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

Emergent Gas Gangrene

Gas gangrene is an emergent case where a bacterium, most commonly Clostridium perfringens grows inside the body and produces harmful toxins and gas causing tissue death. It can be caused by other bacteria such as Group A streptococcus, Staphylococcus aureus and Vibro vulnificus.

Gas gangrene most often occurs at a wound site, recent surgical site or trauma site. It can develop suddenly and rapidly accelerate causing irreversible tissue damage.

Symptoms of Gas Gangrene

 Change in color of the skin to a pale to brownish-red color

 

 Crepitus– gas can be felt as a cracking sensation when pressing on the swollen area

 

 Brown fluid filled blisters

 

 Fever

 

 Sweating

If not treated immediately a person can go into shock which will lead to kidney failure and eventually lead to death.

Diagnosis

Gas Gangrene can be diagnosed by clinical examination. To confirm the presence of Clostridium bacteria a tissue culture may be taken. Blood cultures can also be used to determine a bacteria infection. X-rays can be used to identify the presence of gas in the soft tissue.

Treatment

Gas gangrene is an emergent case and surgical intervention is required. Surgical debridement of the damaged and infected tissue must be removed. In severe cases partial amputation may be required to prevent further spread of the infection. IV antibiotics will be prescribed. In some cases hyperbaric oxygen (HBO) treatment may be implemented. Clostridium bacteria cannot survive in an oxygen rich environment and therefore HBO can be used to kill the bacteria.

Dr. Farshid Nejad

Pediatric Clubfoot

Every 1 in 1,000 births a child is born with a clubfoot, which can be devastating to parents. Pediatric clubfoot is curable and if the deformity is corrected early, children born with clubfoot are indistinguishable from other children with normal feet.

 

What is Clubfoot?

 

Clubfoot occurs when a child’s foot is turned inwards and the heel points downwards. In 50% of cases the deformity can occur in both feet. The calf muscles of the affected side are smaller than normal. Clubfoot is a congential deformity, meaning the child is born with the condition.

 

Causes

 

 Clubfoot is most often idiopathic (no apparent cause)

 

 Associated with genetic syndromes and birth defects

 

 Result from a neuromuscular disorder

 

Treatment

 

The “Ponseti” casting method is the preferred method for treating pediatric clubfoot. Treatment should begin within the first month of life for best results. The child’s foot is manipulated into the correct position through a serious of casting. 6-8 leg casts are applied every 5-7 days to slowly correct the deformity overtime. In some cases a small cut may be made to the heel cord to release contracture of the Achilles tendon. After the casting series is completed a special brace is required to be worn during naps and at night until the age of 4.

 

Clubfoot is visible at birth and can be detected by fetal ultrasound. If your child has been diagnosed with clubfoot come see us at Foot& Ankle Doctors, Inc for more information.

 

Dr. Dardashti

Neuropathic Joints

Charcot is a condition in patients who have neuropathy or loss of sensation. Charcot can lead to fractures and dislocations in the foot and ankle. As the disease progresses the joints collapse and the foot can take an abnormal shape known as a rocker-bottom foot. Diabetes is the most common cause of Charcot because diabetes is associated with poor blood flow, causing weakening of bones, and neuropathy, which is the main cause of Charcot. Other causes and risk factors include repetitive microtrauma and patients with peripheral neuropathy secondary to:

– Chronic alcoholism

– Leprosy

– Syphilis

– Poliomyelitis

Symptoms

There are various stages of Charcot and symptoms will vary depending on the stage of the deformity.

Stage 1: Red, hot, swollen foot/ankle.

X-rays show soft tissue edema and bony fragments

Stage 2: Decreased local edema foot/ankle

X-rays reveal coalesence of bony fragments

Stage 3: No local edema

X-rays show consolidation and remodeling of the bone

Imaging

In addition to reviewing your overall health, symptoms and discussing your medical history, our physicians at Foot& Ankle Doctors, Inc may order various imaging tests for further detailed pictures of your foot or ankle.

X-rays:

In early stages of Charcot, x-rays may appear normal. As the disease progresses the bones may fracture or dislocate. As a result repeat x-rays may be taken several weeks later.

MRI:

Ordered to evaluate soft tissue and when a bone infection is suspected

Bone Scans:

Helpful to differentiate between Charcot and infection. Charcot and an infection are positive on a technetium bone scan, however infection will only produce a hot spot on an indium bone scan and Charcot will not.

Non-Surgical Treatment

– Immobilization is important in the early stages of Charcot to protect the bones

from stress and shear forces that can further damage the bones

– Total contact cast changed every 1-2 weeks for 2-4 months

– Charcot restraint orthotic walker (CROW) boot

Custom Shoes designed to decrease the risk of ulcers

– Rocker bottom shoes will help reduce the risk of ulceration

Surgical Treatment

Depending on the type and extent of the deformity surgery may be recommended

Dr. Dardashti

Melanoma of the Foot

Melanoma is a serious skin cancer that can affect people of all ages.  Exposure to UV radiation from the sun or tanning beds can increase your risk of developing melanoma. However, melanoma can occur anywhere on the body, even on less sun-exposed areas such as the soles of your feet.

Signs and Symptoms

  • Change in an existing mole

  • Development of a new pigmentation that grows over time  – predominately brown, black or blue in color and in some cases red

 

To help identify characteristics of unusual moles or spots on the body use the mnemonic ABCDE:

  • Asymmetry – Melanoma is asymmetric

  • Border – Melanoma is will have an irregular border or edge that is typically ragged

  • Color – Melanoma is typically a mix or colors rather than one solid color

  • Diameter – Melanoma grows in diameter where benign moles remain the same size. A mole larger than 5mm, the size of a pencil eraser should be seen by a physician

  • Evolving over time – change in color, size, shape or symptoms (itching tenderness or bleeding)

 

Diagnosing Melanoma

To accurately diagnose melanoma a biopsy should be taken and analyzed by a pathologist

  • Punch biopsy – a tool with a circular blade is pressed into the skin around the suspicious mole or pigmented area to remove a round piece of skin

  • Excisional biopsy – the entire mole or pigmented area is removed

  • Incisional biopsy – only parts of the irregular mole or pigmented area is taken for analysis

 

Prevention

  • Use adequate sunscreen on areas of the body not covered by clothes or shoes

  • Wear a wide brimmed hat and sunglasses

  • Wear water shoes that provide protection

  • Inspect your feet daily

  • Remove nail polish to inspect the toenails

 

Early detection of malignant melanoma is key. If you notice any changes in size of a mole on your foot or new pigmentations/discolorations come see us at Foot& Ankle Doctors, Inc.

 

Dr. Nejad

Extensor Hallucis Longus Tendon Injury

We all have our clumsy moments where we accidentally drop something on our foot. The top of the foot lacks a lot of fat or padding to protect vital structures such as arteries, nerves and tendons which makes dropping a piece of glass, metal or plastic worrisome. Pain, swelling, bruising and bleeding are common symptoms of injury to the foot. If you notice the inability to move your big toe up towards the ceiling you may have severed your extensor hallucis longus (EHL) tendon and should come to see one of our physicians at Foot& Ankle Doctors, Inc.

 

Severing the EHL can be treated conservatively or surgically depending on the severity of the injury. If the EHL tendon ends are close enough to each other conservative care would include a non-weight bearing cast for 6 weeks. This would allow the two torn tendon ends to heal together.

 

If the tendon ends are far apart surgery will be required to sew the two ends together or a tendon graft may be necessary to bridge the gap and restore tendon alignment and function.

 

Dr. Dardashti

Avoid Overuse Injuries This Spring

Spring is around the corner and many of us are ready to get back into shape and hit the pavement with the first spring thaw.  Many of us haven’t hit the gym for months and it’s important to get back into the routine of working out slowly to prevent overuse injuries.


Overuse injuries occur over time with repetitive microtrauma to tendons, bones and joints. Common overuse injuries in the lower extremities include runner’s knee, jumper’s knee, Achilles tendinitis and shin splints.


Causes of overuse injuries include

  • Training errors – over training or increasing acceleration, intensity, duration or frequency too quickly instead of gradually over time

  • Form error – improper technique or shoe gear can lead to injury overtime

  • Returning to a sport or activity too soon after injury

  • Biomechanical and individual factors – body alignment and foot structure can predispose individuals to overuse injuries


Treatment of overuse injuries can be remembered by the mnemonic RICE-AR

  • Rest – complete rest from the activity may be necessary or cross training with a different sport/activity

  • Ice – apply ice to injured area for 15 minutes a day

  • Compression – apply an ACE bandage or elastic wrap after icing to prevent further swelling

  • Elevation – elevate the injured extremity above the level of the heart when resting

  • Anti-inflammatory medication – ibuprofen or Tylenol can be taken to reduce inflammation

  • Re-condition – stretching and strength training are important steps in rehabilitation and preventing future injury


If you suspect you have an overuse injury, consult one of our doctors at Foot& Ankle Doctors, Inc.


Dr. Nejad

Toe Injuries Are Not Just For High Athlete Performers

Athletes involved with high impact sports will often suffer from toe injuries. Sports fans will remember when Pierre Garcon and Taylor Martinez both suffered from a plantar plate tear. Although a lot of us are not professional athletes we too can suffer from plantar plate tears.

The plantar plate is a ligament located on the bottom of the toes. It is responsible for cushioning the ball of the foot when walking and running and prevents hyperextension of the toes. With repeated overuse the ligament can stretch and tear and lead to a predislocation syndrome also known as a crossover toe deformity or a floating toe syndrome. Plantar plate tears most commonly affect the second toe.

Symptoms of a plantar plate tear:

  • Persistent pain at the ball of the foot

  • A toe that is changing position – lifting up or crossing over

  • Swelling

Plantar plate tears can be difficult to diagnose. Common misdiagnoses include a neuroma, tuff toe or a stress fracture. If you were given one of these diagnoses and you are unresponsive to treatment, ask your doctor about the possibility of a plantar plate tear.

At Foot& Ankle Doctors, Inc we will first offer conservative treatment options:

  • Rest

  • Ice

  • Anti-inflammatory medication

  • Accommodative padding to alleviate pressure from the ball of the foot

  • Plantarflexion strapping of the digit to hold it in place

  • Orthotics and stiff soled shoe or rocker-bottom shoes may be recommended

If conservative treatments fail, surgery may be required to repair the ligament.

 

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

Tarsal Coalition In Children

If your child is complaining of foot or ankle pain that is unexplained by an injury come see us at Foot & Ankle Doctors, Inc where our physicians will examine for a tarsal coalition. Tarsal bones are bones located in the middle of the foot, the heel and the ankle. A tarsal coaltion occurs when there is an abnormal connection between two or more of these bones. This condition is usually present at birth, but your child may not show symptoms until later in life, usually around ages 9 to 16. Children with a tarsal coalition display the following symptoms

 

 Limp when walking

 

 Experience stiffness around the ankle and has decreased range of motion

 

 Tired legs

 

 Muscle spasms in the legs

 

 Flatfoot can be present in one or both feet

 

An x-ray and advanced imaging studies may be required to fully evaluate the condition before treatment is made. The goal of treatment is to reduce pain in your child’s foot. Our physicians at Foot & Ankle Doctors, Inc will take a conservative approach first by offering

 

 Physical therapy to increase range of motion

 

Custom orthotic devices to stabilize the foot and relieve pain

 

 Immobilization to remove stress from the foot and allow painful areas to rest

 

 Oral medication to reduce pain and inflammation

 

 Steroid injections to reduce pain and inflammation

 

If pain persists with conservative treatment, surgical intervention may be needed.

 

Dr. Dardashti