Pediatric Flatfoot

Pediatric Flatfoot

What Is Pediatric Flatfoot?

Flatfoot is common in both children and adults. When this deformity occurs in children, it is referred to as “pediatric flatfoot.” Although there are various forms of flatfoot, they all share one characteristic – partial or total collapse of the arch.

Pediatric flatfoot can be classified as symptomatic or asymptomatic. Symptomatic flatfeet exhibit symptoms such as pain and limitation of activity, while asymptomatic flatfeet show no symptoms. These classifications can assist your foot and ankle surgeon in determining an appropriate treatment plan.

Symptoms
Flatfoot can be apparent at birth or it may not show up until years later. Most children with flatfoot have no symptoms, but some have one or more of the following symptoms:

• Pain, tenderness, or cramping in the foot, leg, and knee 
• Outward tilting of the heel 
• Awkwardness or changes in walking 
• Difficulty with shoes 
• Reduced energy when participating in physical activities 
• Voluntary withdrawal from physical activities

Diagnosis
In diagnosing flatfoot, a Doctor from Hosey Foot and Ankle Centers will examine the foot and observes how it looks when the child stands and sits. One of our doctors at Hosey Foot and Ankle Centers also observes how the child walks and evaluates the range of motion of the foot. Because flatfoot is sometimes related to problems in the leg, the surgeon may also examine the knee and hip.

X-rays are often taken to determine the severity of the deformity. Sometimes additional imaging and other tests are ordered.

Non-surgical Treatment
If a child has no symptoms, treatment is often not required. Instead, the condition will be observed and re-evaluated periodically by the foot and ankle surgeon.

Custom orthotic devices may be considered for some cases of asymptomatic flatfoot.

When the child has symptoms, treatment is required. The foot and ankle surgeon may select one or more of the following non-surgical approaches:

• Activity modifications. The child needs to temporarily decrease activities that bring pain as well as avoid prolonged walking or standing. 
• Orthotic devices. Hosey Foot and Ankle Centers can provide custom molded orthotics that fit inside the shoe to support the structure of the foot and improve function. 
• Physical therapy. Stretching exercises, supervised by the foot and ankle surgeon or a physical therapist, provide relief in some cases of flatfoot. 
• Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to help reduce pain and inflammation. 
• Shoe modifications. The foot and ankle surgeon will advise you on footwear characteristics that are important for the child with flatfoot.

When Is Surgery Needed?
In some cases, surgery is necessary to relieve the symptoms and improve foot function. The surgical procedure or combination of procedures selected for your child will depend on his or her type of flatfoot and degree of deformity.

Raynaud’s Phenomenon

Raynaud’s Phenomenon

Raynaud’s phenomenon is a condition which results in a bluish-white discoloration of fingers and toes, often as a result of exposure to cold. Stress, smoking, and certain medications may trigger or worsen symptoms. The color change, which occurs from spasms in small blood vessels, becomes red and then returns to normal when blood flow resumes.

The condition most often affects women, with symptoms varying depending on the severity of the condition. Because there are no specific blood tests to diagnose this condition, the diagnosis is based on symptoms.

However, a Doctor from Hosey Foot and Ankle Centers may order blood tests to determine whether the Raynaud’s phenomenon is associated with certain autoimmune diseases or other medical conditions.

Treatment for Raynaud’s phenomenon is aimed at prevention and protection of the digits.

Contact Dermatitis

Contact Dermatitis

Contact dermatitis of the foot is an inflammation of the skin in response to an irritant. This irritant is something with which the foot has come into contact, such as materials and chemicals with which shoes are made, poison ivy or harsh chemicals.

When the skin of the foot comes into contact with the substance, an allergic response is initiated. Symptoms, including:

• redness 
• itchiness
• small blisters

usually occur within 24 hours of exposure to the irritant. The symptoms should be evaluated by one of our Doctors at Hosey Foot and Ankle Centers for proper diagnosis and treatment.

Visit our website, http://www.hoseypodiatry.com for more information and to contact our offices.

Talar Dome Lesion

Talar Dome Lesion

What is a Talar Dome Lesion?

The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. The top of the talus is dome-shaped and is completely covered with cartilage—a tough, rubbery tissue that enables the ankle to move smoothly. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). “Osteo” means bone and “chondral” refers to cartilage.

Talar dome lesions are usually caused by an injury, such as an ankle sprain. If the cartilage doesn’t heal properly following the injury, it softens and begins to break off. Sometimes a broken piece of the damaged cartilage and bone will “float” in the ankle.

Signs and Symptoms

Unless the injury is extensive, it may take months, a year, or even longer for symptoms to develop. The signs and symptoms of a talar dome lesion may include:

Chronic pain deep in the ankle—typically worse when bearing weight on the foot (especially during sports) and less when resting 

An occasional “clicking” or “catching” feeling in the ankle when walking 

A sensation of the ankle “locking” or “giving out” 

Episodes of swelling of the ankle—occurring when bearing weight and subsiding when at rest

Diagnosis

A talar dome lesion can be difficult to diagnose, because the precise site of the pain can be hard to pinpoint. To diagnose this injury, one of our Doctors at Hosey Foot and Ankle Centers will question the patient about recent or previous injury and will examine the foot and ankle, moving the ankle joint to help determine if there is pain, clicking, or limitation of motion within that joint.

Sometimes the surgeon will inject the joint with an anesthetic (pain-relieving medication) to see if the pain goes away for a while, indicating that the pain is coming from inside the joint.
X-rays are taken, and often an MRI or other advanced imaging tests are ordered to further evaluate the lesion and extent of the injury.

Treatment: Non-Surgical Approaches

Treatment depends on the severity of the talar dome lesion. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following non-surgical treatment options may be considered:

Immobilization. Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. During this period of immobilization, non-weightbearing range-of-motion exercises may be recommended. 

Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation. 

Physical therapy. Range-of-motion and strengthening exercises are beneficial once the lesion is adequately healed. Physical therapy may also include techniques to reduce pain and swelling. 

Ankle brace. Wearing an ankle brace may help protect the patient from re-injury if the ankle is unstable.

When is Surgery Needed?

If non-surgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. Surgery may involve removal of the loose bone and cartilage fragments within the joint and establishing an environment for healing. A variety of surgical techniques is available to accomplish this. One of our Doctors at Hosey Foot and Ankle Centers will select the best procedure based on the specific case.

Complications of Talar Dome Lesions

Depending on the amount of damage to the cartilage in the ankle joint, arthritis may develop in the joint, resulting in chronic pain, swelling and limited joint motion. Treatment for these complications is best directed by a foot and ankle surgeon, and may include one or more of the following

Non-steroidal or steroidal anti-inflammatory medications 

Physical therapy 

Bracing 

Surgical intervention

Puncture Wounds

Puncture Wounds

What Is a Puncture Wound?

Puncture wounds are not the same as cuts. A puncture wound has a small entry hole caused by a pointed object, such as a nail that you’ve stepped on. In contrast, a cut is an open wound that produces a long tear in the skin. Puncture wounds require different treatment from cuts because these small holes in the skin can disguise serious injury.

Puncture wounds are common in the foot, especially in warm weather when people go barefoot. But even though they occur frequently, puncture wounds of the foot are often inadequately treated. If not properly treated, infection or other complications can develop.

Proper treatment within the first 24 hours is especially important with puncture wounds because they carry the danger of embedding the piercing object (foreign body) under the skin. Research shows that complications can be prevented if the patient seeks professional treatment right away.

Foreign Bodies in Puncture Wounds

A variety of foreign bodies can become embedded in a puncture wound. Nails, glass, toothpicks, sewing needles, insulin needles, and seashells are some common ones. In addition, pieces of your own skin, sock, and shoe can be forced into the wound during a puncture, along with dirt and debris from the object. All puncture wounds are dirty wounds because they involve penetration of an object that isn’t sterile. Anything that remains in the wound increases your chance of developing other problems, either in the near future or later.

Severity of Wounds

There are different ways of determining the severity of a puncture wound. Depth of the wound is one way to evaluate it. The deeper the puncture, the more likely it is that complications such as infection will develop. Many patients cannot judge how far their puncture extends into the foot. Therefore, if you’ve stepped on something and the skin was penetrated, seek treatment as soon as possible.

The type and the “cleanliness” of the penetrating object also determine the severity of the wound. Larger or longer objects can penetrate deeper into the tissues, possibly causing more damage. The dirtier an object, such as a rusty nail, the more dirt and debris are dragged into the wound, increasing the chance of infection.

Another thing that can determine wound severity is if you were wearing socks and shoes, particles of which can get trapped in the wound.

Treatment

A puncture wound must be cleaned properly and monitored throughout the healing process to avoid complications.

Even if you have gone to an emergency room for immediate treatment of your puncture wound, see a foot and ankle surgeon for a thorough cleaning and careful follow-up. The sooner you do this, the better: within 24 hours after injury, if possible.

The surgeon will make sure the wound is properly cleaned and no foreign body remains. He or she may numb the area, thoroughly clean inside and outside the wound, and monitor your progress. In some cases, x-rays may be ordered to determine whether something remains in the wound or if bone damage has occurred. Antibiotics may be prescribed if necessary.

Avoiding Complications

Follow the Doctors instructions from Hosey Foot and Ankle Centers for care of the wound to prevent complications (see “Puncture Wounds: What You Should Do”).

Infection is a common complication of puncture wounds that can lead to serious consequences. Sometimes a minor skin infection evolves into a bone or joint infection, so you should be aware of signs to look for. A minor skin infection may develop in two to five days after injury. The signs of a minor infection that show up around the wound include soreness, redness, and possibly drainage, swelling, and warmth. You may also develop a fever. If these signs have not improved, or if they reappear in 10 to 14 days, a serious infection in the joint or bone may have developed.

Other complications that may arise from inadequate treatment of puncture wounds include painful scarring in the area of the wound or a hard cyst where the foreign body has remained in the wound.

Although the complications of puncture wounds can be quite serious, early and proper treatment can play a crucial role in preventing them.

Puncture Wounds: What You Should Do Seek treatment right away.  Get a tetanus shot if needed (usually every ten years).  See one of our doctors at Hosey Foot and Ankle Centers within 24 hours.  Follow your doctor’s instructions:  Keep your dressing dry.  Keep weight off of the injured foot.  Finish all your antibiotics (if prescribed).  Take your temperature regularly.  Watch for signs of infection (pain, redness, swelling, fever). Call your doctor if these signs appear.