Hyperbaric Oxygen

Hyperbaric oxygen treatments  (HBOT) have been effective in treating hypoxic wounds. Wounds need an optimal environment of nutrients and oxygen to promote new cell growth and healing. Chronic wounds take years to heal because the blood circulation to the wound area has diminished. As a result of poor blood flow the wound has a poor supply of nutrients and oxygen. Hyperbaric oxygen therapy has been used to heal chronic wounds by placing patients in a chamber of 100% pure oxygen. During the HBO treatment and up to 4 hours afterwards, the oxygen is dissolved in the blood and carried to the wound site. As a result new blood vessel production occurs which helps with collagen and epithelial formation at the ulcer site to increase healing time. Patients are placed in an HBO tank for no longer than 90 minutes. HBOT can also be used for:

  • Diabetic ulcers
  • Wound healing
  • Burns
  • Gas gangrene
  • Necrotizing infections
  • Compromised or failed skin grafts and flaps

For more information about HBOT, come see one of our physicians at Foot & Ankle Doctors, Inc

Dr. Dardashti

 

 

 

Viscosupplementation for Ankle Arthritis

Osteoarthritis is the most common forms of arthritis. It occurs over time as the cartilage on the ends of bones wears down resulting with bone on bone grinding. Osteoarthritis worsens with time and patients often experience pain, stiffness, loss of flexibility, grinding sensation and formation of bone spurs. Currently there is no cure, and maintaining a healthy weight and healthy lifestyle can help slow the progression.

Knee and ankle implants have a lifespan of 10 years and is often reserved as a treatment option for later in life. An alternative treatment option is the use of hyaluronate injections. Hyaluronate sodium is a derivative of hyaluronic acid a natural substance that surrounds joints. The fluid acts as a lubricant and shock absorbent protecting joints. Over a course of four to eight weeks the use of hyaluronate injections may reduce the need for a joint replacement and help promote production of synovial fluid. In a diseased arthritic joint the production of hyaluronate decreases leading to mechanical destruction of the joint and pain. At the moment hyaluronate products are considered as off-labeled use in the ankle joint, but FDA approved for the knee joint. There are six major trade name products: Euflexxa, Gel-one, Hyalgan, Supartz, Synvisc, Orthovisc. Most of these products are injected into the ankle joint 3 times a week. Patients can return to normal daily activities but should postpone strenuous activities for 48 hours after the injection. For more information about viscosupplementiation come see one of our physicians at Foot & Ankle Doctors, Inc

Dr. Dardashti

Septic Arthritis

Septic arthritis is a painful infection of a joint cavity, most commonly caused by bacteria. The knee and ankle are common joints in the lower extremity to be infected. The joint cavity is a sterile environment containing synovial fluid. Infection of the joint can occur from either:

  1. Direct penetration into the joint (ie. an injection)
  2. Hematogenously from bacteria in the blood
  3. Other routes such as trauma or surgery

Septic arthritis can cause rapid destruction leading to permanent damage of a joint, thus requires immediate attention. A septic joint typically presents with a fever and a red, hot, swollen joint that is extremely painful to move. Diagnosis is performed via synovial fluid aspiration. The fluid is analyzed for the following tests: clarity, color, presence or absence of crystals, cultures, glucose levels, mucin clot, white blood cell count and viscosity.

Acute joint sepsis requires admission to the hospital for prompt IV antibiotics. An arthrocenteses should be performed every other day to monitor response to therapy and to help remove the infection.

If you think you have a septic joint, go to the emergency department immediately. For more information contact us at Foot& Ankle Doctors, Inc.

Dr. Nejad

Permanent Nail Removal

If you suffer from recurrent ingrown toenails or thick painful nails, come talk to one of our physicians at Foot & Ankle Doctors, Inc to discuss a permanent nail removal. Toenail removal can be partial, complete or permanent. With permanent removal the matrix that causes the nail to grow is removed or destroyed. Chemical cauterization involves cutting the desired amount of nail off and applying phenol or sodium hydroxide to the nail matrix. The chemical acts as a cauterization and destroys the matrix forming scar tissue preventing nail from growing back.  If chemical cauterization is not successful, the matrix is removed surgically. This involves surgically creating a skin flap at the base of the nail to access the nail matrix for removal. The flap is then sutured and the nail bed is allowed to heal.

After surgical removal of the matrix, the nail plate will not grow back. The body will produce hard-thickened skin in place of the nail. When the skin covering has developed and healed, normal activities can be resumed. Some women choose to paint over their thickened skin with polish to resemble a nail.

Come see us for more information

Dr. Dardashti

 

Skin Grafts

Skin grafts are commonly used for ulcers, burns, wound dehiscence, amputation, and surgical excision. The best types of skin graft are those that come directly from the patient. These grafts are known as autografts, auto meaning self. These grafts are safest to use and heal faster than other types of grafts. The only pitfall with using an autograft is that a second wound is created when harvesting the graft from a different site.

There are split thickness grafts and full thickness grafts. Split thickness grafts contains the epidermis and dermis where as a full thickness graft contains more layers of the skin. Split thickness grafts are more commonly used because they are less likely to form a contracture over time. The thickness of a skin graft depends on what area of the body is harvested. For example the skin of the outside of the thigh is thicker than the inside of the thigh.

Types of Split Thickness Grafts

Thin:                             0.008-0.011 inches
Intermediate:                0.012-0.014 inches
Thick:                           0.015-0.024 inches

Graft healing occurs in 4 phases:

  1. Plasmatic Stage (24-48hrs): the graft adheres to the bed
  2. Inosculation (end of 48hrs): vascular network forms connecting the vessels to the new graft to restore blood flow. The graft will turn a pink hue color
  3. Capillary Ingrowth: capillary network penetrates into the graft
  4. Maturation: lymphatic channels and nerves develop

Most grafts fail within the first 72 hours as a result of inadequate adherence that disrupts the blood supply from establishing. A hematoma and seroma can separate the graft from the bed and disrupt ingrowing vessels. It is important to have a compression dressing applied and to leave it intact for a week and limit motion to the area. Infection can also result in graft failure.

For more information on grafts and how they are harvested come see us at Foot & Ankle Doctors, Inc

Dr. Dardashti

 

Treating Foot Drop

Foot drop is not a disease, rather a sign of an underlying neurological or muscular condition. Foot drop is defined as the inability to dorsiflex the foot. It is further characterized by numbness and loss of function. Individuals with foot drop have a unique tiptoe walk. During the gait cycle some may drag their toes along the ground and others raise the leg higher than normal and slightly bend the knee to prevent the foot from dragging or slapping against the ground.

The classic foot drop is caused by damage to the common peroneal nerve that weakens the anterior and lateral muscle groups. Other causes include: nerve compression from a lumbar disc herniation, injury to the sciatic nerve, gunshot wounds, crush injuries, tumors or lower motor neuron diseases such as poliomyelitis and Charcot-Marie-Tooth disease.

Our physicians at Foot & Ankle Doctors, Inc. will perform an extensive workup before diagnosing a patient with foot drop. A compressive history and physical examination will be performed. We ask our patient to walk so we can examine leg muscles for weakness and observe how the patient is compensating for the muscle imbalance. Imaging test such as: x-ray, CT and MRI can help pinpoint various causes. A nerve conduction test called an electromyography (EMG) measure electrical activity in the muscles and nerves and are useful in determining where and which nerve is damaged.

Treatment options include:

  • Braces or splits – these will fit into the shoe and help hold the foot up assisting with ambulation
  • Physical therapy – exercises can strengthen the muscles and maintain range of motion
  • Nerve stimulation – stimulating the nerve can help recondition the nerve and improve the severity of foot drop
  • Surgery – a physician may recommend nerve grafting, nerve transfer or tendon transfers depending on the cause of the foot drop

Dr. Nejad

Schwannoma

A Schwannoma is a benign tumor arising for the covering of nerve sheath. These tumors do not invade the nerve, but rather simply lie on top of the nerve sheath. The cause of it is unknown and can elicit a variety of symptoms. Some patients experience no symptoms at all, and only notice a lump on the bottom of their foot. Other patients experience shooting pain and numbness to the area, and symptoms worsen as the tumor grows.

Imaging modalities can be used to help identify the lesion. MRI will reveal cystic fluid collection in the affected area.

The lesion must be surgically excised and sent to pathology for evaluation. After surgery symptoms should subside. Early diagnosis of this lesion is important in preventing long-term nerve damage.

If you questions or concerns about an abnormal lump or bump on your feet come see us at Foot & Ankle Doctors, Inc

 

Dr. Dardashti

Correct Your Hammertoes Without Going to the OR

Hammertoes are a painful and progressive deformity that commonly results from a muscle or tendon imbalance. There are tendons that run on top of toes known as extensors, which are responsible for pulling the toes up. There are also tendons that run on the bottom of toes known as flexor tendons that pull the toes down. When the flexor tendons become stronger than the extensor tendons the toes contract creating a hammertoe.

Patients often complain of pain when wearing shoes, contracture of toes, corns and calluses that form on top of the toes where the contracture is occurring and in between toes.

Flexor tenotomy is a quick, minimally invasive procedure with few complications or risks. There are no sutures needed or dressings that need to be changed. Patients will have a reduction in pain and do not need to take time off work. Flexor tenotomies give instant results, however it is not meant to be a cosmetic fix.

Local anesthetic will be administered to the toe before the procedure begins. Once the toe is numb a small stab incision will be made on the bottom of the toe with a needle. The needle is moved back and forth in a sweeping motion to cut the fibers of the flexor tendon. The toe will aggressively be moved up and down to ensure the fibers have been cut. Once the tendon has been cut the toes will immediately straighten and have increased flexibility. Patients will be shown how to splint their toe with adhesive strapping and educated on stretching the toe upwards.

If you are suffering from painful toes come see us at Foot & Ankle Doctors, Inc

Dr. Nejad

Embarrassing Sweaty Feet

At Foot & Ankle Doctors, Inc we understand that sweaty feet can be an embarrassing and stressful problem, and worrying about it makes the sweating worse. Hyperhydrosis is the term for excessive sweating of the feet and is more common in men than women. The cause of hyperhydrosis is unknown, some believe it is an inherited problem.

Hyperhydrosis can cause the feet to turn a whitish color. The excess sweat can break down the skin and increase risk of infection. Odor and fungal infection are commonly associated with hyperhydrosis.

Treatment options are tailored towards the severity of the symptoms. Various treatments include:

  • Antiperspirants: plug sweat glands and prevent the body from producing excess sweat
  • Iontophoresis: a low electrical current is used to temporarily “shut off” sweat glands
  • Botulinum toxin: works by blocking a chemical that stimulates sweat glands
  • Prescription medication: prevent sweat glands from working
  • Surgery
    • Surgical removal of sweat glands
    • Sympathectomy: destroying nerves that send signals stimulating sweat glands

Good hygiene is essential. Washing your feet and between your toes daily with antibacterial soap will help prevent infections. Dry your feet well after showering and apply a foot powder or antifungal powder. Change your socks daily or multiple times during the day. It is best to wear socks made with acrylic fiber, which will help wick away moisture and keep your feet dry.

At Foot & Ankle Doctors, Inc we can help ease your anxiety about hyperhydrosis and help control the problem.

My Child is Toe Walking

Toe walking in children is always a concern for parents. Children who walk normally for a period of time and then start to toe walk should be evaluated. A medical history, family history, gait evaluation, musculoskeletal examinations are necessary to determine the cause of toe walking. Toe walking can be attributed to:

  • Equinus (tight calf muscle)
  • Muscular dystrophies
  • Peripheral neuropathy
  • Spinal cord pathology
  • Acquired contractures
  • Cerebral palsy

If your child began toe walking from the first time they started walking you can try placing your child in high top shoes/boots with stiff soles. This prevents your child from being able to walk on their toes and their heel won’t slip out from the back. If toe walking persists, come see one of our physicians at Foot & Ankle Doctors, Inc. An ankle foot orthosis (AFO) may need to be custom fitted for your child. This device is a rigid plastic that runs from the foot all the way up to the back of the calf muscle. This prevents motion at the ankle and again, limits the child’s ability to walk on their toes. If the calf muscle is tight and is contributing to your child’s toe walking, physical therapy can be prescribed as a modality that will help stretch and strengthen the calf muscle.

If you notice your child toe walking come see us for a full evaluation of your child. It is important to rule out more serious causes of toe walking other than a tight calf muscle. It is helpful if you videotape your child toe walking to evaluate their gait pattern.

Dr. Dardashti