Causes of Posterior Tibial Tendon Dysfunction/ Adult Acquired Flatfoot Deformity

Dr. Dana Waters, a Hillsborough Podiatrist explains the common condition adult flatfoot. The clinical name, Posterior Tibial Tendon Dysfunction, is a common condition that effects many adults. The cause of Posterior Tibial Tendon Dysfunction is usually overuse. Athletes, diabetics, those overweight, and people who work on their feet are the most effected with this condition. Treatment is usually done with conservative measures, and treatment is easiest if the condition is detected early.
 If you are having pain in your feet or ankles, click here or call one of our NJ offices to make an appointment with one of our doctors. (732) 968-3833.

Easy and Effective Winter Foot Care Tips

One of the best feelings in the world might be warm, fuzzy socks on cold feet. When your feet are cold, it's likely your body will be cold as well. Your head and feet are the two biggest outlets of heat on your body. If you keep them warm and cozy, the rest of your body will likely feel the same way.

The cold months of winter can wreak havoc on your feet. It's especially important to keep your feet warm and protected during the winter in order to keep them...and the rest of your body safe. In the article below, Dr. Robert Kosofsky, a podiatrist in Piscataway, NJ at Family Foot & Ankle Specialists explains some easy and effective tips to keeping your feet healthy and happy. He explains it is especially important for children and seniors are they are more susceptible to illness and injury.

For example,

• Always keep a change of socks
• Wear weather appropriate socks
• Children & babies need to wear extra blankets or protection
• Seniors need to regularly visit their healthcare professionals

Click here to learn how to keep your feet happy, dry and COZY all winter long!

Hillsborough Podiatrist Discusses Stress Fractures

Dr. Dana Waters, a podiatrist in Hillsborough, NJ explains the causes and treatments of stress fractures. Stress fractures are commonly caused by overuse. Athletes such as runners, soccer players, and gymnasts experience them often. Treatment for the condition includes rest, ice, compression and elevation as well as anti inflammatories.

If you think you may have a stress fracture, it is recommended to see a podiatrist to ensure that there is not further damage.

Do you have a rash on your leg?

 I once had a woman come to me as a patient for an evaluation of a dark rash on the front of her right leg with mild swelling.  She says the rash always stays the same but the swelling is worse at the end of the day.  The key to her story is that she has almost no swelling when she wakes up in the morning.  She saw a dermatologist who prescribed some antifungal creams for this rash but it never cleared up.  She was very frustrated.  What was this rash?   

The official diagnosis was venous stasis dermatitis from venous insufficiency.  Well to break it down, this is a circulation issue.  Not the arteries.  She had good pulses in her feet (pedal pulses) so the arteries were bringing the oxygenated blood to the feet.  This is the most important part of foot health – the arterial circulation.  You must have good arterial circulation to literally keep your feet but that is another topic.  

This patient had insufficient venous circulation.  It is easier for the arteries to bring blood down to the feet with the help of gravity but the veins have to bring the deoxygenated blood back up to the heart and lungs against gravity.  So to help this venous blood to travel up, there are valves in the veins that push this blood up.  Over time, sometimes these valves get damaged, become insufficient and cannot do a good job at this so the venous blood pools in the legs and the legs increasingly swell.  Superficial and deep varicose veins develop and the venous purplish blood deposits some of its contents called hemosiderin deposits.  

This is what is responsible for the “rash” on this patient’s legs.  This is called venous stasis dermatitis.  So that is why the antifungal did not work as it is not a fungus nor did the steroids work as it doesn’t help the venous blood travel up the leg.  If this persists, venousstasis ulceration can develop with the increased swelling as the fluid has nowhere to go but out and the skin breaks opens.  

Increased age, smoking, genetics, obesity, trauma and pregnancy are all risk factors of venous insufficiency.  Compression stockings (support hose), pneumatic compression devices, weight loss, elevation and exercise can all help manage this condition.  Wound care is needed for an open wound (ulceration) and sometimes if severe enough, referral to a vascular specialist is necessary.

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

Are You A Bathroom Surgeon?

Taking Care of an Ingrown Toenail is Simple and Easy...

How many of you are bathroom surgeons?  You know what I mean.  You have an ingrown toenail that is painful and you decide to go to the bathroom and take out a nail clipper and try to digout the nail.  You know you have done that before.  So, how did you do?  Did you cut that “V” at the top like grandma told you to do?  Or, did you take that little file at the end of the nipper and try to pop it out? 

Well, if you did any of the above, you’ve found out very quickly that it didn’t work and in matter of fact, you have made it worse.  Now, the skin is all red, and there is some icky pus oozing out of the corner.  Now you have caused an infected ingrown toenail. 

The above situation is very common.  You think it is not a big deal to eliminate the ingrown.  However, because you are not as flexible as Cathy Rigby and you do not have the right tools or knowledge, you simply can’t do this yourself.  That’s good, because otherwise, I would be out of a job. 

Most people do not go see their podiatrist to take care of this problem because of three things: 1) Time, 2) Fear, and 3) Money.  What if I told you that the whole process of removing an ingrown toenail takes five minutes and it is virtually painless (definitely a lot less painful then if you did it yourself) and that insurance covers this procedure?  You still might be hesitant to come in but once you do, I can tell you the most common responseI get from my patients is, “Is that all? I should have done this months ago.”

So, now I am going to give away the big secret of how to remove the painful nail.  Please do not share this with anyone, because I might be left without a job.  The first thing we do is explain the procedure to you. We do everything in our power to relax you.  We have drinks (not the hard stuff) and snacks and might tell a joke or two.  Then, I will numb your toe.  This takes all about 20 seconds and from here on in, you will not feel a thing. 

Then I use a regular nail nipper to just cut the ingrown away.  Here comes the big secret.  If you just remove the ingrown without doing anything else, it will come right back.  Just circle your calendar for six months from now and you will find yourself in the same pickle.  This is because the ingrown toenail damaged the root and the root will continually produce another ingrown.  So, to prevent this, I apply four swabs of 89% phenol, which stops the root from making another ingrown.  The rest of the nail will grow back normally.  You will now have a normal nail. 

Afterwards, you can go back to most activities.  If you run or play soccer or other sports, you might need a few days of rest.  You can definitely go back to work immediately (oh, bummer).  To care for the toe, all you have to do is wash it with a cleanser and apply an antibiotic ointment and a band-aid.  This comes in a kit which we will give you.  We will check your toe a couple of times to assess the healing. 

So stop being a bathroom surgeon and get your feet properly taken care of.

 

Dr. Dana Waters a podiatrist in Hillsborough and Piscataway, NJ explains how to treat ankle sprains at home. There are different treatments you can do at home, but if the pain persists you need to see a podiatrist.

How You Walk Shows Early Signs of Dementia and Alzheimer’s

The elderly population is booming and more than ever, people are living longer.  This is causing great energy in the medical community to explore diseases affecting our aging population.   Though we expect our bodies to age, it often troubles us to see ourselves or our loved ones have a decline in cognitive ability.  Alzheimer’s disease and Dementia can be a very painful disease for all involved.  New ways of detecting these diseases are being developed rapidly and now researchers are watching the way we walk to gain insight into our aging cognitive ability. 

The study of gait as it relates to medical pathology has been an increasing interest since the 1970’s.  You may notice that your podiatrist, orthopedist, physical therapist, or other health professionals take special interest in the way you walk.  Some offices now have gait labs that use state of the art technology to gain information about your walking patterns.  The way you walk gives great insight to a podiatrist on the cause or effect of different foot and ankle pathologies.  Gait analysis can be used to help train professional athletes to improve their performance, detect postural related pathology or injuries, and identify stroke patterns or other neuromuscular ailments.  Now science is discovering that our gait may give great insight into our cognitive ability.

In recent studies exploring gait patterns in the elderly population a correlation was found between a person’s gait pattern and their overall cognitive, memory, and executive function.   It appears that a person’s gait becomes slower and more variable as their cognitive function declines.  One study also evaluated brain atrophy using an MRI and found atrophy of the entorhinal cortex related to a decrease in gait velocity.  This portion of the brain functions as the center for a widespread network for memory and navigation.   Those patients with Dementia and Alzheimer’s disease showed measurable variations in gait compared to healthy individuals and as the severity of the disease increased.

Though it may seem logical that as we age we move slower, but these studies demonstrate gait to be much more dynamic than a simple, automatic, motor activity.  Gait is dependent on our cognitive ability and with cognitive decline, our ability to walk within normal parameters declines.  As the science of gait continues to evolve it may become common to have a doctor study your movements as you walk into the treatment room.  Examination of your gait may become as common as taking a blood pressure

Click here to have your gait analyzed by podiatrist in order to learn your chances of developing Alzheimer's Disease or Dementia. 

Peroneal Tendonitis: A Common Missed Problem in an Ankle Sprain

Below the outside ankle bone there are two tendons that can be easily injured during an ankle sprain.  These tendons are called the peroneals.  The longer tendon is called the peroneus longus and the shorter one, the peroneus brevis.

The function of these tendons is to turn the foot outward.  Most anklesprains occur when the foot and ankle roll inward causing an excessive amountof tension on these tendons.  The brevis tendon attaches to a bone on the outside of the foot, called the fifth metatarsal.  Due to this, it is very common to have the tendon pull off a piece of bone during a sprain.  When one sprains his ankle, most emergency room physicians will order only an ankle x-ray.  A foot x-ray is also needed to diagnose this fracture.

Ankle sprains are not the only cause of peroneal tendon injuries.  Feet with severe high arches will cause excessive strain on thetendon.  This is because the foot is naturally severely inverted (turned in).  Another culprit of peroneal tendonitis is direct trauma, so anything that hits or rubs against the tendon.  Besides the above causes, improper or abnormal shoe wear is a huge reason people get pain along these tendons.  Flip-flops allow the foot to move in all directions without any support and can cause a myriad of problems.  In addition, shoes with worn out sides cannot support the foot or ankle. 

When you have pain in this region, the doctor will first get an x-ray to rule-out a fracture. The next step is to treat this problem with the RICE method.  This is rest, ice, compression and elevation.  Depending on the severity of the pain or injury, you will either have a removable compression sleeve or a soft cast and a walking boot for a week or two.  If there is a fracture, then a hard cast and crutches might be necessary for 4-6weeks.  In really severe fractures, where the bone is displaced, surgical intervention is required.

Once the initial inflammation calms down, an injection of a steroid (anti-inflammatory) might be needed, as well as physical therapy to strengthen the area as well as to increase mobility and decrease swelling.  The final treatment would be a custom orthotic, which is an insert, made specifically for your foot, which will control the foot’s poor function. Family Foot & Ankle Specialists in Piscataway and Hillsborough NJ also offers a painless FDA approved laser to not only treat the pain but to help in the healing process of the tendon.   In very rare instances, the tendon is bogged down with scar tissue, and surgical intervention is needed to clean it out. 

As you can see, peroneal tendonitis is not something you want to ignore.  If you are suffering with this condition, go see your local podiatrist as soon as possible.  Remember, the faster you treat this, the quicker it will heal and get you back into the game. 

Big Papi Grounded With Heel Pain

David Ortiz, also known asBig Papi, the designated hitter of the Boston Red Sox, is presently sidelined with heel pain.  Heel pain should not be taken lightly.  In matter of fact, JoeDimaggio, the great centerfielder of the New York Yankees, was on the disabledlist for three months with heel pain.  The difference is that Joe D suffered from a condition called plantar fasciitis, where Ortiz has Achilles tendinitis.

Plantar fasciitis is the mostcommon cause of heel pain, but if your pain is at the back of the heel, then the usual culprit is the Achilles tendon.  The Achilles tendon is that thick tendon at the back of the ankle and attaches to the heel bone.  This tendon becomes the calf muscle.

Achilles tendinitis is verycommon especially in athletes or in people over the age of 40.  Athletes tend to torque their bodies in such a way that it puts excessive strain on the tendon.  Achilles tendinitis will also occur in people who have very high arches.  In this case, the tendon becomes shorter and tighter.  So, any strenuous activities can lead to an inflammation of this tendon.  People with very flat feet also can get Achilles tendinitis because the heel is over-pronating, meaning it is turning outward excessively, causing the arch to collapse.  This leads to the torque of the tendon, which causes the pain.

Activities that make you runon the balls of your feet are also the culprit, such as runners who run on their toes, basketball and volleyball players who are constantly jumping, and sports that require ballistic movements such as baseball and football.  The key to prevention is to make sure one always stretches before and after the activity.  Caution: Never stretch a cold muscle or joint, so always warm up first.

Another cause of heel pain at the back of the heel is a condition called retrocalcaneal bursitis.  There is a bursa (sac of fluid) between the bone and the tendon.  This structure prevents excessive friction of the tendon from the bone when it moves.  In a lot of these cases, the heel bone will be thickened in this area with a prominent “bump.”  This irritates the bursa and now you have bursitis.  The bump is also called a pump bump, because it rubs against the back of pump style shoe. 

The main treatments for these conditions are rest, ice, and a compression sleeve.  A lot of times a heel lift will be applied into both shoes to allow for the Achilles tendon to rest.  This should only be used for a very short time, because the bottom line is that you want to stretch out the tendon, and not shorten it.  Physical therapy is an extreme necessity in most cases.

If the cause of the tendinitis is biomechanical, meaning the way the foot functions during gait,then a custom orthotic is very beneficial.  If the above treatments do not help, then there are many newer treatments and technologies out there that can help.  At Family Foot & Ankle Specialists inPiscataway/Hillsborough NJ, we employ most of these treatments.

The first one is extracorporeal shock wave therapy, also known as ESWT.  This is a non-invasive procedure that is done in the office.  After the area is numbed, the ESWT machinewill send deep, penetrating sound waves into the heel.  This will break down any scar tissue that might be present as well as to increase blood flow to the area.  The patient can walk immediately and will find relieve within the next couple of months.

In addition, the K-Laser is an FDA-approved laser for the use of pain resulting from all types of tendonopathies.  The procedure is also totally non-invasive and does not require any anesthetic.  The laser is painless and takes about five minutes.  Usually 10-12 treatments are required.  At Family Foot & Ankle Specialists, we have had wonderful results using this laser for these problems. 

The key is that if Achilles tendonitis is not treated quickly, scar tissue can result, making the treatments more difficult and increasing the liklihood of a less than optimum result.  So, you should not let the problem linger for too long.  Call your local podiatrist and get back into the game.