When a patients comes to my office complaining of cold or numb toes there a three things that instantly pop into my head; diabetes, vascular disease, or Raynaud’s phenomenon. Now before you get all excited and start self diagnosing, many people just have cold feet because it is cold! We may think it is a new problem or it has gotten worse, but we must also take note that the temperature is dropping, our floors are colder and it has been months since our feet have seen this weather. Still, persistent coldness, numbness, or pain is not normal.
Why do diabetics have cold feet? Diabetes cause many changes in your body over time. One such change happens in the nerves. The elevated sugar levels in the blood damage the nerves and inhibit their ability to function properly. This is called peripheral neuropathy. Neuropathy can affect the foot in two ways. First it changes our perception of sensations and eventually progresses to loss of sensation. Most patients describe the process as burning and tingling that eventually leads to numbness, but I have heard many different descriptions. Just yesterday a gentlemen with neuropathy said, “It felt like was standing in ice cold water and my toes eventually froze with no feeling.” Secondly, neuropathy changes the way nerves reacts to stimuli. The nerves in the feet do not communicate well with the rest of the body. For example when we are warm the blood vessels dilate, this explains why we get rosy cheeks. But with diabetes the nerves in the foot don’t always get the message and the vessels stay constricted and less warm blood is getting the toes.
Are cold feet a sign of vascular disease? Our body produces heat in many different ways but a major facilitator to maintain body temperature is our blood. Blood vessels enlarge when we are warm and get smaller when we are cold. It is more important to keep our organs at a certain temperature than our hands, so our body naturally adjusts blood flow to facilitate the demands. With vascular disease, our vessels are damaged or clogged and either blood is not traveling where it needs to be fast enough or it is has trouble getting back to the heart to get re-warmed and refilled with oxygen. In the most simplistic terms: less blood moving means less warmth moving through our hands and feet.
Are cold feet a disease in itself? Actually, there is a disease that causes cold, numb feet! Raynaud’s disease is a condition in which your body over-reacts to cold stimuli. As I mentioned before, our blood vessels get smaller when we are cold. They can also get small when we are stressed or excited so our heart and brain get the most blood in demanding situations. With Raynaud’s our body blows the situation out of proportion and the vessels go into vasospasms. The toe(s) and or finger(s) will turn white due to the lack of blood flow, and then purple due to the increase in venous blood flow, finally when the toe is re-warmed it will turn red due to the return of blood flow. More often Raynaud’s occurs with other conditions such as Lupus, rheumatoid arthritis, or many other systemic diseases.
I cannot count the number of times I have heard the complaint about having cold feet. We have all had them and know the pure agony of freezing toes. Occasional coldness with changes in weather is normal. Struggling every day with cold feet is not normal.
Wednesday, March 7, 2012
Monday, February 27, 2012
Losing Weight Workouts without Foot Pain
The optimistic visions of the New Year are contagious. Lofty goals are being set and we all aim high in January. Still, many of us hold back. We paddle through a long list of excuses on why this year is not the year. Weight can be a huge aggravator for foot pain. Losing weight helps foot pain, but how do you lose weight when you can barely walk without pain?
In a survey done by the American Podiatric Medical Association, 72 percent of Americans says they do not exercise because of foot pain. First, foot pain is not an excuse and will not be accepted as one in my office! If you are having foot pain that is keeping you from healthy activities then something is wrong and you need to be treated. There are a variety of reasons that you may be having foot pain. Common conditions like plantar fasciitis require treatments such as cortisone injections, physical therapy, and night splints. Occasionally surgery is needed but this is a last resort.
The first thing to evaluate is your shoes. Not just the shoes you exercise in but all of your shoes. Most of us wear bad shoes or none at all. Whether it is dress codes or personal style, we do not give our feet enough room or support. We also love to kick the shoes off. Yes, walking barefoot around your house can be very bad for your feet! Some of us need extra support all of the time. Your shoes should be wide enough, long enough and have support in the arch area. Some athletes have trended towards the minimalist shoes or barefoot running. Is it ok? For some people, yes it is ok, but this is not for everyone and is only for the elite athlete with impeccable foot structure. Very few of us have the foot type that can bare the abuse.
Next is to evaluate the type of activities you are doing. Some sports or work outs have a higher impact on your feet than others. Swimming and biking have very low impact on the feet and are great alternatives if you are struggling with your feet. Other activities put a greater demand on your feet such as running on a treadmill or blacktop. You must also evaluate the consistency of high impact activities. Alternating between low and high impact activities will keep you doing what you love but also keep you on your feet!
It is that time of year to be optimistic. You will cure your foot pain, get back to the gym and lose the weight! First find the source of the pain, seek treatment, and stay focused. It is easy to find excuses and the foot is an easy target. Don’t let your feet get the best of you. 72 percent is an unreasonable amount of Americans struggling with foot pain.
Monday, January 23, 2012
Losing Weight Workouts without Foot Pain
The optimistic visions of the New Year are contagious. Lofty goals are being set and we all aim high in January. Still, many of us hold back. We paddle through a long list of excuses on why this year is not the year. Weight can be a huge aggravator for foot pain. Losing weight helps foot pain, but how do you lose weight when you can barely walk without pain?
In a survey done by the American Podiatric Medical Association, 72 percent of Americans says they do not exercise because of foot pain. First, foot pain is not an excuse and will not be accepted as one in my office! If you are having foot pain that is keeping you from healthy activities then something is wrong and you need to be treated. There are a variety of reasons that you may be having foot pain. Common conditions like plantar fasciitis require treatments such as cortisone injections, physical therapy, and night splints. Occasionally surgery is needed but this is a last resort.
The first thing to evaluate is your shoes. Not just the shoes you exercise in but all of your shoes. Most of us wear bad shoes or none at all. Whether it is dress codes or personal style, we do not give our feet enough room or support. We also love to kick the shoes off. Yes, walking barefoot around your house can be very bad for your feet! Some of us need extra support all of the time. Your shoes should be wide enough, long enough and have support in the arch area. Some athletes have trended towards the minimalist shoes or barefoot running. Is it ok? For some people, yes it is ok, but this is not for everyone and is only for the elite athlete with impeccable foot structure. Very few of us have the foot type that can bare the abuse.
Next is to evaluate the type of activities you are doing. Some sports or work outs have a higher impact on your feet than others. Swimming and biking have very low impact on the feet and are great alternatives if you are struggling with your feet. Other activities put a greater demand on your feet such as running on a treadmill or blacktop. You must also evaluate the consistency of high impact activities. Alternating between low and high impact activities will keep you doing what you love but also keep you on your feet!
It is that time of year to be optimistic. You will cure your foot pain, get back to the gym and lose the weight! First find the source of the pain, seek treatment, and stay focused. It is easy to find excuses and the foot is an easy target. Don’t let your feet get the best of you. 72 percent is an unreasonable amount of Americans struggling with foot pain.
In a survey done by the American Podiatric Medical Association, 72 percent of Americans says they do not exercise because of foot pain. First, foot pain is not an excuse and will not be accepted as one in my office! If you are having foot pain that is keeping you from healthy activities then something is wrong and you need to be treated. There are a variety of reasons that you may be having foot pain. Common conditions like plantar fasciitis require treatments such as cortisone injections, physical therapy, and night splints. Occasionally surgery is needed but this is a last resort.
The first thing to evaluate is your shoes. Not just the shoes you exercise in but all of your shoes. Most of us wear bad shoes or none at all. Whether it is dress codes or personal style, we do not give our feet enough room or support. We also love to kick the shoes off. Yes, walking barefoot around your house can be very bad for your feet! Some of us need extra support all of the time. Your shoes should be wide enough, long enough and have support in the arch area. Some athletes have trended towards the minimalist shoes or barefoot running. Is it ok? For some people, yes it is ok, but this is not for everyone and is only for the elite athlete with impeccable foot structure. Very few of us have the foot type that can bare the abuse.
Next is to evaluate the type of activities you are doing. Some sports or work outs have a higher impact on your feet than others. Swimming and biking have very low impact on the feet and are great alternatives if you are struggling with your feet. Other activities put a greater demand on your feet such as running on a treadmill or blacktop. You must also evaluate the consistency of high impact activities. Alternating between low and high impact activities will keep you doing what you love but also keep you on your feet!
It is that time of year to be optimistic. You will cure your foot pain, get back to the gym and lose the weight! First find the source of the pain, seek treatment, and stay focused. It is easy to find excuses and the foot is an easy target. Don’t let your feet get the best of you. 72 percent is an unreasonable amount of Americans struggling with foot pain.
Monday, January 9, 2012
Corns 101
Corns have been the bane of your toes since the invention of closed toe shoes. People resort to all sorts of home remedies to try and relieve themselves of the little devils. The cure is really very simple…prevention.
Corns are those thick, often painful excrescences that pop up on the top joints of your toes after wearing shoes that are either too short or too narrow (or both). Toes like to lie flat inside of shoes for a comfortable walking experience. Style often dictates otherwise in the form of shoes that are too narrow, or in the case of ladies shoes, having a high heel that pushes the toes together and rubbing them at the top of the shoe. Over time, this cramping of the toes causes the tendons on the tops of the toes to shorten causing a contracture of the toe till it assumes the shape of a “hammer”. Thus the “hammertoe” is born. That round, thickened skin on the top of the toe joint is in fact the “corn”. Shaving off the corn or padding it only gives temporary relief. The cure comes in two forms.
First part of the cure would be prevention. The shape of the shoe must fit the shape of the foot. Corns and the contracted digits don’t occur with the wearing of just one pair of shoes for an evening. They occur over several years of shoe abuse to your toes. Many people feel they know the size of their feet and, and buy shoes without even trying them on. Fashion often dictates the shape of the shoes and height of the heels. Over years, this is the recipe for painful corns and hammertoes.
Second part of the cure if you fail to heed the advice of the above paragraph, would be correction. This involves the surgical correction of the digits with the removal of a small piece of bone that has come to form the corn as well as the lengthening of the tendon that caused the toe to hammer. The human body is an amazing thing. If the toes are continuously stuffed into shoes that are too small, the tendons contract and eventually stay that way. “Hammertoe” correction to relieve the pain of the corns is a simple outpatient procedure, but why not try and avoid the problem in the first place?
Ladies…I’m not saying that you can never wear fashionable, high heels shoes. All I am saying is that you should use sensibility in when and where you wear them.
Men also suffer from this painful malady. Though they may not be in high heels, men also fall victim to wearing shoes that are too narrow or too pointy for the shape of their feet.
So folks what do you say? Let’s just “shoe “ a little common sense when buying and wearing shoes. Save those high heeled and pointy shoes for the weekend.
Rob Kosofsky D.P.M.
Corns are those thick, often painful excrescences that pop up on the top joints of your toes after wearing shoes that are either too short or too narrow (or both). Toes like to lie flat inside of shoes for a comfortable walking experience. Style often dictates otherwise in the form of shoes that are too narrow, or in the case of ladies shoes, having a high heel that pushes the toes together and rubbing them at the top of the shoe. Over time, this cramping of the toes causes the tendons on the tops of the toes to shorten causing a contracture of the toe till it assumes the shape of a “hammer”. Thus the “hammertoe” is born. That round, thickened skin on the top of the toe joint is in fact the “corn”. Shaving off the corn or padding it only gives temporary relief. The cure comes in two forms.
First part of the cure would be prevention. The shape of the shoe must fit the shape of the foot. Corns and the contracted digits don’t occur with the wearing of just one pair of shoes for an evening. They occur over several years of shoe abuse to your toes. Many people feel they know the size of their feet and, and buy shoes without even trying them on. Fashion often dictates the shape of the shoes and height of the heels. Over years, this is the recipe for painful corns and hammertoes.
Second part of the cure if you fail to heed the advice of the above paragraph, would be correction. This involves the surgical correction of the digits with the removal of a small piece of bone that has come to form the corn as well as the lengthening of the tendon that caused the toe to hammer. The human body is an amazing thing. If the toes are continuously stuffed into shoes that are too small, the tendons contract and eventually stay that way. “Hammertoe” correction to relieve the pain of the corns is a simple outpatient procedure, but why not try and avoid the problem in the first place?
Ladies…I’m not saying that you can never wear fashionable, high heels shoes. All I am saying is that you should use sensibility in when and where you wear them.
Men also suffer from this painful malady. Though they may not be in high heels, men also fall victim to wearing shoes that are too narrow or too pointy for the shape of their feet.
So folks what do you say? Let’s just “shoe “ a little common sense when buying and wearing shoes. Save those high heeled and pointy shoes for the weekend.
Rob Kosofsky D.P.M.
Friday, January 6, 2012
Is Cryotherapy Painful?
Virtually painless, long lasting, and now down time....Learn how to end your foot pain today!
Wednesday, January 4, 2012
What is a HIGH Ankle Sprain?
We are glued to the TV watching the big game and there goes a key player. Out with a High Ankle Sprain!!! So….what is a high ankle sprain? Can you have a low ankle sprain? The Vikings have been struggling, and now that Adrian Peterson, their star running back, has a high ankle sprain, do they even have a chance? The answer is no, but Peterson will be just fine and back in the game soon.
A high ankle sprain is a tear in the syndesmotic ligament. This ligament lies between the tibia and fibula and connects the bones throughout the lower leg. A typical ankle sprain involves the ligaments that surround the ankle joint. As the name suggest, the Syndesmosis is above the ankle joint and thus a tear in this ligament is called a “high ankle sprain.” Syndesmotic tears occur more commonly with an ankle fracture but isolated syndesmotic tears are also reported. The typical mechanism of injury is external rotation of the foot on the tibia and fibula, as seen on the photo below, on the right.
Syndesmosis injuries are more common than classic ankle sprains. They frequently occur in collision sports or those sports that have rigid ankle immobilizing gear such as skiing. Nearly 74% of ankle injuries reported in hockey are syndesmotic sprains. In the general population syndesmotic sprains make up only 10-20% of all ankle sprains. Typically, the athlete will present with a sore sometimes sharp pain over their leg between the tibia and fibula. The pain is worse when bearing weight and often the athlete cannot bear any weight on the extremity. The diagnosis of a syndesmotic tear is not difficult on physical exam but further studies are performed to identify any associated injuries or the extent of the injury. It is standard to take x-rays and to examine for any fractures, typically seen in the fibula or tibia. Often, an MRI is also ordered to identify the extent of the tear. Very rarely, surgery to repair the torn ligament is necessary.
The degree of severity can vary greatly. Due to the high incidence of associated injuries, it is difficult to outline the recovery time. Multiple studies have been done to determine the average recovery time. This can range from as low as 1 week to as high as 6 months. Studies have consistently showed that stage I and II ankle sprains on average have a faster recovery time than a syndesmotic sprain.
If an isolated syndesmotic sprain is identified with no other associated injuries than recovery time is very short. I feel comfortable saying that Peterson will be back on the field with the rest of the Vikings to finish the season. Unfortunately, with or without and injured Peterson, I don’t see them making it to the play offs.
Friday, December 23, 2011
New Jersy Nets Center Has Foot Surgery
Brooks Lopez, the starting center for the New Jersey Nets, broke a bone in his foot and is having surgery to repair it today. He is expected to be out six weeks. The bone he broke is the fifth metatarsal and is located on the outside of the foot.
This is probably one of the most common foot fractures. It usually occurs when your foot rolls over. There is a tendon, called the peroneal brevis tendon that is under tension when you twist your ankle. This causes the tendon to pull on the bone and break a piece off. Sometimes, the piece is broken off in such a way that it needs to be put back surgically. Other times, the bone breaks but is not displaced, meaning it is a stable fracture and can be healed just by applying a cast.
There are three types of fractures in this location. The base of the fifth metatarsal fracture is called an avulsion fracture. This is because the tendon yanks or avulses the bone. This fracture is usally stable enough to be treated conservatively without surgery.
A second type is a stress fracture, which is not a through and through break and not displaced. They occur usually in young athletes that put a lot of strain on the bone, thus stressing the area.
The Jones fracture is located above the base (see above diagram) and is associated with poor healing. This fracture usually requires surgery and then non-weight bearing in a cast for six weeks. Surgery consists of putting in a screw to put the fracture back. We use intra-operative x-rays to make sure the screw and bone is in proper placement. The Jones fracture is in the area of good blood supply to this bone, thus, the nutrition to the bone is disrupted in this instance. This is the reason for the poor healing, unless it is surgically corrected.
However, in basketball players, or any athlete that is required to jump or pound on their foot for their sport, the best option is to surgically repair it just by using a screw. It takes about 6 weeks for the bone to heal and afterwards, Lopez will need to get back into playing shape. So, don’t expect him to be playing for about two months which is now almost the whole season, due to the shortened schedule.
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