, sesamoiditis, and ankle sprains. Stretching is recommended for a minimum of 15 minutes before performing any kicking or punching.

Aerobics:

Proper shoes are crucial to successful, injury-free aerobics. Shoes should provide sufficient cushioning and shock absorption to compensate for pressure on the foot many times greater than found in walking. They must also have good medial-lateral stability. Impact forces from aerobics can reach up to six times the force of gravity, which is transmitted to each of the 26 bones in the foot.

Team Sports:

Activities such as football, basketball, soccer, field hockey and lacrosse often lead to ankle and big toe joint injuries as a result of play on artificial surfaces.

Turf toe:

Big toe injuries also called "turf toe," often result from hyperextension of the big toe joint as the heel is raised off the ground. An external force is placed on the great toe and the soft tissue structures that support the big toe on the top are torn or ruptured.

Symptoms include pain, tenderness and swelling of the toe joint. Often there is a sudden acute onset of pain during push-off phase of running. Usually, the pain is not enough to keep the athlete from physical activities or finishing a game. This causes further injury to the big toe and will dramatically increase the healing time.

Treatment includes rest, ice, compression, and equipment modification or change. Non-steroidal anti-inflammatory drugs (NSAIDs) may be used for relief of minor pain as well as to decrease the inflammation of the injury. Consult your physician before taking any medication.

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Custom Orthotics - Podiatrist in Chelmsford and Newburyport, MA

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Custom Orthotics - Podiatrist in Chelmsford and Newburyport, MA

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What are Orthotics?

Orthotics are shoe inserts that are intended to correct an abnormal, or irregular, walking pattern. Orthotics are not truly or solely "arch supports," although some people use those words to describe them, and they perhaps can best be understood with those words in mind. They perform functions that make standing, walking, and running more comfortable and efficient, by altering slightly the angles at which the foot strikes a walking or running surface.

Doctors of podiatric medicine prescribe orthotics as a conservative approach to many foot problems or as a method of control after certain types of foot surgery; their use is a highly successful, practical treatment form.

Orthotics take various forms and are constructed of various materials. All are concerned with improving foot function and minimizing stress forces that could ultimately cause foot deformity and pain.

Foot orthotics fall into three broad categories: those that primarily attempt to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.

Rigid Orthotics

The so-called rigid orthotic device, designed to control function, may be made of a firm material such as plastic or carbon fiber, and is used primarily for walking or dress shoes. It is generally fabricated from a plaster of paris mold of the individual foot. The finished device normally extends along the sole of the heel to the ball or toes of the foot. It is worn mostly in closed shoes with a heel height under two inches. Because of the nature of the materials involved, very little alteration in shoe size is necessary.

Rigid orthotics are chiefly designed to control motion in two major foot joints, which lie directly below the ankle joint. These devices are long lasting, do not change shape, and are usually difficult to break. Strains, aches, and pains in the legs, thighs, and lower back may be due to abnormal function of the foot, or a slight difference in the length of the legs. In such cases, orthotics may improve or eliminate these symptoms, which may seem only remotely connected to foot function.

Soft Orthotics

The second, or soft, orthotic device helps to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. It is usually constructed of soft, compressible materials, and may be molded by the action of the foot in walking or fashioned over a plaster impression of the foot. Also worn against the sole of the foot, it usually extends from the heel past the ball of the foot to include the toes.

The advantage of any soft orthotic device is that it may be easily adjusted to changing weight-bearing forces. The disadvantage is that it must be periodically replaced or refurbished. It is particularly effective for arthritic and grossly deformed feet where there is a loss of protective fatty tissue on the side of the foot. It is also widely used in the care of the diabetic foot. Because it is compressible, the soft orthotic is usually bulkier and may well require extra room in shoes, or prescription footwear.

Semirigid Orthotics

The third type of orthotic device (semirigid) provides for dynamic balance of the foot while walking or participating in sports. This orthotic is not a crutch, but an aid to the athlete. Each sport has its own demand and each sport orthotic needs to be constructed appropriately with the sport and the athlete taken into consideration. This functional dynamic orthotic helps guide the foot through proper functions, allowing the muscles and tendons to perform more efficiently. The classic, semirigid orthotic is constructed of layers of soft material, reinforced with more rigid materials.

Orthotics for Children

Orthotic devices are effective in the treatment of children with foot deformities. Most podiatric physicians recommend that children with such deformities be placed in orthotics soon after they start walking, to stabilize the foot. The devices can be placed directly into a standard shoe, or an athletic shoe.

Usually, the orthotics need to be replaced when the child's foot has grown two sizes. Different types of orthotics may be needed as the child's foot develops, and changes shape.

The length of time a child needs orthotics varies considerably, depending on the seriousness of the deformity and how soon correction is addressed.

Other Types of Orthotics

Various other orthotics may be used for multidirectional sports or edge-control sports by casting the foot within the ski boot, ice skate boot, or inline skate boot. Combinations of semiflexible material and soft material to accommodate painful areas are utilized for specific problems.

 

*Article and pictures provided by the American Podiatric Medical Association.

 

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Children’s Feet - Podiatrist in Chelmsford and Newburyport, MA

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Children’s Feet - Podiatrist in Chelmsford and Newburyport, MA

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Your Children's Feet

You worry about your children's teeth, eyes, and other parts of the body. You teach washing, brushing, and grooming, but what do you do about your child's feet--those still-developing feet which have to carry the entire weight of the body through a lifetime?

Many adult foot ailments, like other bodily ills, have their origins in childhood and are present at birth. Periodic professional attention and regular foot care can minimize these problems in later life.

Neglecting foot health invites problems in other parts of the body, such as the legs and back. There can also be undesirable personality effects. The youngster with troublesome feet walks awkwardly and usually has poor general posture. As a result, the growing child may become shy, introverted, and avoid athletics and social functions. Consultation between the podiatrist, pediatrician, and other medical specialists helps to resolve these related problems.

Your Baby's Feet

The human foot -- one of the most complicated parts of the body --has 26 bones, and is laced with ligaments, muscles, blood vessels, and nerves. Because the feet of young children are soft and pliable, abnormal pressure can easily cause deformities.

A child's feet grow rapidly during the first year, reaching almost half their adult foot size. This is why foot specialists consider the first year to be the most important in the development of the feet.

Here are some suggestions to help you assure that this development proceeds normally:

• Look carefully at your baby's feet. If you notice something that does not look normal to you, seek professional care immediately. Deformities will not be outgrown by themselves.
• Cover baby's feet loosely. Tight covers restrict movement and can retard normal development.
• Provide an opportunity for exercising the feet. Lying uncovered enables the baby to kick and perform other related motions which prepare the feet for weight bearing.
• Change the baby's position several times a day. Lying too long in one spot, especially on the stomach, can put excessive strain on the feet and legs.

Starting to Walk

It is unwise to force a child to walk. When physically and emotionally ready, the child will walk. Comparisons with other children are misleading, since the age for independent walking ranges from 10 to 18 months.

When the child first begins to walk, shoes are not necessary indoors. Allowing the youngster to go barefoot or to wear just socks helps the foot to grow normally and to develop its musculature and strength, as well as the grasping action of toes. Of course, when walking outside or on rough surfaces, babies' feet should be protected in lightweight, flexible footwear made of natural materials.

Growing Up

As a child's feet continue to develop, it may be necessary to change shoe and sock size every few months to allow room for the feet to grow. Although foot problems result mainly from injury, deformity, illness, or hereditary factors, improper footwear can aggravate preexisting conditions. Shoes or other footwear should never be handed down.

The feet of young children are often unstable because of muscle problems which make walking difficult or uncomfortable. A thorough examination by a podiatrist may detect an underlying defect or condition which may require immediate treatment or consultation with another specialist.

The American Podiatric Medical Association has long known of the high incidence of foot defects among the young, and recommends foot health examinations for school children on a regular basis.

Sports Activities

Millions of American children participate in team and individual sports, many of them outside the school system, where advice on conditioning and equipment is not always available. Parents should be concerned about children's involvement in sports that require a substantial amount of running and turning, or involve contact. Protective taping of the ankles is often necessary to prevent sprains or fractures. Parents should consider discussing these matters with their family podiatrist if they have children participating in active sports. Sports-related foot and ankle injuries are on the rise as more children actively participate in sports.

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Podiatrist in Chelmsford and Newburyport, MA - Caroline Gauthier, DPM

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Podiatrist in Chelmsford and Newburyport, MA - Caroline Gauthier, DPM - New England Foot and Ankle Foot Doctor

http://www.nefootankle.com

Dr. Caroline Gauthier received her Bachelor of Science degree from McGill University, Montreal and her doctorate from Temple University School of Podiatric Medicine, Philadelphia. She completed a 3-year surgical training in reconstructive foot and ankle surgery at the Cambridge Health Alliance, a teaching affiliate of Harvard Medical School.

Dr. Gauthier has extensive training in adult and pediatric foot and ankle surgery including flatfoot and high-arch foot reconstruction, congenital foot deformity repair, arthroscopic surgery, lower extremity trauma, sport-related injuries, internal and external fixation, and diabetic limb salvage.

She is originally from Canada and speaks French fluently. Dr. Gauthier is a former ballet dancer and teacher. She continues to be physically active through running, aerobics, and scuba diving. She is an active member of the American Podiatric Medicine Association. She is on staff at Cambridge Health Alliance, Lowell General Hospital, Anna Jaques Hospital, Drum Hill Surgery Center, and Saints Medical Center.

Visit our website: http://www.nefootankle.com