Archive for April, 2010
Please watch this tv clip about our new peripheral arterial disease screening process. I am very excited about our new ability to avoid amputations for our patients and early recognition of circulatory deficit with this new machine. Please watch this! http://thedoctorstv.com/main/procedure_list/1527
Sesamoiditis in Nacogdoches and Carthage Texas at Sowell Podiatry
Posted by: | CommentsSesamoids are small bones that are connected only to tendons or are embedded in muscle. This structure appears in only a few places in the human body, one of which is the foot. Two very small sesamoids (about the size of a kernel of corn) are found in the underside of the forefoot near the big toe—one on the outer side of the foot and the other closer to the middle of the foot. Sesamoids provide a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. In the foot, sesamoids assist with weight-bearing and help elevate the bones of the big toe.
Like other bones, sesamoids can fracture. Additionally, the tendons surrounding the sesamoids can become irritated or inflamed, which is called sesamoiditis and is a form of tendonitis. Sesamoiditis is a common condition among ballet dancers, runners, and baseball catchers because of the pressures placed on their feet.
Symptoms include:
- Pain under the big toe or on the ball of the foot.
- Swelling and bruising.
- Difficulty and pain in bending and straightening the big toe.
Surgery is usually not required to treat sesamoiditis. Treatments generally include:
- Discontinuation of the activity causing the pain and inflammation.
- Over-the-counter pain medications and anti-inflammatories, such as ibuprofen and aspirin. Note: Please consult your physician before taking any medications.
- Icing the sole of the foot.
- Wearing shoes that are soft-soled and low-heeled.
- Using cushioning in shoes to relieve stress.
- Injection of a steroidal medication to reduce swelling.
If symptoms persist, you may need to wear a removable brace on the leg for four-to-six weeks to give the inflammation time to subside and the bones to heal.
Diabetes and Your Feet – Take Care of Them! Sowell Podiatry
Posted by: | CommentsAccording to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.
Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation.
With a diabetic foot, a wound as small as a blister from wearing a shoe that’s too tight can cause a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When your wound is not healing, it’s at risk for infection. As a diabetic, your infections spread quickly. If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror.
Here’s some basic advice for taking care of your feet:
- Always keep your feet warm.
- Don’t get your feet wet in snow or rain.
- Don’t put your feet on radiators or in front of the fireplace.
- Don’t smoke or sit cross-legged. Both decrease blood supply to your feet.
- Don’t soak your feet.
- Don’t use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet.
- Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, contact our office.
- Use quality lotion to keep the skin of your feet soft and moist, but don’t put any lotion between your toes.
- Wash your feet every day with mild soap and warm water.
- Wear loose socks to bed.
- Wear warm socks and shoes in winter.
- When drying your feet, pat each foot with a towel and be careful between your toes.
- Buy shoes that are comfortable without a “breaking in” period. Check how your shoe fits in width, length, back, bottom of heel, and sole. Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. Wear new shoes for only two hours or less at a time. Don’t wear the same pair everyday. Inspect the inside of each shoe before putting it on. Don’t lace your shoes too tightly or loosely.
- Choose socks and stockings carefully. Wear clean, dry socks every day. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toes socks will not squeeze your toes. Avoid stockings with elastic tops.
When your feet become numb, they are at risk for becoming deformed. One way this happens is through ulcers. Open sores may become infected. Another way is the bone condition Charcot (pronounced “sharko”) foot. This is one of the most serious foot problems you can face. It warps the shape of your foot when your bones fracture and disintegrate, and yet you continue to walk on it because it doesn’t hurt. Diabetic foot ulcers and early phases of Charcot fractures can be treated with a total contact cast.
The shape of your foot molds the cast. It lets your ulcer heal by distributing weight and relieving pressure. If you have Charcot foot, the cast controls your foot’s movement and supports its contours if you don’t put any weight on it. To use a total contact cast, you need good blood flow in your foot. The cast is changed every week or two until your foot heals. A custom-walking boot is another way to treat your Charcot foot. It supports the foot until all the swelling goes down, which can take as long as a year. You should keep from putting your weight on the Charcot foot. Surgery is considered if your deformity is too severe for a brace or shoe.
Peroneal Tendon Injuries
Posted by: | CommentsPeroneal tendons are two tendons that support two important foot muscles (peroneus brevis and peroneus longus) that originate on the outside of the calves. These two muscles allow you to roll to the outside of the foot while standing.
Peroneal tendons are also called stirrup tendons because they help hold up the arch of the foot. The two muscles are held in place by a band of tissue, called the peroneal retinaculum. Injury to the retinaculum can cause this tissue to stretch or tear. When this happens, the peroneal tendons can dislocate from their groove on the back of the fibula. The tendons can be seen to roll over the outside of the fibula, which damages the tendons.
Skiing, football, basketball, and soccer are the most common sports activities leading to peroneal tendon dislocation. In some cases, ankle sprains have also caused this condition. Patients usually have to use crutches after such an injury, in order to allow the retinaculum tissue to heal and the tendons to move back to their natural position on the fibula. Sometimes a splint or compression bandage is applied to decrease swelling. Anti-inflammatory medications and ice are often part of the treatment. Note: Please consult your physician before taking any medications.
In moderate to severe cases of injury, when the peroneal retinaculum is torn or severely stretched and susceptible to dislocation, surgery may be required.
A Quick Note on Athletic Shoes from Sowell Podiatry
Posted by: | CommentsRecently a new footwear company asked me to review their shoes. They have sent me a pair and I have been wearing them while walking each morning. I’ll write a detailed review at some point in the future but I wanted to share a few basic points about athletic shoes in general.
Athletic footwear should be fitted to hold the foot in the position that’s most natural to the movement involved. Athletic shoes protect your feet from stresses encountered in a given sport and to give the player more traction. The differences in design and variations in material, weight, lacing characteristics, and other factors among athletic shoes are meant to protect the areas of the feet that encounter the most stress.
Well-fitted athletic shoes need to be comfortable, yet well-constructed and appropriate for a given activity. A good fit will mitigate blisters and other skin irritations.
Sports-specific athletic shoes are a good investment for serious athletes, though perhaps a less critical consideration for non-athletes. Don’t wear any sport or other shoes beyond their useful life.
A running shoe is built to take impact, while a tennis shoe is made to give relatively more support, and permit sudden stops and turns. Cross training shoes are fine for a general athletic shoe, such as for physical education classes or health club exercising, such as on stair machines and weight-lifting because they provide more lateral support and less flexibility than running shoes. They also tend to be heavier than running shoes, but most people don’t need light, flexible shoes for cross-training. If a child is involved more heavily in any single sport, he or she should wear shoes specifically designed for that sport.
Our practice recommends sturdy, properly fitted athletic shoes of proper width with leather or canvas uppers, soles that are flexible (but only at the ball of the foot), cushioning, arch supports, and room for your toes. Try a well-cushioned sock for reinforcement, preferably one with acrylic fiber content so that some perspiration moisture is “wicked” away.
Athletic shoes need to be replaced after one year, whether or not they are worn, and after a certain amount of repetitive load is placed on them and wears them down. The American Academy of Podiatric Sports Medicine advises replacing running or walking shoes after 300 to 500 miles of wear, and replacing aerobic, basketball, and tennis shoes after 45 to 60 hours of wear. Athletic shoes should also be replaced if they show signs of unevenness when placed on a flat surface, display noticeable creasing, and/or when the heel counter breaks down.
SensiLase System Enhances Wound Care Planning Strategies
Nacogdoches and Carthage Texas– Sowell Podiatry has begun evaluating wounds using the SensiLase® System, which evaluates the circulatory conditions of the skin. These tests are conducted to assess blood flow of a patient’s legs, feet or toes. The SensiLase System conducts two tests, the Skin Perfusion Pressure (SPP) and the Pulse Volume Recording (PVR).
“When I am treating a patient with diabetes who has foot ulcers, the SensiLase System will tell me with approximately 90 percent accuracy which ulcers are likely to heal with good wound care and which are unlikely to heal despite an optimal wound care program,” says Dr. Mark Sowell,DPM, at Sowell Podiatry. “This level of accuracy greatly improves our ability to provide that individual with the most appropriate and effective wound care possible.”
The SPP test is a useful tool for physicians as they determine the best course of therapy because the data provided enables the physician to:
- Monitor disease progression in patients with conditions such as peripheral artery disease and other circulatory problems
- Assess wound healing potential
- Monitor pre- and post-therapy (e.g., surgery)
- Plan arterial reconstruction and monitor post-procedure healing
The PVR test evaluates changes in arterial blood volume in the extremities with each pulse, and aids in determining the level and severity of arterial disease in the extremities. Performing a PVR with an SPP test provides correlation between the capillary disease process (micro) and the arterial component (macro) to offer further insight into a patient’s circulatory health.
PVR enables the clinician to assess lower extremity circulation, lower extremity arterial occlusive diseases and functional severity of the disease process. Pulse Volume Recording is of significance in that it:
- Is indicative of vascular status
- Provides qualitative patient information about arterial health
- Immediately provides reliable, reproducible results
“Noninvasive tests are much less stressful for our patients than some alternative choices,” said Dr.Sowell. “The SensiLase System gives us the value-added information we need to better diagnose disease and thus provide high quality care for our patients.”
The SPP and PVR tests are especially valuable for physicians who are treating wounds on persons with diabetes. According to the American Diabetes Association, between 60 and 70 percent of people with diabetes experience mild to severe loss of sensation in the feet, often causing foot ulcers to develop. The ADA further reports that amputation of limbs is 10 times more prevalent in these patients than in the general population. Wounds leading to amputations totaled 82,000 in 2002. Appropriate monitoring and care is essential to minimize the necessity of amputation.
According to the Centers for Disease Control (CDC), diabetes is a growing problem with 14.6 million adults diagnosed with diabetes and an estimated 6.2 million adults who are undiagnosed in the U.S. The prevalence of diabetes is growing with the ADA estimating that one in four individuals born after 2000 will develop diabetes.
The SensiLase System is designed, manufactured and marketed by väsamed, Eden Prairie, Minn., a technology development company specializing in cost-effective, vascular diagnostic systems for noninvasive hemodynamic monitoring.
Sowell Podiatry, with clinics in Nacogdoches and Carthage Texas provides complete podiatric services two both communities and over fifteen area nursing facilities. For more information about us contact us at: (936) 559-1700 or at www.sowellpodiatry.com.
