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.
Toenail fungus is an embarrassing problem and many patients are willing to try something new to cure their yellow discolored nails. JUBLIA is a new topical solution that has successfully made a splash in the media and has many patients requesting it.
When talking about curing fungal nails, there are two types of cures, a clinical cure and mycological cure. Clinical cure means that the nail looks clear of fungus, however if a sample of the nail were taken it would reveal the presence of a fungal infection. Mycological cure means that the nail is no longer infected with fungus. Ideally you want both a clinical and mycological cure, however many patients are satisfied with just a clinical cure.
JUBLIA has to be applied every day for 48 weeks and in two separate clinical studies JUBLIA only had a 18%-26% clinical cure rate. It can also cost up to $400 for a 4ml bottle if not covered by insurance, and you would need to buy more than one bottle during the 48 weeks.
There are fewer side effects to using JUBLIA than an oral medication, however the price and cure rates are not impressive and nothing to boast about.
Other treatment options for fungal nails include:
- Oral antifungal medications
- Laser and light therapies
- Nail removal
- Medicated nail polish
- Medicated nail cream
- Natural or home remedies: Vicks VapoRub, snakeroot extract, tea tree oil
If you are concerned about your fungal nails come visit us at Foot & Ankle Doctors, Inc.
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.
Tight end, Randall Telfer for the Cleveland Browns was placed on the reserve list. We are hopeful he has recovered from his Lisfranc injury back in December.
A Lisfranc injury involves the joints and ligaments in the middle of the foot. A simple fall or twisting motion of the foot can tear the ligaments at the joint of the midfoot. There are three types of Lisfranc injuries, which can occur in combination:
- Sprain: ligaments that connects the metatarsal to the tarsal bones in the midfoot can be stretched (sprained) or torn leading to instability
- Fracture: Ligaments connects bone to bone. In some cases the force of the injury can cause the ligament to avulse a piece of bone resulting in a midfoot fracture
- Dislocation: The bones of the Lisfranc joint become unstable and buckle or shift out of place
Telfer tried treating his injury conservatively and postponed surgery until February. The goal of surgical treatment is to adequately realign the joints and return the broken bone fragment(s) to a normal position. The bones are reduced and held in correct alignment with plates or screws. In severe cases where the joint cannot be reduced back to its original position, a fusion of the bones is recommended so the bones heal into a single, solid piece.
After surgery, Patients are non-weight bearing for 6 to 8 weeks in a cast or boot. Weight bearing commences once the x-rays reveal proper bone healing.
Out staff at Foot& Ankle Doctors, Inc hope Telfer can return to the field without further injuries.
Corey Peters, defensive tackle for the Arizona Cardinals is out for the 2015 season after tearing his left Achilles tendon. Peters recovered from a 2013 torn right Achilles, and unfortunately has to endure the same road of recovery again.
The Achilles tendon is the largest tendon in the body. It connects the calf muscle to the back of the heel. The Achilles helps to raise the heel off the ground and is used with every step and jump we make. The Achilles tendon can be partially torn or completely torn when the tendon is stretched beyond its capacity. As a result it can no longer function normally.
Most individuals report a sudden pain and a popping or snapping sound after tearing their Achilles tendon. Tears are commonly caused by a trip, fall, sudden pivot or sudden acceleration when running.
The tendon ends start to retract 3-4 days following rupture and therefore is crucial that the injury be treated non-surgically with a cast or surgically repaired. Surgical intervention will provide a faster return to activity and decreases the chance of re-rupture in the future. Peters’ surgeon will decide which surgical repair method is best suited for him. It will take 6-8 weeks to recover from surgery followed by physical therapy/rehabilitation.
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.
- 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
- 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.
Kevin Durant suffered a Jones fracture back in October 2014, the same injury that ended former NBA center Yao Ming’s career. A Jones fracture is a break in the bone of the 5th metatarsal, a long bone on the outside of the foot. Durant had undergone surgery and a screw was inserted into the bone. Unfortunately, Durant complained of discomfort and his doctor discovered the screw head was rubbing against the cuboid bone, a bone that sits behind the base of the 5th metatarsal, and was causing discomfort and irritation. The original screw was taken out and replaced, however the revisional surgery fell short of the desired outcomes. With little success of healing his broken bone, Durant agreed to a third surgical procedure where a non-FDA approved bone graft would be used. Durant’s surgeon used Medtronic INFUSE Bone-Graft, a graft that is FDA approved for use in the cervical area of the spine, but not in the foot. INFUSE bone graft is a synthetic protein that helps grow new bone, however it is associated with many side effects such as: infection, bone and nerve injury, male sterility, increased cancer risk and more.
Durant’s radical surgery has so far been worth the risk as he has been cleared to play. Durant’s bone will continue to remodel for a year and all of us at Foot & Ankle Doctors, Inc. wish him a full recovery.
It was recently announced that Baltimore Ravens tight end, Allen Reisner is suffering from a “ broken ankle,” also referred to as an ankle fracture. Our staff at Foot & Ankle Doctors, Inc. are saddened to see an NFL player injured so early in the season and hope Reisner makes a full recovery.
The ankle joint is composed of three bones: the tibia, the fibula and the talus. Regardless of which bone(s) are broken, ankle injuries can take up to 6 weeks to heal. A twisting or rotation motion of the ankle, rolling the ankle, tripping or falling and high impact accidents are causes of ankle fractures. Reisner most likely experienced swelling and immediate pain after his injury. It is unlikely he was able to place any weight on his injured ankle. Doctors caring for the athlete more likely than not x-rayed his ankle and performed various stress tests to determine which ligaments were injured. CT and MRI images may have been ordered for further work up of his ankle.
We are unsure of the details of Reisner’s injury, however reports state that he has undergone surgery. We assume his fracture was severe enough to require an operation for stabilization of his ankle. It will take several months of rehab before Reisner can make a full recovery.
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.
Individuals under the age of 20 who complain of pain, and swelling in long bones for less than 3 months should be evaluated for an aneurysmal bone cyst (ABC). ABC is a benign bone tumor commonly found in long bones. It is more frequently present in younger individuals between the ages of 10 to 20. ABCs are blood filled expansile lesions that cause pain as the cavity fills with fluid.
An ABC is generally induced by major or minor trauma that results in a vascular anomaly in the long bone. In a small percent of cases it is associated with a pathological fracture.
Radiographic images will reveal an eccentric “blow-out” or “soap bubble” lesion in the metaphysis of long bone. It is often difficult to differentiate an ABC from malignant bone tumors, and MRI imaging is needed to confirm findings on x-ray.
Treatment involves curetting the cavity and filling the defect with a bone graft. Patients will be immobilized in a below-knee cast for 6 weeks followed by physical therapy. If you or a loved one is experiencing pain and swelling and don’t recall any recent trauma, come visit one of our physicians at Foot & Ankle Doctors, Inc.