New NJ Podiatrist

 Introducing Dr. Amit Kalra!!

 Dr. Amit Kalra joins Family Foot & Ankle Specialists, in Hillsborough and Piscataway, NJ. 

As an athlete myself I know what it is like to have a foot/ankle injury. My mission here at Family Foot and Ankle is to make sure we give you the best and most up to date treatment for whatever issue you may have; Welcome!” 

Extensive Education “I pride myself on the education I have received to date and the years it took to get me to where I am today. By educating myself, I am able to provide my patients with the best and highest quality care imaginable.” 

• Bachelor of Science in Nutritional Sciences, Cornell University, Ithaca, NY Class of 2003 
• Masters of Science in Exercise Physiology, Ithaca College, Ithaca, NY Class of 2005 
• Doctor of Podiatric Medicine, Scholl School of Podiatry at Rosalind Franklin University Medical Center, North Chicago, IL Class of 2009 
• Residency in Foot & Ankle Surgery, Long island Jewish Medical Center/NSLIJ Health systems, Long Island, NY Class of 2012 

Highly Qualified “By continually educating myself and attending local and national seminars, workshops and conferences I stay abreast of new therapies to help my patients in all aspects of Foot and Ankle care.” 

• Board Qualified in Foot Surgery by the American Board of Podiatric Surgeons 
• Board Eligible in Reconstructive Rearfoot & Ankle Surgery 
• Member, American College of Foot and Ankle Surgeons 
• Certified, Foot and Ankle Arthroscopy

Matt Schaub, quarterback for the Houston Texans, has suffered a Lisfranc injury and is facing the possibility of being out for the rest of the season. A Lisfranc injury…like a hot dog? No, he didn’t suffer from hot dog poisoning, although you never really know what’s in those things. The name actually stems from the French doctor who first described this injury. Schaub suffered a painful fracture of his midfoot that could cause him to sit sidelined for the rest of the season.

A Lisfranc injury can come in different forms or be a mix of complex injuries in the foot. A Lisfranc injury could be a sprain, fracture or dislocation of the area in the middle of the foot including bones and ligaments. The Lisfranc joint is responsible for connecting the metatarsal bones and the tarsal bones.

This joint helps to support the foot by transferring the weight of a step from the heel to the padded forefoot. Although this condition is extremely rare, once you have a Lisfranc injury the recovery can be quite a battle. To determine the difference between a Lisfranc injury and a sprain check the following symptoms. Usually the top of the foot will be swollen and painful, and there could be noticeable bruising. Depending on the severity of the injury, the foot may not be able to handle any weight or pressure.

The treatment for a Lisfranc injury can include the following. First, it is recommended to try the RICE technique (rest, ice, compression, and elevation) to reduce swelling and bruising. If the pain persists you will need to see a podiatrist, who is specially trained to handle serious foot injuries. The doctor will need to take X-rays and possibly get an MRI of the foot to determine the status of the bones and make sure none are broken. In addition, a Lisfranc dislocation, where the joints are not aligned, has to be assessed. Then a person will be wearing a cast, non weight bearing for up to a few months. In the worst case scenarios the injury could require surgery for proper healing.

Although the injury is rare, once you have experienced a Lisfranc injury, your foot may be susceptible for further damage. For example, mobility would be a great concern, especially for an athlete. In addition, arthritis is common in those who have had this injury which could lead to less mobility. Aches, pains, and stiffness are also amongst the top complaints of Lisfranc injury sufferers.

The future of Matt Schaub’s season and career are yet to be determined. Sources connected with the athlete are trying to stay positive as the Texan’s quarterback travels from state to state gathering specialist’s opinions on the damage. Although Schaub is concerned to help his team and get back in the game, not treating the condition properly could lead to more serious problems down the road.

Q&A: The top 7 Questions about Ankle Fractures

Breaking your ankle can be a very devastating injury which can involve significant time off your feet depending on the extent of your injury. The below question and answer format will give you much of the information you need to know about treatment if you or someone you know sustains a broken ankle.

FAQ (Frequently asked questions):

1. What should I do if I think I broke my ankle?
You should be treated immediately. If a local podiatric surgeon is not immediately available in his/her private office, a hospital emergency room is the best place to go. Pain medication will be administered and X-rays will be taken. If a fracture is confirmed and the fracture segments have moved apart significantly, pain medication will be given and a manual (closed) reduction to put the segments closer together will be attempted. If surgery isn’t needed, then an above or below the knee fiberglass cast will be applied and crutches, a walker and/or wheelchair will be given as no weight can be applied to the foot.

2. How do I know if I have a broken bone vs. a bad sprain?
There is no way of knowing whether you sprained your ankle instead of fracturing it without getting an X-ray. Blisters, swelling, pain, bruising and redness with either a fracture or a sprain may be present. Pain directly on the bones of the ankle with direct touch is a clinical test but often times even in a sprain there is pain everywhere even on the bone. X-rays are the only way of knowing for sure if you broke a bone. If you sustained a very intricate fracture, your doctor may also order a CAT scan.

3. Will I need surgery?
If the bones cannot be manually reduced or put back together, than surgery will be performed. This surgery for an ankle fracture is called an open reduction with internal fixation (ORIF).

4. How long does it take to recover?
Bony healing typically takes 6-8 weeks to occur. However depending on your overall health, other factors such as smoking, diabetes, poor nutrition and poor circulation can delay this process.

5. How long will I be in a cast?
Regardless of if you have surgery or not, a cast will be in place for at least 6-8 weeks in order to give the bone enough time to heal
.
6. When will I be able to walk normal again?
This depends on the severity of the fracture but typically one will be able to ambulate in a sneaker after 8-10 weeks. Even then, the ankle will still be somewhat swollen.

7. How long will I be out of work?
It depends on the type of work you do. If you have a very accommodating job and can sit most of the time, then you may be able to return as soon as 2-3 weeks after treatment. While at work you need to keep your foot elevated on another chair. You should keep ice applied for 20 minutes every hour when awake. Most people will need to take at least 4-6 weeks off from work, but if you have a job where you need to stand and walk, then you will need to take at least 3-4 months off from work. You may qualify for short-term disability or workman’s compensation (if the injury occurred at work).


SAQ (Should ask questions):
1. What bones are involved in an ankle fracture?
The ankle consists of the end of the tibia bone called the medial malleolus, the end of the fibula bone called the lateral malleolus and the bottom of the ankle called the talus bone.

2. Are certain people prone to breaking their ankle?
Oftentimes, an ankle fracture involves a simple, unintentional slip, fall or accident. Other times it involves a twisted ankle injury from someone who has frequently sprained his or her ankle in the past. These people have chronic ankle instability and have high arches that are unstable on uneven surfaces. This leads them to sprain their ankle a lot and even fracture it if the force of the sprain is high enough.

3. How can I prevent an ankle fracture if I am prone to this?
If you have high arches, have sprained your ankle in the past and feel unstable on uneven surfaces, you need the proper support to prevent not just another sprain but a fractured ankle. Good, sturdy shoes as well as a pair of functional customized orthotics (inserts) to straighten out the foot and offer stability are best to prevent a fracture or sprain.

4. What determines if I need surgery for the ankle break?
If the bony segments of the fracture are shifted enough more than 2mm and closed manual reduction cannot close the gap enough, you will need surgery/ORIF. Also surgical repair of the ligaments may be performed if the ligaments are torn as seen as a wide gap of the bones on X-ray.

5. Will I have long-term pain after the ankle is healed?
Just as in other joints, the ankle joint should be comprised of healthy cartilage that covers the bone to allow for up (dorsiflexion) and down (plantarflexion) motion. A break of the ankle usually involved a break or injury to the cartilage as well. Therefore and theoretically, someone who sustains an injury to the ankle joint (intra-articular fracture) may develop chronic ankle arthritis called osteoarthritis or degenerative joint disease. Arthritis involves cartilage damage where the bones rub together causing inflammation and pain. You might not have severe arthritis, but if the cartilage is slightly damaged you may have persistent but occasional pain and stiffness in cold or rainy weather.

6. Will I need physical therapy?
Yes, most patients whom are in a cast for 6-8 weeks will develop weakness and visible calf atrophy or a smaller calf. These muscles need to be strengthened and the ankle needs to be moved to increase ankle range of motion. A formal therapy program of 2-3 times per week for at least 1 month is needed at a therapy facility for optimal healing.

7. What is the difference between a podiatric surgeon and orthopedic surgeon? Who should I see for my ankle injury?
Seek treatment from a podiatric foot and ankle surgeon as they are uniquely qualified to not just perform the surgery but also to carry out the long-term care of patients by addressing the biomechanical conditions affecting the foot and ankle. Unlike orthopedists, a podiatric foot and ankle surgeon, in addition to the general medical training, focuses on the foot and ankle from the beginning of their medical training.

By Dana Waters, DPM
Podiatric Surgeon in Hillsborough and Piscataway, NJ

As Does Ryan Howard’s Achilles Tendon Goes Pop, so Does the Phillies Season

The favorite Philadelphia Phillies lost their playoff series last night to the St. Louis Cardinals. On the very last play, Ryan Howard, the Phillies first baseman, was running out a ground ball. On the way to first base, Howard crumbled to the ground. “I heard my Achilles Tendon pop,” he said.

That pop that Howard describes is a sign of an Achilles Tendon tear. You might say well, he has all off season to recover, but Achilles Tendon ruptures are not to be taken lightly. Since the Achilles is the largest and the strongest tendon, it is also the hardest tendon to heal after an injury. The tendon attaches the big calf muscle to the back of the heel bone, also known as the calcaneus. When the calf muscle contracts, the tendon allows you to point your foot and stand tiptoe. The tendon is necessary to run, walk and put your foot down.

How does the Achilles Tendon Tear?

Tears are really not that common and usually occur in Men over 40 or in athletes who perform a ballistic movement, like Dan Marino did several years ago, when he pushed off his foot to throw a pass. The athlete pivots, jumps or runs in a very quick fashion.

The injury can also happen in these situations.

1) You make a forceful push-off with your foot while your knee is straightened by the powerful thigh muscles. One example might be starting a foot race or jumping.

2)You suddenly trip or stumble, and your foot is thrust in front to break a fall, forcefully overstretching the tendon.

3)You fall from a significant height.
When the injury occurs, a loud pop sound usually happens. It is sometimes sounds like a gun shot went off. Sometimes the tendon doesn’t fully tear, and you get a partial rupture. Partial tears can lead to a full blown rupture if left untreated. In young athletes, surgery is usually needed to repair the tendon if it was fully ruptured. Partial tears can be treated with initial immobilization and physical therapy.

Rehabilitation after surgery can be from 3-6 months. Most professional athletes, like Ryan Howard, would need about three-four months before being ready to play their sport.

Another way to get a tear of the tendon is to ignore pain in the area. It is very common to develop Achilles Tendinitis, which is a swelling along the tendon. If one ignores this pain and continues to stay very active, the inflamed tendon can tear. So, it is very important to see your podiatrist if this happens.

Wendy Williams Loses Because of her Feet!

I am not a Dancing with the Stars nut but I did get a chance to see Wendy Williams’ feet and I must say they do not look good. With bunions, blisters, and swelling I am not sure how she managed to put her feet in stilettos and put on a show. That in itself is talent. Still, she was voted off and her dancing didn’t make the cut.

I haven’t done any professional dancing but I can respect the intense work it does on your entire body and on your feet. Spinning, stepping, dipping, swaying all push your body to use it in ways you are not used to and it also puts increased stress and strain on your feet. It is no secret that podiatrist do not promote heel wearing. Surely we wouldn’t promote heel wearing while spinning, stepping, dipping, and swaying across a glossy dance floor right? Well entertainment is entertainment. No one is going to line up to see a beautiful ballroom dance with sweeping elegant gown and well supportive athletic shoes. Seriously!!!!

I’ve worked with ballerinas and other professional dancers and it is just devastating what happens to a professional dancer’s feet. What they endure is unbelievable. There are things to keep your feet healthy if you are a dancer or are pursing to take up dancing as a new hobby. First, you have to know your feet. Are you prone to ankle sprains? Do you have a flat foot or a foot with a high arch? There are general precautions and taping techniques to prevent you from injuries depending on your foot type. Second, know your shoes. Not all heels are created equal. Most importantly, flip them over and take a look at the bottom. Dance floors are made slightly slick to help the dancer glide along the floor. Paired with the wrong shoe, the dancer may be gliding across the floor on their bum. Lastly, know when to stop. Your feet are a part of your body. You can push them too hard and do too much damage. They hurt for a reason! Your body is trying to tell you something.

When you are a non-dancer who goes to dancing 7 days week like Wendy Williams, there is no way you will make it without blisters, bleeding, and stiffness. The biggest mistake is going to long too soon. Dancing is like running. You have to take baby steps and work yourself up to the long hours and the advanced moves. Blisters go away with time, but some injuries will change how your foot functions.

Foot Surgery Nearly Kills Serena Williams???

Less than a year ago, Serena Williams underwent foot surgery. She was in cast, walking boots and crutches for some time after the injury. She recently underwent surgery for a life threatening condition. Did her foot surgery have anything to do with her blood clot?

Pulmonary Embolisms are most often the result of a blood clot that has traveled from the blood vessels through the heart and then to the arteries of the lung. The blockage causes shortness of breath, chest pain, and can be life threatening. The clot typically originates in the deep veins of the leg. These clots are also known as a DVT. Blood clots can form in anyone, but are most likely to occur after immobilization, in the elderly, or those that have a family history of blood clots. Those who smoke, are overweight or take birth control are also at an increased risk. The risk of having a pulmonary embolism is greater in high risk large orthopedic cases such as hip surgery. The risks of a DVT after foot surgery is less than 1% and the risk of a pulmonary embolism is even less.

Why is there a risk of a DVT or pulmonary embolism after foot surgery? It is common to be immobilized after foot surgery. While in a casts, surgical boots and crutches, your lower leg is generally inactive. The calf muscles are an internal pump to move blood back to the heart. If the leg is immobile, the body has to work harder to move the blood. If there is an insufficiency in blood movement, there is a higher risk of a blood clot. Not only did Serena have recent surgery, but she has also been doing a lot of traveling. Sitting on a plane for hours will only worsen a blood clot.

Linking the surgery to Serena William’s blood clot is hard to do. The surgery was some time ago and there may be other risk factors that we are unaware of. It does demonstrate that even healthy, young individuals may be at risk of a blood clot. It is important to take certain precautions to prevent clots before they happen. If you are at high risk of a blood clot, your doctor may prescribe medication after foot surgery to help prevent blood clots and pulmonary embolism. The risk is still very low, below 1%, but the results can be serious if not treated promptly.

Is Rex Ryan a Frustrated Podiatrist?

A video was just released showing Rex Ryan, the NY Jets football coach and his wife, depicting Rex of having a foot fetish. It is this video that made me think of the endless times I get asked, “Dr. Wishnie, why did you become a podiatrist? Do you have a foot fetish?”

Let me first answer that as simply as, absolutely not. I usually tell my patient, “Do you think a gastroenterologist has a butt fetish?” Then I ask, “What body part is beautiful? At least the foot is an external appendage that I don’t have to go digging into any holes.”

Well, why did I become a podiatrist? Podiatrists see many different types of patients. We see patients ranging from the age of infancy to the geriatric. On one day I can see both an 18 month old baby and a 104 year geriatric. I can see patients with sports injuries, like ankle sprains, Achilles tendinitis, fractures and dislocations. I see runners who don’t want to stop running, no matter how bad their foot hurts. Then I see little old ladies who remind me of my grandmother.

As you can see, I love the diversity that podiatry offers. I also love the fact that I can usually get people feeling better immediately. See, when you are not feeling well and you go to your family physician, they say, “Take this pill and you will feel better in a week.” Then the patient asks, “Hey doc, what happens if I don’t take the pill.” The doctor answers. “Then you will feel better in seven days.”

A lot of people are afraid of going to the doctors. They are afraid of the pain that might be inflicted upon them. Then what happens if they delay in making an appointment? The pain and the problem usually worsen. In podiatry, we can treat a problem many different ways. If a child comes in with a plantar’s wart, we usually use a topical medication to kill this virus. We usually don’t have to use any needles or do any cutting. If you have a corn, which is dead skin on a toe due to a deformity called a hammertoe, we can trim it painlessly. The patient leaves the office immediately feeling better. If you suffer from heel pain, we can tape the foot and give medication to relieve the pain. Many times we need to give an injection but then the patient is walking out the office feeling ten times better.

Getting patients better quickly and seeing almost immediate results is very satisfying. Podiatry is a wonderful profession and with millions of active baby boomers turning 65 on a daily basis, podiatrists will be very busy and will be an extremely necessary profession for many years to come.

Hey Rex, if this football coaching doesn’t work out, I can help you get in touch with my podiatry school professors.

Dr. Wishnie is Finally Legal!

Today Marks the 21st Anniversary for

Family Foot & Ankle Specialists

We would like to thank all of our incredible patients as we celebrate our 21st anniversary! We have met so many amazing people through the years, many of which were patients when we first started. We have seen each other through a lot; marriages, children, grandchilren, birthdays and more. You are more than just patients to us, you are considered a special part of our family!



We hope you continue to grow with us for many years to come. Wishing everyone a safe holiday season,

The Doctors & Staff Of Family Foot & Ankle Specialists

Joints Under the Weather

It is that time of year when the air gets crisp and you enjoy evening walks through the leaves. Unfortunately, it is also the time of year when arthritis pain flares up. After the rain, before the storm, and changes of temperature seem to have a poor relationship with our joints. Much like pollen aggravated seasonal allergies; the change in seasons aggravates joints. Is the weather really the cause of your joint pain?

Science has not been able to justify the theory. It is believe that the change in weather alters the pressure and changes the pressure threshold within your body. The tissues are able to expand or swell to a greater capacity. A number of large studies closely examined arthritis pain and compared it to temperature and air pressure. Unfortunately, the research has not given us any concrete answers. So many of my patients relate their joints are better weather predictors than the weather man and I can’t disagree with them.

Whether it is an old wise tale or the cold hard truth, joint pain can put a halt to your fall activities. Arthritis has a number of different causes. Most arthritis is causes by years of wear and tear that leads to damage in the cartilage. Cartilage provides a glossy, lubricated surface that allows for smooth pain free movement. As the cartilage degenerates bone comes in contact with bone and the joint loses its ability to move freely without causing irritation. Irritation leads to inflammation and inflammation leads to pain.

To treat arthritis, we start with trying to decrease the inflammation. This can be done with Non steroidal anti-inflammatory, and corticosteroids. Depending on the degree of arthritis, decreasing the inflammation to decrease pain is nearly impossible. In the foot and ankle, arthritis is very difficult to combat because we never give our feet time to relax. We are constantly up on our feet and push through pain because we have to. When conservative care fails, many patients ask for surgery.

There are generally two surgical options for foot and ankle arthritis. The joint can be replaced with an artificial joint made of titanium or stainless steel. The joint can also be fused, eliminating motion at the site. Not everyone or every joint is suitable for a joint replacement or a joint fusion. Many are turned off by the thought of having a joint fused, but in many cases it is very suitable for the condition and the patient can quickly adjust. The big toe is a joint that gets fused often and has a very high patient satisfaction rate.

Arthritis can be a very difficult and aggravating disease to combat. In our busy lives and our growing concerns on staying active and healthy, joint pain can really hinder the ability to live life to the fullest. You can however give the weather man a run for his money with those weather predicting joints!!!<

Is Brett Favre’s Ankle Serious

The reason Favre is so enjoyable to watch is because you never know what is coming next. No one could have predicted the scene at Lambeau as the Green Bay Packers defeated their rival and hero, the Vikings with Bret Favre. Are you really a Hero when you play through injuries and avoid medical attention during a game?
I have read many articles trying to decipher this ankle injury, but the reports are vague only stating Favre suffers from two minor ankle fractures including a stress fracture and an avulsion fracture. I have also read a report that discusses a so called “heel” problems or injury. The reports say neither injury is severe and surgery is not necessary and the Vikings star is not practicing and resting in a controlled ankle motion boot (CAM Walker). Whether Favre will play on Sunday is still unknown.

I cannot predict or diagnose an injury without seeing them physically but here is what I know about Favre’s recovery time. Bone takes about 6 weeks to regain adequate strength after it breaks. Stress fractures heal faster since they are only hairline defects but still require a significant time of rest and decreased activity. Most stress fractures are secondary to overuse over time and not the result of a blunt trauma. Avulsion fractures result when ligaments or tendons pull off a piece of bone during a traumatic event. This injury most certainly happened after Favre was tackled. These injuries do not always need surgery, but they do require time to heal.

I find it interesting we nearly praise someone for playing through pain and injury when infarct they are only hurting themselves and their team. Ignoring an injury that is visibly impairing you can be very dangerous. I worry that many young men athletes think Favre’s actions are heroic. High school football injuries are getting a lot of attention this year. Many are suffering from damaging concussions and few have even died during a high school football game. Favre may be sending the wrong message to these young athletes. Your body does have a limit and ignoring a painful limp does not make you superhuman. It is after all just a game.

The future hall of famer, the Green Bay legend and the greatest quarterback of all time will always be remembered as a man who redefined the odds of the game and was at times above the game.

Today, we wonder if Childress and Favre are reading comic books or pretending to be Superman. You can’t play football with a broken ankle, a heel problem and tendonitis in your throwing arm. Well, Favre probably can but will he be any good? Favre has proven everything he possibly could on the field, now it is time to prove he can sit the bench. Not even Favre can go beyond his body’s limits.

Knee Pain Is A Foot Problem

Up to 75% of athletes have chronic knee pain. Is your knee pain driving you crazy? There are a million different reasons why so many people suffer from knee pain. Henry (Hank) Aaron, a home run king, is one of many professionals that suffer from arthritis in the knee. Is there anything you can do to treat or prevent these aches and pains in the knee?

All arthritides are irreversible. Once you have arthritis, you will always have arthritis. The first thing to identify is what is causing the arthritis. Weight is a very important factor. The heavier a person is the more stress and strain that is place on the knee.

Many people attribute activities to knee problems. Though high stress, pivoting, and jarring activities put a lot of stress on the knee, it does not always lead to arthritis. More importantly, a person’s biomechanics can cause chronic increased forces and instability that leads to damage and injuries. The knee is the most unstable joint in the body.

Most other joints have boney boarders that help stabilize the joint. The knee is simply two bones separated by cartilage and ligaments and surrounded by muscles, tendons, and ligaments. These are all soft tissue structures. The knee is surrounded by two more stable joints in the body, the hip and the ankle. However, small problems in these joints easily affect the unstable knee joint. Thus, if someone has chronic ankle or hip problems, it is not unlikely that they will also suffer from knee problems.

Since soft tissues are the major stabilizers of the joint, they can be strengthened with physical therapy, strength training, stretching and range of motion exercises. A biomechanical exam can be done to assess your ankle and hip range of motion, stability and muscle tightness that causes changes in joint function. Most people benefit from several different forms of physical therapy and other treatments gauged at correcting the mechanics of the joint, such as orthotics, custom shoe inserts made by a podiatarist.

Orthotics are not just for your foot pain! You may not have any foot pain and still benefit from orthotics. Many of my patients are extremely active in sports and running. From weekend warriors to obsessive marathon runners, I have heard patients say their orthotics helped their knees, hip, back and everything in between. Biomechanics is the application of mechanical principles to the human body and is studied extensively by podiatrists. Many of the basic concepts are also applied in physical therapy and sports training are biomechanical in nature. Orthotics are devices that enhance function and compensate for biomechanical problems in the leg. Changing joint positions and alignment in the foot and ankle have a direct effect on your knee and hip.
Not everyone needs orthotics, but many people benefit from them.

My clinical experience has me convinced me that orthotics are necessary treatment modalities for a number of musculoskeletal disorders in the lower extremity including arthritis.

Winter De-Feet

Winter is knocking on our doors and bringing cold air to chill our bones. The cold air gives us so many reasons to snuggle up in bed or cozy up by the fire, but it also gives us so many reasons to enjoy the outdoors.

Skiing, ice-skating, snowshoeing, snowmobiling, and snowboarding are all common winter activities that expose our bodies to the cold. It is important to protect yourself from the cold weather. Many are unaware that you can still acquire cold injuries in weather above freezing! Sometimes we underestimate the weather, or sometimes we just don't have a pair of boots to go with our outfit. Whether on a ski hill or walking to work, you need to keep your feet protected from the cold.

Chilblains is an extremely common cold injury that does not involve freezing of the body's tissues. After exposure to cold weather, areas of the skin will be painful, red to purple, and swollen. The discomfort can last for days and eventually subsides. Occasionally, the affected area will permanently have an increased sensitive to cold Trench Foot occurs after the foot is exposed to cold and wet conditions. This was a common injury in soldiers of WWII. As in Chiliblains, none of the body's tissues are freezing but the cold weather does cause damage. The foot will be very painful, red, and blotchy. Depending on how long the foot was exposed and how cold the foot got, determines the severity. In rare cases, trench foot can lead to gangrene and the need of an amputation.

Frostbite is the actual freezing of the affected area and is the most severe of cold induced injuries. Ice crystals form and damage the surrounding tissues due to the lack of blood flow and heat. The longer the body is exposed or the colder the air, the more severe the injury. The skin may appear, pale, blue, red and will be extremely painful. Eventually the injury will cause nerve damage and loss of sensation. Blisters may form shortly after the injury.

The prognosis varies from mild complications to amputations. Those who are more susceptible to cold injures are children and elderly. Children have very small toes and fingers and therefore it is easier for these small areas to become cold. The elderly tend to have poor circulation and less mobility. Blood flow helps keep our extremities warm, thus anybody with poor circulation is at a greater risk for cold injuries. If you know you are going to be exposed to cold weather, make sure to dress for the occasion. Wear layers but make sure no area is too tight. Tight clothes can restrict circulation. Bring extra clothes and stay dry. If you have sweaty feet, try changing your socks as often as possible. Avoid drinking alcohol or using illicit drugs since these products can alter your perception of the weather. Take some time to warm up when you are getting cold. Going indoors and enjoying a cup of hot chocolate is sometimes the best part of playing outdoors!

A Painful Foot Tattoo

You can get a tattoo just about anywhere of anything. Surprisingly, the foot has become a tattoo hot spot. Young and old tattoo enthusiasts are racing to get their foot art. Even though the feet are one of the most painful areas to get a tattoo, their popularity is growing! Is it safe for anyone to get a tattoo on their foot?

The foot has many tendons, ligaments, bones, blood vessels, and nerves. The bottom part of the foot is nicely cushioned with fat, but the top of the foot has a very thin layer of skin and fat. Thus, there is very little protecting the delicate structures underneath. The less fat an area has, the more painful the tattoo sight. The skin is basically made up of three parts called the epidermis, dermis, and hypodermis. The epidermis is the skin that regularly flakes off on a daily basis. The dermis is deeper and is the layer that tattoo ink is injected into. The tattoo needle injecting the ink is not intended to go into the hypodermis that contains larger blood vessels and nerves. There are tiny nerve endings in the dermis and thus the tattoo procedure will be very painful. One reason that foot tattoos are extremely painful and tedious is due the fact that the skin is thinner on the top of the foot and there is little space between the layers.

In simple terms, a tattoo is a wound with a dye injection. The skin which is a protective barrier to bacteria is broken and a foreign object, the dye, is injected into the sight. The body reacts to the dye and “walls it off” to protect the rest of the body from this foreign object. As a result, a permanent tattoo is formed. Most tattoos do not lead to serious complications, but occasionally a foot tattoo can go sour. It is important to keep the tattoo sight clean and protected after the procedure. Unfortunately the foot is often in socks and shoes that can harbor bacteria. The foot also bears a lot of weight and can put stress on the structures surrounding the tattoo and the tattoo itself. Many have to resort to flip flops or other non-supportive shoes for days to weeks before returning to their normal shoes. If your feet are not used to being in unsupportive foot gear, this may lead to generalized or focal foot pain. Still, it is more important to keep the tattoo sight clean since the complication is much more severe than not wearing proper shoe gear. Once the tattoo sight has healed, one should go back to wearing socks and supportive shoes during regular day activities.

Since tattoos are wounds, there is a population that should avoid getting a tattoo on the lower extremity and especially the foot. Peripheral Arterial Disease (PAD) is an extremely common disease among diabetics, and all people over 50 years old. It is the aging of the arteries that causes the vessels to be narrower than normal and thus decreases the blood supply to the feet. Wounds need blood and oxygen to heel. Remember, a tattoo is a wound and it also needs blood and oxygen to heel. Thus, if you have diabetes or PAD, your wound could turn into an ulcer that is limb threatening. People with lymphatic diseases and those who are have lost feeling in their feet are also at increased risk for developing an ulcer.

If you are interested in expressing body art on your feet, make sure your feet are healthy! Visit your podiatrist to have a foot exam to evaluate the health of your feet. If you have decreased pulses or sensation, your cool foot statement could lead to a not so beautiful wound or even an amputation!

Aaron Rodgers and Brett Favre: The Foot Comparison!

You cannot watch football this season without hearing about Brett Favre and Aaron Rodgers. They have been over analyzed in every way possible. So much attention surrounds the legend and the rising star who replaced him. They have faced each other twice already this season, both with a Favre victory, yet the discussions don't seem to subside for a moment. So, to add on to this intense analysis, let us explore the foot injuries of the two athletes!

Prior to the Viking and Packer game, Favre had his first report on the Viking's injury list with foot pain. Nothing more was said about the issue other than that he had a sore foot. The irony of the situation is that after the game, Rodgers suffered from a foot and a toe sprain. Is this the beginning of the end? Did Favre get the last word through foot injuries?

A sprain describes an injury in which a ligament between two bones is stretched, damaged or torn. A Grade 1 injury is fairly mild with only minor damage to the ligament. A Grade 2 injury is a partially torn ligament and a Grade 3 is a ligament that is completely torn. With a grade 1 injury, the recovery time is short with very few possible complications.

On the other hand, a grade 3 can takes months to heal and is often extremely painful. Foot sprains are rare in the general population, but are common in sports that put the foot in abnormal twisting positions. Such injuries usually result in a grade 1 or grade 2 damage and complete recovery can be seen within the season with much improvement in only weeks.

Treatment consists of rest, icing, strapping, and anti-inflammatory drugs. A sprained big toe is better known as turf toe. This usually results when the big toe is abnormally hyper-extended. This injury can often be more debilitating than a foot sprain because of the important role the big toe plays in pushing off the ground when running. The grading system is the same as a foot sprain with Grade 1 being a minor injury and grade 3 being more severe.

To prevent further damage with the ability to continue activities, taping techniques have been proven quite effective. The severity of the foot injuries of Favre and Rodgers has been downplayed and seeing their continued performance on the field allows us to assume they are minor.

Still, these injuries can be very painful and increases the risk for a more severe injury. To prevent further injuries, both players should be undergoing physical therapy and switch to a more stable shoe gear. The cleats and the flexibility of football shoes increase the chance that the foot will be twisted in a position that could worsen the injury.

Rodgers' first line of treatment should be to have more protection on the field. It is likely that the injury resulted after one of his many sacks this season. Favre, has age working against him. Younger athletes tend to recover better and faster than older athletes, but Favre has proven that age does not define his ability to play football. Only time will tell if these injuries will advance to a more serious problem that will take them off the field.

The likelihood of these injuries progressing is unlikely since they seem to be only presenting with minor symptoms. Thus, the live football drama series of Favre versus Rodgers will continue.

The Ankle Sprain that Doesn’t Improve

25% of all musculoskeletal injuries are ankle sprains! What does spraining the ankle actually mean? The ankle joint is made up of three bones: the tibia, fibula and talus. These bones are held into proper position by a number of ligaments. The soft tissues surrounding the joint help stabilize the bones so they do not move too much in the wrong directions. Sprains usually occur during athletic activities but sometimes we step down or trip on a rug and put abnormal pressures on our ankle. Most often, a sprain occurs when the foot gets tilted inward or inverted. These abnormal forces causes stretching or tears to the ligaments that stabilize the joint.

The injured ligaments will lead to swelling, inflammation, and pain. If the injury is severe, there may be a fracture present. It is standard for doctors to order x-rays and do multiple different maneuvers to the foot and ankle to asses which ligaments are damaged and if any of the bones are broken. When no bones are involved, rest, ice, compression, elevation, and anti-inflammatory medication usually does the trick. When a fracture occurs there may be need for surgical intervention.

Many people recover from ankle sprains with no problems, but about 10% of ankle sprains do not improve with traditional therapy. In these patients, the ankle sprain was only part of the problem. Below the ankle is another joint between the talus and the calcaneus called the subtalar joint. Thus the talus bone is connected to both the ankle and the subtalar joint. You can imagine that if abnormal forces are put on the talus there will sometimes be damage to the ankle joint and the subtalar joint. Just as ligaments are torn or damaged at the ankle joint, ligaments can be damaged at the subtalar joint.

Unfortunately, it is nearly impossible to tell the difference between ankle instability and subtalar joint instability by physical evaluation. To evaluate the damage, radiographs have to be carefully evaluated and some non-traditional evaluations should be utilized. Placing the foot in specific forced positions is necessary to open up the joint spaces to assess the damage. These can be very painful and a local anesthetic may be necessary in order to complete the exam. Ultrasound has shown to be a great way to evaluate injuries, but not all medical care centers have this modality available. If this injury is caught early , the treatment is mostly non-surgical. Different immobilization devices and physical therapy can usually strengthen the ligaments. Occasionally the injury will become a chronic problem that requires surgery.

Since this injury is hard to assess and difficult to differentiate from ankle joint injuries, your doctor may have a difficult time recognizing the issue. It is important to communicate your symptoms and pain as thorough as possible. Knowing how the injury occurred and the position your foot was in when the injury occurred can be very useful information for your doctor to determine what ligaments were injured. If you had an ankle sprain that doesn’t seem to be getting better, it may be an unstable subtalar joint that is the root of your problems.

Summer Bumming Hard on Your Feet!

Though it is hard to admit in a heat wave, summer is coming to a halt. It won’t be long until the kids are at school, and pumpkin picking, football games, and turkey dinners will be on the agenda! Thankfully there is still a good month of sandals and barbeque left! But, are your feet still up for the summer challenge or has summer gotten the best of them already. You may need to pay special attention to your feet on the last stretch of fun in the sun!

Complaint: My feet are dry and cracked. My feet are itchy, red, and sometimes have blisters.
Cause: Believe it or not, both of these complaints will often root from the same problem! Warm, dark, humid environments create a delightful home for fungus! Dry feet are a sign of sweaty feet and sweaty feet are a precursor to fungal feet.
Prevention: The number one thing to avoid is going barefoot in public. Wear sandals around the pool, in the locker room, and in public showers. When possible wear sandals over shoes to allow your feet to breath. Wear dry shoes, change socks often and inspect your feet on a regular basis.

Complaint: I have calluses or corns making my feet ugly. I have thick skin on my foot and it hurts.
Cause: The summer shoe selection can be referred to as the podiatrist’s best resource for job security. Too often men and women put their feet in shoes or sandals that are nowhere near the shape of their foot. This causes the foot to rub against the shoe. Friction causes a buildup of skin that can become painful or unsightly.
Prevention: Wearing wide toed shoes or just properly fitting shoes can help with this problem! Over the counter creams and lotions can help soften the skin, but be careful with corn pads. They often make the problem worse over time. If the callus or corn is continuously painful see a podiatric physician to properly remove the ailment.

Complaint: I have warts. I have a hard, flat, bump on the bottom of my foot.
Cause: Warts are caused by the human papilloma virus. It only takes a small cut or opening in the skin to allow the virus into your skin. These opening are often unseen by the naked eye. Some people are more susceptible to getting warts and need to take extra precautions to avoid the virus.
Preventions: Avoid walking around barefoot, even in your own home! If your family members have warts, you can all get warts! Avoid at home or over the counter treatments. Picking at the wart or improperly removing them can make the wart spread and what started out as one wart can quickly multiply creating a mosaic of many warts.

So as summer comes to an end make sure you keep your feet healthy and safe. If you have any
questions or concerns about your foot health or other summer threats to your feet, seek medical help
from a foot and ankle specialist also referred as a podiatrist. They are trained to treat all foot ailments of children and adults.

Sending Your Child's Feet to College

Some of you have been dreading this day since the day he/she was born. Some of you have been waiting anxiously since he/she became a teenager. Your bundle of joy is all grown up and on their way to college. Parents across the world are preparing their lectures on sex, drugs, and alcohol. There is so much they have to learn on their first adventure with independence. What parents often overlook at this vulnerable time in their child’s life is the “foot talk.”
Hear me out before you think I’m crazy. I don’t want to undermine the importance about talking to your child about sex, drugs, and alcohol, but there are other important conversations to have. Young adults can be afflicted with a magnitude of foot disorders that can be very embarrassing and socially limiting.
Sweaty, Smelly Feet!

How on earth will your son your daughters make any friends if they have the smelly feet dorm room! If you think your child’s feet stink, imagine confining all of their dirty socks and shoes and their feet in a small poorly ventilated, overheated dorm room. It may not seem like a big deal now, but it is a major problem that can lead to athletes foot and toenail fungus. In your 20s with a fungus farm growing on your feet… good luck meeting your life partner!

Bare feet among fungus, bacteria, and who knows what!

We have all heard the importance about wearing sandals in public showers, but what about public areas in general. How often do the hallways of the dorm or your child’s dorm room floors actually get cleaned? It is college, so we can only imagine what is on the carpet. All you need is a tiny cut or skin opening to get infections. Plantar warts can be very common among college students because the virus can easily transfer from person to person when everyone is walking around barefoot in their new home called the dorms!

Ladies are walking home barefoot because their feet hurt!

If you’re a woman, you know the pain induced by wearing cute shoes. After spending all night in those high heels at a party (I mean “library”), the girls’ kick off their heels to relieve their feet on the walk home. What’s on the sidewalks in a college town? The most dangerous is glass! I recently went to surgery for a young lady who had a piece of glass lodged in her foot for 3 months! This lucky girl avoided a severe infection, but that is not always the case.

Pedicure day with the girlfriends!

Whether your daughter is familiar with getting pedicures or not, the girls will hang out and do girly things like pedicures. Don’t forget your college driven child is broke, thus they are always looking for a good deal whether it is penny beer pitchers or affordable pedicures. A pedicure can be disastrous if the tools are not cleaned properly, the spa chairs are not flushed properly, and the pedicurist does not use proper precautions to not cross contaminate. Remember, people with foot fungus or bacterial infections get pedicures too. Now I’m not saying the more expensive the pedicure the safer it is, but remind your child to ask about the cleaning techniques of the pedicure instruments.

So if you don’t have enough to worry about sending your child off to college, here some more things to add to your list. If your child has sweaty feet, see a podiatric physician before all possible friends are running away from the odor. Remind your children to watch their feet and take note of any changes. Don’t wait 3 months before you seek medical help for glass lodged into the foot, toenails changing color, or flaky, itchy athlete’s foot.

Why See a Foot Doctor?

It is interesting to me how many people ignore foot and ankle problems. My feet hurt. My toe looks funny. My foot doesn’t feel right. My ankle is sore. I can’t run because of foot pain. My ankle gives out. This should warrant one to suspect a problem but most turn a blind eye to their foot problems. When you have a tooth ache, you go to the dentist. When you can’t see well, you go to the eye doctor. When your child has a fever, you go to your family doctor. So, when you have foot and ankle pain, shouldn’t you see a foot and ankle doctor?
For whatever reason, people have become to believe that sore feet are a part of life. Instead of seeking medical help, we adjust our activities to avoid the pain. I can’t tell you how many people I have met that have halted their favorite hobbies because they thought they didn’t have the feet to do it anymore.
Sandy, a dear patient of mine once told me she was an avid runner in her youth, but after college she stopped running because her feet couldn’t “handle” it anymore. She never did anything about her foot pain except decreased her activities and wore “ugly shoes.” As a result of her new found sedentary lifestyle, she gained quite a bit of weight and is now suffering from type 2 diabetes. Her primary care doctor referred her to me to monitor her foot health, which now is in great jeopardy due to her diabetes. It breaks my heart that Sandy, not only gave up something she loved but also put her heath at risk because of treatable foot pain. Since Sandy’s first visit with me 1 year ago, we have eliminated her foot pain, greatly decreased her chance of diabetic foot complications, and Sandy has taken up more physical activities and lost almost 100Ib.
Just yesterday, I had a patient who recently returned from a family vacation in Walt Disney World. Jim was upset because after the first day his feet hurt so badly, he spent most of the time sitting on benches as the rest of his family toured the park. I hear similar stories all the time. He admitted to suffering from moderate heel pain prior to the trip, but had a desk job so he never noticed the pain except when he went golfing, a hobby he practically gave up because of his busy schedule. Thus, since he only rarely had foot pain, he didn’t think it was a big deal. The full day of walking through Disney World flared up his condition, and his heel pain became unbearable for the remainder of the trip. Once again this could have been prevented if he would have gone to a podiatric physician about his foot pain.
I told Jim, “If you have difficulty seeing while driving in the dark, you go to the eye doctor and get glasses even though you are not suffering from a problem all day long. If your feet hurt with activity, you should go to the foot doctor (podiatrist), and receive treatment even if your pain is not all day or every day.”
If you find yourself adjusting your daily activities or avoiding hobbies because of your feet, call your foot doctor today! No matter your age, your feet should not limit the way you live your life, but rather be walking you up and down every hill and through every garden life has to offer. Take care of your feet!

Ingrown Nails Got You Hanging?

If you have an ingrown toenail, you can relate when I say the pain and discomfort is beyond aggravating. Trying to find comfortable shoes is sometime impossible. But what do you do about an ingrown toenail? Do you try to cut it out with a toenail clipper? Will it be there forever? Some people are scared to seek medical attention because they think they will have to get their nail removed. Though sometimes this is necessary, it is rare that it one will have to lose their entire nail.
An ingrown toenail is a nail that digs into the skin and cause pain, swelling, redness, and sometimes infections. It can be cause by genetics, trauma, or improper trimming. Stubbing your toe or dropping an object on your toe may result in an ingrown toenail. Many people cut their nails too short. This encourages the skin to surround the nail and the nail can then pinch the close confiding skin.
When you first notice the problem, there are some at home treatments to reduce the inflammation and pain. Soaking your foot in luke warm water with Epson salt may reduce some of the symptoms. Wearing wider shoes that decreases the pressure applied to the area will also help with the pain. It is highly discouraged to try to remove the ingrown portion of the nail yourself. Continuously cutting the nail inappropriately will worsen the condition. These areas are highly susceptible to infection. Thus at-home surgeries of the nail can be very dangerous. If you continuously feel discomfort from your toenail, it is recommended to see a foot and ankle doctor, also referred to as a podiatrist.
A podiatric physician can do a simple in office procedure to remove the offending nail border. The nail will continuously grow to be ingrown unless the matrix or the root of the nail is destroyed. When only the outside border is causing problems, the doctor can remove that portion of the nail and only kill the root of that area of the nail. Thus you will still have a nail but a small portion will be removed and will not grow back. Those concerned with cosmetics will be happy to know that the removal of the border of a nail often goes unnoticed by others when the condition is minor. If there is a serious infection present, the root of the nail will not be killed due to the reaction of the chemicals used with the infectious tissue. The nail boarder is removed and the injury is allowed to heal until the tissue is healthy to undergo chemical insult.
Though some need to undergo more invasive surgeries to remove the matrix, most have their problems solved by a simple 15 minute visit to the doctor. The most important thing to do is to keep your hands off your toenails. Do not try to pick at it or cut it because a small problem can become a big problem if you do not remove of it correctly.

Ingrown Nails Got You Hanging?

If you have an ingrown toenail, you can relate when I say the pain and discomfort is beyond aggravating. Trying to find comfortable shoes is sometimes impossible. But what do you do about an ingrown toenail? Do you try to cut it out with a toenail clipper? Will it be there forever? Some people are scared to seek medical attention because they think they will have to get their nail removed. Though sometimes this is necessary, it is rare that it one will have to lose their entire nail.
An ingrown toenail is a nail that digs into the skin and cause pain, swelling, redness, and sometimes infections. It can be cause by genetics, trauma, or improper trimming. Stubbing your toe or dropping an object on your toe may result in an ingrown toenail. Many people cut their nails too short. This encourages the skin to surround the nail and the nail can then pinch the close confiding skin.
When you first notice the problem, there are some at home treatments to reduce the inflammation and pain. Soaking your foot in luke warm water with Epson salt may reduce some of the symptoms. Wearing wider shoes that decreases the pressure applied to the area will also help with the pain. It is highly discouraged to try to remove the ingrown portion of the nail yourself. Continuously cutting the nail inappropriately will worsen the condition. These areas are highly susceptible to infection. Thus at-home surgeries of the nail can be very dangerous. If you continuously feel discomfort from your toenail, it is recommended to see a foot and ankle doctor, also referred to as a podiatrist.
A podiatric physician can do a simple in office procedure to remove the offending nail border. The nail will continuously grow to be ingrown unless the matrix or the root of the nail is destroyed. When only the outside border is causing problems, the doctor can remove that portion of the nail and only kill the root of that area of the nail. Thus you will still have a nail but a small portion will be removed and will not grow back. Those concerned with cosmetics will be happy to know that the removal of the border of a nail often goes unnoticed by others when the condition is minor. If there is a serious infection present, the root of the nail will not be killed due to the reaction of the chemicals used with the infectious tissue. The nail border is removed and the injury is allowed to heal until the tissue is healthy to undergo chemical insult.
Though some need to undergo more invasive surgeries to remove the matrix, most have their problems solved by a simple 15 minute visit to the doctor. The most important thing to do is to keep your hands off your toenails. Do not try to pick at it or cut it because a small problem can become a big problem if you do not remove of it correctly.