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.

Bone Tumors in the Foot

Bone Tumors in the Foot

Bone tumors are caused by an abnormal growth of cells. They may be benign (noncancerous) or malignant (cancerous). Although rare, bone tumors can occur in the foot and ankle. They can be primary (originating in the bone), or secondary (originating in another part of the body).

Symptoms of a bone tumor may include:

•Fracture from slight injury,
•Bone pain, often at night,
•Occasionally a mass or swelling in the area.

A bone tumor is first diagnosed with x-rays. Advanced imaging modalities may be used to further evaluate the tumor. One of our Doctors at Hosey Foot and Ankle Centers may  require surgical removal for a definitive diagnosis.

Drop Foot

Drop Foot

“Drop foot” refers to the inability to lift the front part of one’s foot off the ground when walking, resulting in a scuffing or dragging of the foot or lifting the thigh (known as “steppage” gait). It is most often caused by nerve or muscle disorders or damage, or by a central nervous system disorder.

Drop foot is usually diagnosed by physical examination through a Doctor at Hosey Foot and Ankle Centers, although additional testing may be recommended in some cases. Treatment may include use of braces, physical therapy, and electrical nerve stimulation. In some cases surgery may be required.

Eczema of the Foot

Eczema of the Foot

Eczema is a general term that includes many conditions that cause inflammation of the skin. The symptoms of eczema vary, but generally appear as dry, red, extremely itchy patches of skin. Small blisters may sometimes form.

Eczema can occur on any part of the body including the foot. It occurs in both children and adults and is not contagious. There is no known cause for eczema, but it often affects people with a family history of allergies.

Although there is no cure for this disease, treatments make it very manageable. The most helpful treatment is to prevent scratching. Cold compresses can be applied to help reduce itching. Lotions and creams are often used to help keep the skin as moist as possible. Corticosteroid creams can also be used to help reduce inflammation. The first step in effective treatment of eczema is a correct diagnosis. After examination and diagnosis, one of our Doctors at Hosey Foot and Ankle Centers can recommend the best treatment for you or your child.

What is a Podiatrist?

What is a Podiatrist?

              A podiatrist is responsible for the medical and surgical treatment of the foot. They treat all foot problems including corns, bunions, hammertoes, problems with tendons and ligaments, bone disorders and complications from diabetes. If you suffer from any foot problems, you should immediately see a podiatrist. 

              They may be symptoms of a disease that if not treated quickly may develop into serious health problems. The podiatrist must complete a minimum of four years of medical school and three years of residency before receiving the degree of doctor of podiatric medicine. Many podiatrists obtain advanced training during a residency at a hospital.

For more information, please visit http://hoseypodiatry.com/

Hallux Rigidus

What Is Hallux Rigidus?

Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the joint, and with time it gets increasingly harder to bend the toe. ‘Hallux” refers to the big toe, while “rigidus” indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis.

This disorder can be very troubling and even disabling, since we use the big toe whenever we walk, stoop down, climb up, or even stand. Many patients confuse hallux rigidus with a bunion, which affects the same joint, but they are very different conditions requiring different treatment.

Because hallux rigidus is a progressive condition, the toe’s motion decreases as time goes on. In its earlier stage, when motion of the big toe is only somewhat limited, the condition is called “hallux limitus.” But as the problem advances, the toe’s range of motion gradually decreases until it potentially reaches the end stage of “rigidus,” in which the big toe becomes stiff, or what is sometimes called a “frozen joint.”

Causes

Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis – the kind that results from “wear and tear” – often develops in people who have defects that change the way their foot and big toe functions. For example, those with fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux rigidus.

In some people, hallux rigidus runs in the family and is a result of inheriting a foot type that is prone to developing this condition. In other cases, it is associated with overuse – especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often have to stoop or squat. Hallux rigidus can also result from an injury, such as stubbing your toe. Or it may be caused by inflammatory diseases such as rheumatoid arthritis or gout. A Doctor from Hosey Foot and Ankle Centers can determine the cause of your hallux rigidus and recommend the best treatment.

Symptoms

Early signs and symptoms include:

·     Pain and stiffness in the big toe during use (walking, standing, bending, etc.)

·     Pain and stiffness aggravated by cold, damp weather

·     Difficulty with certain activities (running, squatting)

·     Swelling and inflammation around the joint

As the disorder gets more serious, additional symptoms may develop, including:

·     Pain, even during rest

·     Difficulty wearing shoes because bone spurs (overgrowths) develop

·     Dull pain in the hip, knee, or lower back due to changes in the way you walk

·     Limping (in severe cases)

Diagnosis

The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best time to see a Doctor from Hosey Foot and Ankle Centers is when you first notice symptoms. If you wait until bone spurs develop, your condition is likely to be more difficult to manage.

In diagnosing hallux rigidus, the surgeon will examine your feet and move the toe to determine its range of motion. X-rays help determine how much arthritis is present as well as to evaluate any bone spurs or other abnormalities that may have formed.

Non-Surgical Treatment

In many cases, early treatment may prevent or postpone the need for surgery in the future. Treatment for mild or moderate cases of hallux rigidus may include:

·     Shoe modifications. Shoes with a large toe box put less pressure on your toe. Stiff or rocker-bottom soles may also be recommended.

·     Orthotic devices. Custom orthotic devices may improve foot function.

·     Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

·     Injection therapy. Injections of corticosteroids may reduce inflammation and pain.

·     Physical therapy. Ultrasound therapy or other physical therapy modalities may be undertaken to provide temporary relief.

When Is Surgery Needed?

In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery for treatment of hallux rigidus. In selecting the procedure or combination of procedures for your particular case, one of the Doctors from Hosey Foot and Ankle Centers will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.

 

Varicose Veins

Varicose veins are usually due to improperly functioning valves within the veins. The veins typically appear prominent or look "raised." The condition can cause swelling of the legs, ankles, and feet. The skin may become discolored due to leakage of blood into the surrounding tissues, and ulcers may form on the skin. One of the Doctors from Hosey Foot and Ankle Centers may advise use of compression stockings or other treatments

Yellow Toenails

The most common cause of yellow discoloration in the toenails is a fungal infection. The fungus often develops underneath the nail, resulting in it becoming thick, raised, and yellow in color.

Other potential causes for yellow discoloration of the nail include diabetes mellitus and lymphedema (chronic leg swelling). Yellow staining of the nails can also occur in individuals who use nail polish. A stained nail may take several months to grow out.

Fractures of the Calcaneus

Fractures of the Calcaneus (Heel Bone Fractures)

What is the Calcaneus?
The calcaneus, also called the heel bone, is a large bone that forms the foundation of the rear part of the foot. The calcaneus connects with the talus and cuboid bones. The connection between the talus and calcaneus forms the subtalar joint. This joint is important for normal foot function.

The calcaneus is often compared to a hard boiled egg, because it has a thin, hard shell on the outside and softer, spongy bone on the inside. When the outer shell is broken, the bone tends to collapse and become fragmented. For this reason, calcaneal fractures are severe injuries. Furthermore, if the fracture involves the joints, there is the potential for long-term consequences such as arthritis and chronic pain.

How do Calcaneal Fractures Occur?
Most calcaneal fractures are the result of a traumatic event—most commonly, falling from a height, such as a ladder, or being in an automobile accident where the heel is crushed against the floorboard. Calcaneal fractures can also occur with other types of injuries, such as an ankle sprain. A smaller number of calcaneal fractures are stress fractures, caused by overuse or repetitive stress on the heel bone.

Types of Calcaneal Fractures
Fractures of the calcaneus may or may not involve the subtalar and surrounding joints.  Fractures involving the joints (intra-articular fractures) are the most severe calcaneal fractures, and include damage to the cartilage (the connective tissue between two bones). The outlook for recovery depends on how severely the calcaneus was crushed at the time of injury.

Fractures that don’t involve the joint (extra-articular fractures) include:

·     Those caused by trauma, such as avulsion fractures (in which a piece of bone is pulled off of the calcaneus by the Achilles tendon or a ligament) or crush injuries resulting in multiple fracture fragments

·     Stress fractures, caused by overuse or mild injury.

The severity and treatment of extra-articular fractures depend on their location and size.

Signs and Symptoms
Calcaneal fractures produce different signs and symptoms, depending on whether they are traumatic or stress fractures.

The signs and symptoms of traumatic fractures may include:

·     Sudden pain in the heel and inability to bear weight on that foot

·     Swelling in the heel area

·     Bruising of the heel and ankle

The signs and symptoms of stress fractures may include:

·     Generalized pain in the heel area that usually develops slowly (over several days to weeks)

·     Swelling in the heel area

Diagnosis
To diagnose and evaluate a calcaneal fracture, one of the Doctors at Hosey Foot and Ankle Centers will ask questions about how the injury occurred, examine the affected foot and ankle, and order x-rays. In addition, advanced imaging tests are commonly required.

Treatment
Treatment of calcaneal fractures is dictated by the type of fracture and extent of the injury. The foot and ankle surgeon will discuss with the patient the best treatment—whether surgical or non-surgical—for the fracture.

For some fractures, non-surgical treatments may be used. These include:

·     Rest, ice, compression, and elevation (R.I.C.E.) Rest (staying off the injured foot) is needed to allow the fracture to heal. Ice reduces swelling and pain; apply a bag of ice covered with a thin towel to the affected area. Compression (wrapping the foot in an elastic bandage or wearing a compression stocking) and elevation (keeping the foot even with or slightly above the heart level) also reduce the swelling.

·     Immobilization. Sometimes the foot is placed in a cast or cast boot to keep the fractured bone from moving. Crutches may be needed to avoid weightbearing.

For traumatic fractures, treatment often involves surgery to reconstruct the joint, or in severe cases, to fuse the joint. The surgeon will choose the best surgical approach for the patient.

Rehabilitation
Whether the treatment for a calcaneal fracture has been surgical or non-surgical, physical therapy often plays a key role in regaining strength and restoring function.

Complications of Calcaneal Fractures
Calcaneal fractures can be serious injuries that may produce lifelong problems. Arthritis, stiffness, and pain in the joint frequently develop. Sometimes the fractured bone fails to heal in the proper position. Other possible long-term consequences ofcalcaneal fractures are decreased ankle motion and walking with alimp due to collapse of the heel bone and loss of length in the leg. Patients often require additional surgery and/or long term or permanent use of a brace or an orthotic device (arch support) to help manage these complications.