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
- 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
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
Retrocalcaneal refers to “behind the heel bone.” Bursitis means inflammation of a bursa, which is a fluid filled sac commonly found between tendons and bones. Retrocalcaneal bursitis is a common problem in athletes and is often associated with Achilles tendonitis.
- Pain at the back of the heel with running or with impact activity
- Pain with closed heel shoes
- Tenderness and swelling at the back of the heel
- Pain with side to side compression of the Achilles tendon
The bursa allows the Achilles tendon to smoothly glide over the heel bone without pain. An increase in pressure, friction, impact activity or change in shoe gear can cause the bursa to become inflamed. A tight Achilles tendon or heel spurs are the main contributing factors of retrocalcaneal burisits.
A bursitis in general responds well to conservative treatment. Athletes are encouraged to rest and avoid impact activities. Cross training exercises such as bicycling, elliptical and rowing are a few alternative activities to running. Icing, anti-inflammatory medications and ultrasound can help reduce inflammation and swelling. An off-loading pad such as a donut shaped pad can be placed over the Achilles tendon to relieve pressure from the bursa. Stretching the Achilles tendon and use of heel lifts or a high-heeled shoe will decrease the pull of the Achilles tendon and thus reduce inflammation and swelling of the bursa. In some cases a small amount of cortisone can be injected into the bursa, but it is crucial that the cortisone be injected into the bursa, and not the Achilles tendon as it can cause a rupture of the tendon. An alternative to cortisone is Traumeel, a natural anti-inflammatory medication that can be injected into the bursa with no risk of rupturing the Achilles tendon.
For more information about retrocalcaneal bursitis, come see one of our physicians at Foot & Ankle Doctors, Inc
Pistons backup guard, Spencer Dinwiddie is expected to be out until early March with an ankle sprain according to reports by CBS Sports. A syndesmosis injury is common with an excess twisting motion of the ankle. It doesn’t sound like Dinwiddie is suffering from a syndesmosis injury, but it is something to consider with ankle injuries.
The syndesmosis is composed of three ligaments that provide stability to the ankle joint. These ligaments can become stretched, torn or detached if the ankle bones are broken. If an individual is unable to bear weight on their ankle it could be a sign of a syndesmotic injury.
At Foot & Ankle Doctors, Inc we check the integrity of the syndesmosis by performing provocative clinical exams such as the Squeeze test and the external rotation stress test. Radiographs, CT and MRI imaging can be used to detect syndesmotic injuries if clinical examinations are positive for an injury. Non-weight bearing in a CAM boot or cast for 2-4 weeks can treat syndesmosis injuries non-operatively. Operative treatment options depend on the type of syndesmotic injury but include: screw fixation, and tightrope fixation.
For more information come see us at Foot & Ankle Doctors, Inc
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:
- Direct penetration into the joint (ie. an injection)
- Hematogenously from bacteria in the blood
- 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.
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
Kansas City Chiefs tight end Travis Kelce suffered an ankle sprain on August 31 during practice. Fortunately, his injury is nothing but a low-grade sprain and won’t keep him from playing the regular season.
Ankle sprains are common sports injuries. A sprain occurs when the ankle rolls outward and the foot turns inward and rolls under the leg. This causes the ligaments on the outside of the ankle to stretch and tear resulting in pain, swelling and bruising. The most common injured ankle ligaments are the anterior talofibular ligament, which connects the talus to the fibula and the calcaneal fibular ligament, which connects the fibula to the calcaneus.
The severity of the ankle sprain determines the course of treatment.
- Grade 1 sprain: slight stretching of the ligament
- Grade 2: partial tearing of the ligament
- Grade 3: complete tear of the ligament
Treatment in the first 48 to 72 hours consists of following the R.I.C.E guidelines
- Ice for 20 minutes every 2-3 hours
- Compression with an ACE wrap
- Elevate leg above the level of the heart
- Depending on the severity of the sprain and the degree of ankle instability, you may need a cast or walking boot to immobilize your ankle so that it can heal properly. In rare cases of severe ligament tears, you may require surgery to repair the damage.
Based on reports Kelce suffered a low grade sprain and will make a full recovery and return to normal activities. To prevent future ankle sprains or ankle instability it is important for Kelce to restore his ankle’s flexibility, range of motion and strength.
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:
- Plasmatic Stage (24-48hrs): the graft adheres to the bed
- 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
- Capillary Ingrowth: capillary network penetrates into the graft
- 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
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
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