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

Puncture Wound

Stepping on a thumbtack, nail or piece of glass is something that shouldn’t be taken lightly. Most people try to treat themselves at home, however any object that penetrates the skin can lead to an infection especially if the object is not clean.

A puncture wound can lead to cellulitis, an infection caused by streptococcus or staphylococcus bacteria. Cellulitis will cause swelling and redness to the skin. The infected area will be warm and painful to the touch and you may develop a fever. If the bacteria enter the bloodstream the infection can spread to the rest of the body and sometimes lead to a life threatening infection know as necrotizing fasciitis.

If you step on a nail, seek medical attention immediately. If your tetanus shots are not up to date, your physician will administer a tetanus shot to protect you against lockjaw, an infection that can cause your muscles to painfully contract.

Treatment
Come see us at the Foot & Ankle Doctors, Inc. within 24 hours after injury. We will remove the foreign object and take x-rays to ensure no pieces remain in the foot. We will clean the wound and monitor your progress during healing. In some cases antibiotics may be prescribed.

Complications
Infection is always a concern after a puncture wound. Signs of infection include warmth, redness, swelling, soreness and sometimes drainage. If the object penetrated to bone, a bone infection may occur. In some cases a painful scar or hard cyst may develop.

Dr. Nejad

Jones Fracture

We are sad to hear that Kevin Durant is suffering from a Jones fracture.  A Jones fracture is a common fracture of the 5th metatarsal (a long bone on the outside of the foot that connects to the little toe) commonly caused by an inward twisting injury of the foot. Durant most likely experienced pain, swelling and tenderness along the outside of his foot, had difficulty walking and may have had some bruising. It was crucial that Durant was diagnosed and treated immediately because the 5th metatarsal has a poor blood supply that impedes the healing process.

Nonsurgical treatments for Durant includes resting and icing, immobilizing his foot with a cast and avoiding placing any weight on his foot. Jones fractures can take 6 weeks to heal and another 2-3 weeks of rehabilitation to build up muscle strength and range of motion.

Most professional athletes opt to treat a Jones fracture operatively with a screw or plate placed across the fracture site to avoid the possibility of delayed healing or non-unions, which are frequent with Jones fractures.  It could be 8-12 weeks before Durant returns to the court if he decides to have surgery.

All of us at Foot& Ankle Doctors, Inc are wishing Durant a speedy recovery.

Dr. Dardashti

I Heard a “Pop” in my Foot

The plantar fascia is the largest ligament in the foot. Inflammation of the fascia leads to a condition called plantar fasciitis, which is a common cause of heel pain. When patients say they heard or felt a pop in the arch they most likely ruptured the plantar fascia and may have pain in the arch or in the heel. A popping noise is a good indication that something has torn. X-rays should be taken to rule out a fracture. Sometimes the tendon can avulse a piece of bone as it ruptures. An MRI should also be ordered to identify which tendon ruptured and if it was a partial or complete tear.

In general, a plantar fascia tear is treated with immobilization in either a cast or walking boot until the rupture heals. Physical therapy and a custom orthotics will be beneficial in the healing process. Surgery is rarely needed to repair a ruptured plantar fascia. Plasma rich platelet injections are an advanced biological treatment that is used to improve the overall healing quality and time.

It is important to avoid steroid shots near a tendon once it has been ruptured and to avoid certain antibiotics such as flouroquinalones that are associated with risks of tendon ruptures.

If you have recently heard a pop in your foot and are experiencing pain, come see us at Foot & Ankle Doctors, Inc.

Dr. Nejad

Ankle Injury After Motor Vehicle Accident

A common foot injury we see after a motor vehicle accident is a talar neck fracture.  Excessive dorsiflexion that occurs after slamming on the breaks commonly fractures the neck of the talus. The talus is a bone, which makes up part of the ankle joint. Three main arteries supply blood to the talus, the posterior tibial artery, the anterior tibial artery and the peroneal artery. When two of the three is disrupted avascular necrosis (AVN) occurs and upon weight bearing, the talus can collapse. If lucency is seen on x-rays 6-8 weeks after the injury this is known as the Hawkins sign, and is indicative of revascularization and viability of the talus. The most widely used classification of talar neck fractures is the Hawkins classification. There are four stages describing the severity of dislocation of the talus and its surrounding joints, and each stage predicts the severity of AVN.

Hawkins Classification

  • Stage 1:minimal displacement of talus, 7-15% chance of AVN
  • Stage 2: subtalar joint subluxation, 35-50% chance of AVN
  • Stage 3: ankle joint dislocation, 85% AVN
  • Stage 4: subtalar joint, ankle joint and talonavicular joint dislocation, 100% chance of AVN

Treatment

  • Cast immobilization and non-weight bearing
  • Fusion of the joints

If you have suffered from an ankle injury for a motor vehicle accident, come see us at Foot & Ankle Doctors, Inc.

Dr. Dardashti

 

My Bone Is Not Healing

Any time a bone is fractured, whether due to injury or for a surgical procedure there is a chance it may not heal. A diagnosis of delayed union is made when a fracture has not advanced at an average rate of healing for that particular type of fracture or osteotomy. On average it takes bone 3-6 months to heal. A nonunion diagnosis is established after 8 months if bone healing has ceased. Both delayed union and nonunion are due to variable factors such as:

  • Poor nutritional status
  • Increased activity levels
  • Tobacco use
  • Inadequate fixation
  • Impaired blood supply

Non-unions are classified into two categories based on the viability of the fracture ends. Hypertrophic or hypervascular non-unions have viable bone ends that are capable of healing. Atrophic or avascular non-unions have non-viable ends.

Treatment options for delayed unions include immobilization in a cast or CAM boot with the use of electrical bone stimulators to aid in promotion of new bone growth. Non-unions require a surgery to remove the devascularized bone ends. Once the dead ends are resected, a bone graft can be used to maintain the length of the bone. Immobilization and use of a bone stimulator will be utilized for 4 to 6 months.

For more information on bone healing come visit us at Foot & Ankle Doctors, Inc.

Dr. Nejad

 

Chronic Ankle Pain – Os Trigonum Syndrome

Ballet dancers, soccer players and individuals who frequently plantarflex their foot (point their toes downwards) may experience chronic ankle pain located at the back of their ankle. Os trigonum is an accessory bone located on the lateral process of the talus – the back of the ankle. Most individuals are unaware they have an os trigonum until it becomes symptomatic. Severe plantarflexion can cause the accessory bone to become crushed between the ankle bone and the heel bone. This motion results in injury to the ligamentous attachments of the accessory bone leading to pain and swelling. Individuals complain of a deep aching pain at the back of their ankle when walking or when pointing their foot.
Conservative treatment options include:

  • Rest to allow the inflammation to subside

  • Immobilization with an ankle support/brace/ boot

  • Ice to decrease swelling

  • NSAIDs such as ibuprofen to help reduce pain and inflammation

  • Corticosteroid injection to reduce inflammation and pain

If conservative treatment fails to alleviate symptoms, surgical excision of the os trigonum may be necessary.

If you or a loved one is experiencing chronic ankle pain, come see us at Foot & Ankle Doctors, Inc.

Dr. Dardashti

Bone Spurs in the Big Toenail

If you notice a soft pink mass on the tip of your big toe or sensitive area under the nail plate that is protruding and is painful when pressure is applied you may have a subungal exostosis. A subungual exostosis is a benign bone growth that arises from the dorsal surface of the distal phalanx (a small bone at the end of the toe) and causes pain and deformity of the nail.

Common causes for subungual exostosis include trauma, narrow shoes, previous nail surgery and certain biomechanical deformities such as a Hallux limitus.

At Foot & Ankle Doctors, Inc. x-rays of the foot will be taken to examine the bony growth and its involvement of the big toe. Differential diagnosis include: osteochondroma, Nora’s lesion, and osteosarcoma.

Conservative treatment includes purchasing a wider shoe and continuing with routine podiatric care.

Surgical removal is the recommended course of action. There are various surgical approaches and incisions that can be used to remove the bony prominence depending on its severity. In most cases the big toenail is removed to gain access to the bony prominence, which is then cut out. A surgical shoe will be dispensed and should be worn for 1-2 weeks.

Dr. Dardashti

Puncture Wound

Stepping on a thumbtack, nail or piece of glass is something that shouldn’t be taken lightly. Most people try to treat themselves at home, however any object that penetrates the skin can lead to an infection especially if the object is not clean.

A puncture wound can lead to cellulitis, an infection caused by streptococcus or staphylococcus bacteria. Cellulitis will cause swelling and redness to the skin. The infected area will be warm and painful to the touch and you may develop a fever. If the bacteria enter the bloodstream the infection can spread to the rest of the body and sometimes lead to a life threatening infection know as necrotizing fasciitis.

If you step on a nail, seek medical attention immediately. If your tetanus shots are not up to date, your physician will administer a tetanus shot to protect you against lockjaw, an infection that can cause your muscles to painfully contract.

Treatment
Come see us at the Foot & Ankle Doctors, Inc
. within 24 hours after injury. We will remove the foreign object and take x-rays to ensure no pieces remain in the foot. We will clean the wound and monitor your progress during healing. In some cases antibiotics may be prescribed.

Complications
Infection is always a concern after a puncture wound. Signs of infection include warmth, redness, swelling, soreness and sometimes drainage. If the object penetrated to bone, a bone infection may occur. In some cases a painful scar or hard cyst may develop.

Dr. Farshid Nejad

Fracture Healing

All broken bones in the body undergo a natural healing process. Bone healing is a slow process and can take up to 8 weeks. Immobilization and compression is necessary for optimal bone healing.

There are four phases of bone healing

  • Inflammation: occurs within the first 48 hours. Swelling can help provide stability
  • Soft callus: occurs during the first two months. Fibrous tissue and cartilage tissue develop at the ends of the fracture site
  • Hard Callus: occurs during the 3rd and 4th month. The soft callus is replaced with bone and is visible on x-ray
  • Bone remodeling: Lasts for several months. The bone continues to return to its normal shape. Bone can regenerate back to 100% of its strength after a fracture

At Foot & Ankle Doctors, Inc we like to immobilize patients with fractures. Immobilization is an important part in promoting bone healing. Depending on the type of fracture a surgical shoe or boot may be used. In more severe cases surgery may be needed to fixate the fracture site with screws, plates or wires. A cast will be applied afterwards and physical therapy recommended once the bone is adequately healed.

Factors that Impair Bone Healing

  • Early weight bearing
  • Smoking
  • Fracture ends greater than 1cm apart
  • Poor nutrition
  • Certain medications

If bone healing is slow or delayed, our physicians can provide a variety of treatments to enhance bone growth such as bone stimulators, use of bone growth proteins and bone grafts.

Dr. Dardashti