At Austin Foot and Ankle Specialists, we're always looking for bigger and better options to offer our patients. Although some conditions we treat eventually require surgery, we know that having treatment alternatives can be beneficial for our patients. Not everyone (not many!) is keen about going under the bright lights and having a scalpel cut them. We worry about those who love needles and knives!

There is a treatment option that has begun to show incredible success in managing pain and treating various orthopedic conditions called Laser Therapy. Laser therapy involves the use of light energy, emitted at different wavelengths, which penetrate the skin and stimulate cellular metabolic activity.

Laser therapy can be used for various conditions, including some of the more common conditions seen in our office, such as:

• Tendon and Ligament Injuries
• Arthritis
• Plantar Fasciitis
• Neuropathies
• Muscle Sprains
• Sport Injuries
• Joint and Muscle Pain
• Wound Healing and Inflammation Prevention

If you are wondering about the benefits for using laser therapy treatment then here is a quick list, which we have gathered from the results and responses from our patients.

1) Painless Procedure!! – Unlike other laser treatments, this laser therapy has no associated tingling, heat or needle-prick sensations felt during an office treatment. The laser is programmed by your podiatrist to act on a specific area without causing any discomfort or swelling.

2) Minimal to No Pain - Not only is there no pain associated with treatment, but patients who have experienced years of ongoing pain and have not found a successful method towards managing their pain have finally found a solution. Laser therapy has enormous pain relieving capabilities, within a few treatments the pain can disappear as if it never existed. The pulsating light emissions from the laser interrupt the pain signals that are sent to the brain, thereby diminishing the feeling of pain.

3) Heal Faster – Whether you’ve had a recent surgery or are recovering from a sport related injury, laser therapy can help you recover and get you back on your feet much faster than normal healing time. The concentrated light is released at specific wavelengths, which penetrates the skin and stimulates the metabolic activity of the cells within the damaged tissue. This accelerated cellular activity causes increased cellular growth and tissue repair.

4) Reduced Inflammation – The continuous light emissions from the laser on your treatment area stimulate vascular circulation, which causes increased delivery of immuno-responsive cells. In addition, the increased vascular circulation induces an anti-inflammatory effect by reducing the edema caused by the inflammatory process.

5) No Ugly Scars – Whether you are opposed to surgery or fear the scars and recovery time associated with surgery, laser therapy eliminates all of these problems. Fortunately, laser therapy is non-invasive, so there is no scar or recovery time associated with the procedure.

Overall, if you are looking for an alternative to invasive surgery or want to try a quick and different treatment option due to failed past attempts, then Laser Therapy treatment could be the Right Choice for You.  

Laser Therapy Overview:

http://www.youtube.com/watch?v=32tgBucgSRk&list=PLUQjzApeOORT-F0fAaLBmj9ZkwDLBt_9p

Podiatric use of Laser Therapy:

http://www.youtube.com/watch?list=PLUQjzApeOORT-F0fAaLBmj9ZkwDLBt_9p&feature=player_embedded&v=eNgJLw1SjxM#!

            Before we begin talking about the condition, it is important to understand a couple facts about the anatomy of the cuboid within the foot. The cuboid is a small bone of the midfoot and lies on the lateral edge of the foot. Just like other bones of the foot, the cuboid has bony landmarks, such as the large groove on the bottom, which acts as a fulcrum for the tendon of the peroneus longus muscle. The peroneus longs muscle tendon runs passes through the groove on the bottom of the cuboid in order to reach its insertion on the first metatarsal tuberosity. This anatomical relationship between the cuboid, peroneus longus muscle, and its insertion point enable important actions to occur, such as eversion of the foot, stabilization of the first metatarsal during propulsion (Toe-off) and plantar flexion of the foot and ankle joint.

            As you can see, the anatomical position of the cuboid and its relation to the Peroneus Longus muscle directly contributes to the biomechanics of walking and running. Athletes, such as runners, tend to overuse this pulley-like system, which overtime may cause the cuboid to slip out of its joint. When the cuboid shifts out of its position (Subluxation), it causes scattered pain and affects all of the surrounding bones, muscles and tissues. It is clear that a cuboid subluxation is an important injury to take care of as fast as possible, but the symptoms of the condition replicate many other injuries, such as the common inversion ankle sprain. Therefore, we want to discuss some common symptoms, diagnostic signs, treatments and prevention tips in order to help you diagnose and recover as fast as possible.

1) Symptoms – The most common symptom is an aching pain scattered along the lateral (outer) edge and plantar (bottom) aspect of your foot, which typically gets worse with exercise. Also, pain is usually accompanied by inflammation, swelling and weakness around the area of the cuboid bone.

2) Diagnostic Signs – As mentioned earlier, proper diagnosis of a cuboid subluxation is difficult because it shares the same symptoms as many other injuries and is difficult to see with an X-ray or MRI. However, As an expert in foot and ankle conditions, I am trained to make an accurate differential diagnosis in order to rule out other conditions and properly identify the underlying problem in order to treat your injury. In some cases, the cuboid can be visually seen to be displaced from its normal position when there is either a dorsal sulcus (from a plantar subluxation) or a palpable bump on the dorsum of the foot (from a dorsal subluxation).

3) Treatments – Here is the GOOD NEWS. If you are suffering from a cuboid subluxation then you could be relieved of pain within minutes after proper physical manipulation. Physical manipulation techniques allows realignment of the cuboid bone back to its original location while avoiding any further damage to the surrounding structures. After relocating the bone, we recommend strapping and/or padding around the area of the cuboid in order to maintain its correct position and stabilize the surrounding joints.

4) Prevention – The first precautionary measure to prevent a cuboid subluxation is to wear proper footwear, such as trail running shoes when running on uneven and rocky terrain. You should also avoid improper landings on uneven surfaces or stepping on hazards, such as stones because they can displace the cuboid. By wearing supportive shoes while practicing proper running form and landing can greatly reduce your risk of injury. Also, for any activity or exercise, always remember to stretch properly in order to alleviate the tension on your muscles that insert onto the bones of the foot.

            Unfortunately, there is no guaranteed method to avoid a cuboid subluxation. However, proper realignment of the cuboid through non-invasive manipulation techniques can have you back on your feet and running in no time!

So what happened to Derek Jeter anyway? Well, if you read our blog with regularity or watched last year’s playoff, you will remember that last October the short stop fractured his ankle during game 1 of the American League Central Series. After missing the remainder of a playoff series that saw the Detroit Tigers and San Francisco Giants in the World Series, Jeter spend the rest of the off season allowing his injury to heal.   The span of 4 to 5 months is typically adequate time to heal from and rehabilitate and ankle injury or fracture.  While one would have expected Derek Jeter to be back for this season, he reported to spring training in the Rebound walking boot we mentioned earlier.  It was reported that he sustained another small fracture in the previously injured ankle and would be out until the All Star Break.

Walking boots are usually used in the last stages of the bone healing process.  The process of bone healing involves a soft ‘callus’ of blood over the break which then becomes hard.  As the bone heals together this hard callus begins to remodel with the bone.  It is during this remodeling stage that the bone regains its strength.  Through the use of walking boots, you and your doctor, can slowly introduce the increased strain that allow your bones to be as strong as they are. Walking boots can be used in a variety of ways and is only one of many tools your Austin podiatrist can use to get you well!

Until next time, keep those feet and ankle happy and healthy Austin!

            Did you know that the height difference between the heel and front of your shoe (heel to toe offset) may affect the biomechanics of your stride or landing?

Over the years, this has been a modification made to running shoes due to the benefits for alleviating stress on your knees.

For those with forefoot issues, such as arthritis and ball of foot pain, these kinds of shoes/sneakers may force more pressure into a problem area. Often I educate patients about the shoes they thought would be helpful are actually hurting their condition.

The ultimate goals during running are to Reduce Impact Shock and have Proper Body Alignment When Landing after each stride.

Reduce The Impact Shock – You can reduce the shock of impact by landing properly and evenly on your foot rather than striking heel or toe first. When you land heel or toe first, you increase the loading rate at specific areas on your foot, which ultimately places increased stress at certain joints, such as your knees.

Proper Body Alignment When Landing – In order to reduce the impact of shock when landing, it is important to keep your pelvis level and your thigh in a neutral position. You also want your foot to be aligned underneath your hip and landing flat, around the area of your mid-foot. If you see that your heel is landing first and out in front of the rest of your body, than you may also want to try taking shorter strides to help correct your bodies’ alignment in order to stick a proper landing.           

The problem with running shoes that have a higher Heel-to-Toe drop (10-12mm), is that they encourage you to strike the ground at your heel prematurely since it is closer to the ground. This causes a disproportional, abrupt force and large load (weight) on the small area of your heel. These impact forces are not able to be absorbed by the rest of the foot as well therefore; these forces are directed towards the knee joint. At first, this may not be a problem, but over time, the shock absorbing cartilage around the knee becomes damaged and your muscles begin to work in an unnatural fashion, which makes you prone to injury. Studies have shown that higher heel-to-toe offset shoes increase Hip Internal Rotation Torque and Knee Flexion Torque. These are clear indicators that these running shoes force your bodies’ mechanics in an unnatural position, thus making you prone to injury.

Choosing a more neutral running shoe may decrease the strain on your knees and prevent injury, however, EVERY PERSON IS DIFFERENT! The best way to find out what type of running shoe is best for you, is to see your podiatrist, so they can evaluate your foot-type and assess your running form.

What are some the symptoms of diabetes?  If you fall into the last category, you are probably wondering what changes to look for.  Below is a list of symptoms you may experience if your body’s ability to metabolize sugars has been altered and developed diabetes:

• Frequent urination
• Constant thirst no matter how much you drink
• Extreme hunger no matter how much you eat
• Weight loss – losing a few pounds is nice, but a quick unexplained loss of weight is a sign of something wrong
• Visual distortion, most often blurry vision
• Frequent infections – most commonly of the bladder, gums, or skin
• Numbness or Tingling in your hands or feet - this is typically a late manifestation of uncontrolled diabetes, but if you have missed the other cues this is a common symptom.

If you experience any of these symptoms, do not pass go, do not collect $200, visit the nearest doctor and get treatment.  Sorry for the monopoly analogy, but it is imperative that you see a physician and follow through with treatments.  Any of the symptoms mentioned occur with high blood sugars.  When these sugars remain high for long periods of time, there is the potential for non-reversible damage to your body.  Because your feet are so critical to your daily activities and can be so easily affected by this disease, we recommend you visit us at Austin Foot and Ankle Specialists.  Keeping your sugars under control and visiting your Austin podiatrist can keep your feet happy and healthy!

Until next time Austin!

The previous two blogs focused on the ‘head’ of metatarsal bone or the hypertrophy that can occur there.  This last procedure, the lapidus, is part of the group used to address more extensive deformities.  The first metatarsal (behind your big toe) makes an angle with the second metatarsal (behind your second toe).  When this angle becomes too great, the procedures that focus on the head of the bone cannot fully correct the deformity. A thorough biomechanical exam, which may reveal excessive joint mobility, along with the latest in digital x-ray technology allows our doctors to choose the best procedure for you.

The Lapidus:  This procedure is unique amongst the procedures that focus on the base of the first metatarsal rather than the head. The incision for this procedure is closer to the middle of your foot instead of near the ball.  It is typically a little larger, but utilizing plastic surgery suturing, the surgical site heals without leaving a noticeable scar.  The procedure itself involves fusing, or joining, two bones together to limit deforming forces.  By removing the cartilage that allows the bones to glide along one another, the bones are allowed to heal together.  Small surgical screws or plates are utilized to hold the construct together while it heals. After a sufficient period of time off your feet to allow healing, you can get back into your regular shoes and your bunion will be a thing of the past.

Until next time, keep those feet happy and healthy Austin!

As with all our pediatric patients, we took x-rays for a baseline assessment. Now, I expected to see normal growth plates at different areas and some joint misalignments that correspond to his flat feet.  Boy was I surprised!!

It turns out that he had a large bone cyst that was roughly 50% of his lower tibia (the larger of his lower leg bones). This was an area he wasn’t really conveying issues with. After looking at his x-rays, I started to do a more focused exam to this specific area, which expectedly turned out to be painful with pressure and touch. I had to pull him out of all sports immediately due to his risk of completely breaking the bone with just the right motion or impact!

So this stresses the point that for growing kids, we don’t accept the term “growing pains”. Although the incidence of bone tumors in kids is fairly low, you just never know! It’s better to be suspicious and be wrong, than to be careless and miss something big!

With this incident in mind, I wanted to write a little bit about Bone tumors to better educate our patients.

There are two general classifications of tumor types, which are:

Benign Tumors – These are non-cancerous masses, which do not spread from their original sites to any other parts of the body.

Malignant Tumors – These are the more dangerous masses, which are considered cancerous. The dangerous component of malignant tumors is the spread of uncontrollable dividing cells to other parts of the body, this is known as Metastasis.

The most common group of tumors that arise within the skeleton of children between the ages of 6-12 are Benign Bone Tumors.

There are three main types of Benign Bone Tumors that often appear in children, which are:

Osteochondromas – This is the most common benign tumor of the foot and is usually located under the toenail. The tumor may cause deformities to the toenail, such as an ingrown toenail or irritation to the surrounding tissue, but are not typically painful. This type of tumor growth also appears in the metaphysis of long bones such as the Femur and Tibia in children.

Unicameral Bone Cysts – This is a different type of tumor that forms from the presence of excess tissue and fluid, which fills a hole in the bone.  This type of tumor is usually found after fracturing a long bone, such as the tibia and upper portion of the femur.

Nonossifying Fibromas – This type of tumor growth appears in actively growing sections of long bones, such as an actively growing section of the femur or tibia.

Benign Bone tumors are usually asymptomatic and rarely need surgery because they go away on their own. However, these tumors could put your child at a greater risk of injury or growth problems from the resulting weak spot in the bone. Also, benign tumors should be monitored just in case the growth becomes too large and causes pain or pinches any surrounding nerves.

Malignant Bone Tumors are cancerous tumors called Sarcomas, which are less common in children. However, these tumors are dangerous because over time, the cancerous cells of these tumors find their way into the blood and can spread to vital organs, such as the lungs. These cancerous cells can destroy the limb of the tumors location and can be life threatening when they spread to other parts of the body.

There are two main types of Malignant Bone Tumors that often appear in children, which are:

Osteosarcomas – This is the most common malignant bone tumor in children and young teens. These malignant tumors arise from mesenchymal cells, which are responsible for the formation of bone. Therefore, these tumors primarily affect immature bone, such as the rapidly growing metaphyseal regions of bones in children.

Ewing Sarcomas – This is the second most common malignant bone tumor in children and young teens. These tumors tend to be very aggressive and arise from neuroectodermal cells that affect the metaphyseal regions of bones in the lower extremity of children.

The key symptom for both Osteosarcomas and Ewing Sarcomas is the presence of pain at the affected site. Swelling and weight loss are other key findings in Ewing Sarcomas. Regardless of the severity of symptoms associated with malignant tumors, it is your responsibility to take action because these cancerous cells can spread to your child’s vital organs and cause serious damage or even worse, death.

Therefore, if your child is complaining about pain in a localized region of their bone or you notice an abnormal lump on their limb then it is crucial that you contact your podiatrist as soon as possible. Bone tumors can be extremely challenging to find and diagnose correctly, so your podiatrist may use multiple imaging tests in combination with assessing the tumors location and your child’s age to determine the best course of action. An accurate, early diagnosis and treatment plan significantly enhances the success rate for treating malignant bone tumors.

When it comes to open fractures, or those that break though the skin, immediate hospitalization is critical. A break in the skin with exposed bone can be a prime path for infection to occur.  Additionally, fractures of large bones, like the tibia that Kevin Ware broke, can release fatty clots into the blood stream causing further life threatening problems. Multiple fractures, or those that result in many pieces, are best treated by fixating the bones together with surgical plates or pins. Kevin Ware had a large rod placed to hold the tibia together while it heals. By using this technique, the bone fragments are held in proper anatomical alignment, neutralizing movement in order to allow the bones to heal without complication.

Closed fractures of the foot and ankle can be treated at Austin Foot and Ankle Specialists.  Remember that just because you retain function or can continue to walk on it, doesn’t mean you have not sustained a fracture.  Make an appointment to be evaluated.  We have the latest technology in digital x-ray to allow us to quickly and accurately diagnose fractures.  Simple fractures can be treated with immobilization in a cast.  Those fractures that leave the bones a distance from one another or have tendons pulling on them often require surgical intervention.   Either way, seeking out your Austin podiatrist early can get you better quicker!

Until next time, keep those feet and ankles happy and healthy Austin!

One of the most common secondary symptoms people experience with late stages of the disease are numbness, tingling, or burning sensations in their fingers and toes.  These sensations may not persist or only occur occasionally, but they are classic finding for peripheral neuropathy.  The nerves in the outermost part of your body, fingers and toes, contain the smallest of nerves.  These tiny nerves are the first ones to be damaged by diabetes and elevated sugars.  Nerves are very slow to heal and often damage to them is so significant that it is irreversible. When your nerves are not able to detect pain, the chances of you injuring your feet are greatly increased.  It is important for anyone with neuropathy to examine your feet daily for any problems or injuries.

Through constant monitoring you can avoid the direst of diabetic complications including infection and amputation.  A study from the Southern Arizona Limb Salvage Alliance (SALSA) published last month supports you continuing to exercise even if you have developed diabetic peripheral neuropathy.  They compared non-weight bearing exercises, stationary cycling, to weight bearing exercises, treadmill walking and stair climbing.  They found that the pressure placed on the feet was not increased significantly from one type of exercise to the other.  That being said, it is important to discuss your exercise plans with Austin podiatrist and closely monitor your feet.  As with any exercise, begin slowly and gradually increase the amount. Monitor your feet throughout your exercise routine and visit us at Austin Foot and Ankle Specialist at the smallest change.

Until next time, keep your feet happy and healthy Austin!

Are you experiencing pain in the ball of your foot or (forefoot) while walking or exercising?  If so, than you may be suffering from a condition called Plantar Plate Dysfunction. Our forefoot is a very intricate part of the foot. There are many small ligaments, bones and muscles that hold our forefoot intact and allow for efficient, forward movement during gait (Propulsion). As we walk or run, we disperse all of our body weight from the heel (Hindfoot) to the small, ball of the foot (Forefoot).

All of the structures in the forefoot are strategically aligned to endure the stress of our body weight and convert it into efficient gait. This area receives high pressure and stress from everyday use; therefore, it is common to experience different problems such as, Plantar Plate Dysfunction, which may result in pain within this area.

Unfortunately this is commonly missed and often mistreated by foot and ankle specialists. It can be misdiagnosed as a neuroma, bone pain and joint inflammation. Having been Fellowship trained by an innovator of treating this specific condition (Dr. Lowell Weil, Jr.), I wrote this blog to differentiate this condition from other causes of forefoot pain.

What is a Plantar Plate and Plantar Plate Dysfunction?

            Plantar plate dysfunction is a common problem associated with the dysfunction (stretch or tear) of a ligament within the forefoot called the Plantar Plate. The Plantar Plate is a ligament which is present in the lesser toes and attaches the base of the toe to the metatarsal on the plantar surface. This ligament creates a sturdy connection that prevents the bases of the toes from elevating and slipping out of the joint where it articulates with the metatarsal. This ligament stabilizes the toes with every step you take. When you step forward, your toes bend and after you lift your foot off the ground, the toes are brought back into a straight, articulated position at the joint by the action of this ligament.

What are the symptoms of a Plantar Plate Dysfunction?

When the Plantar Plate is stretched or torn common symptoms include:

• Most common to experience problems associated with the Second Sub-Metatarsal and under the base of the toe
• Sensation of pain in the joint and at away from the ball of the foot.
• Pain most intense during propulsion phase.
• Constant dull ache at the toes
• Partial Dislocation of the joint when the Plantar Plate is completely torn.

The severity of pain is typically associated with the severity of damage to the Plantar Plate. Many factors can cause a plantar plate dysfunction, but the most common causes are associated with overuse and excessive pressure on the ligament and/or joint.

Are you at risk of a Plantar Plate Dysfunction?

Plantar Plate dysfunctions are more common see in:

• Patients with who have Long 2^nd Metatarsals
• Overweight patients
• Patients who Overuse and Abuse the Area (Wearing high heels and Excessive stress exercise).
• Patients with Bunions
• Tight Fitting Shoes.

It is important to take care of your feet and treat a plantar plate dysfunction as early as possible because if left alone, can lead to more severe problems such as: Hammertoe (Deformation/Buckling of the toe), deviation of the toe, progressive instability of the toes, continued pain and arthritis.

Prevention of a Plantar Plate Dysfunction includes:

• Early diagnosis by a podiatric foot and ankle specialist and assessment of pain that arises at the ball of the foot.
• Controlled, mild workouts and exercise.
• Wearing properly fitted shoes with good support.

Treatment of Plantar Plate Dysfunction includes:

• In mild cases, padding within the shoes or orthotics are made to stabilize the foot.
• Strap toes together to stabilize the movement of the injured Plantar Plate.
• Rest and take pressure off of the injury as much as possible.
• In severe cases, instability and/or complete tears, surgery may be required.

Overall, a Plantar Plate Dysfunction is a serious condition due to the dependency of the forefoot in efficient gait/walking. Therefore, make sure to have your condition evaluated and treated as early as possible by a well-trained Foot and Ankle Specialist.

Feel comfortable making an appointment with an Austin Foot and Ankle Specialist to evaluate your foot for this condition.

Medicine has had a long history of doctors associating their names with procedures and anatomical findings.  One such procedure, the Austin bunionectomy, is a common procedure to shift the head, or bump of your bunion, into better alignment with rest of your foot. While our great city was named after Stephen F. Austin, he was not a surgeon and thus the name is of pure coincidence. 

The Austin.  We are using this nomenclature for obvious reasons.  Unfortunately, the generic name for this procedure, the ‘v-shaped’ osteotomy, has been used by podiatrists for a long time.  The main component of most bunion deformities is the misalignment of the first metatarsal, aka the long bone behind your big toe.  The bump on your foot is actually the head, or end, of this bone.  The procedure involves make a v-shaped cut into the side of the head of the bone with the point facing towards your toes. This allows the bump to be shifted over and fixated so that the cartilage of the joint better aligns with the bones of your big toe.  When these bones are back in proper alignment, you will not only be able to fit into your shoes, but should be able to do so pain free.

This surgery normally heals without any complications when following our specific post-operative plan.  The stretches and early range of motion exercises will speed up your recovering.  Getting you back on your feet and pain free is our goal!

Until next time, keep those feet happy and healthy Austin!

Basketball players, professional NBA, collegiate NCAA, or high school, are all at risk of ankle injury.  Even with high topped shoes to help support the ankle, the cutting, dodging and fast speeds of the game continue to put these athletes at higher risk for ankle injuries, especially sprains, than many other sports. The outside of the ankle is at the highest risk because of the limited amount of ligaments holding it together.  In addition to the tendons of muscles that cause the foot to function, there are three ligaments that hold the bones of the outside ankle together.  Any activity or misstep that places the ankle in a poor position with excessive stress can damage one or all of these ligaments.
 

Professional athlete or not, the importance of rehabilitation and protection are critical for everyone.  The severity of the injury will impact the recovery, thus Brandon Knights continued absence from the game.  We have to wonder if Kobe Bryant shouldn’t require a similar absence.  It is important for athletes at every level to avoid the push to continue to play which can create further problems.  Seek out treatment at Austin Foot and Ankle Specialists.  We use the latest technology to identify the extent of you injury and take the proper steps to get you healed.  Taking time to rest as well as intensive physical therapy are both important parts of getting you back to healthy play.

Until next time, keep those ankles happy and healthy Austin!

There are several options for surgical correction.  At Austin Foot and Ankle Specialists a  thorough exam will allow your doctor to see what ‘type’ of bunion you have and decide on the proper option accordingly  Depending on the structure and mechanics of your foot as well as the amount of time the deformity has been present will all influence the best procedure for your bunion. What might look like a simple bump on the side of your foot may actually be a miss aligned bone. Instability in certain joints and the stresses placed on them will effect progression and treatment.  Other times a portion of the bone my hypertrophy, or grow excessively, to create the bump.  While there are always risks of surgery and no option is simple, we want to give you an idea of what it involved in the less complicated deformity.

The Cheilectomy:  One of the first procedures utilized, it is still very appropriate when then deformity is an underlying hypertrophy of the bone. In these cases it is used as a standalone procedure and can have you back on your feet relatively quickly. An incision is made over the deformity and the extra bone is removed before closing the skin back with sutures. .  Additionally, we used radiofrequency ablation and injections of plasma rich protein or PRP, at the surgical site for optimal healing. Most commonly the extra bone growth occurs along with a malaligned bone.  In those cases, other procedure that we will outline in future blogs, are used in conjunction with this one.

Look for the second blog on this topic when we will address another option for surgical correction of your bunion deformity.

Until next time, keep those feet happy and healthy Austin!

            If you are experiencing a leg length difference than it is either due to:

1) Structural/Anatomical Problems – This means that one lower limb is shorter than the other, otherwise known as, a True Limb Length Discrepancy.

Or

2) Functional Problems – This means that both legs are the same length, but your hips are unbalanced, dislocated or unstable, which causes one hip to be situated higher than the other, giving the appearance of a shorter leg.

Leg length discrepancy’s can be caused by multiple factors, including:

• Congenital Defects, which range in severity, leading to lower limb malformations.
• Trauma or Injury to a lower limb bone, especially during younger ages.
• Infection to the Bone, Bone Marrow or Joints, which can stunt growth
• Bone diseases, such as Juvenile Arthritis.
• Tumors, which can cause nerve or blood vessel damage, hindering bone growth.
• Underdevelopment and Deformities of the Hip or Spine, which can cause unequal alignment of the hips or lower limbs.
• Surgical procedures such as Hip and Knee Repair and/or Replacement can create a limb length discrepancy

If you have a leg length discrepancy than you may be experiencing multiple problems, which can affect your Hips and Knees, such as:

• Pain – You may experience pain in your Hips and Knees because the length difference affects the biomechanics of your lower extremities and gait. The result of these affects forces you to apply pressure on your bones and joints unnaturally, causing your body to relay the message that something is wrong through pain.
• Posture – Your posture changes in response to a lower limb length discrepancy in order to compensate for the height difference. When this occurs you become more prone to injuring your hips and knees.
• Range of Motion – Your bodies self defense mechanism may limit your range of motion in your hips and knees during daily activities in response to the unequal alignment of your lower extremities.
• Weight Distribution – Improper alignment of your lower extremities can cause unequal weight distribution on your hips and knees, which may result in injury or arthritis in the longer limb
• Joint Problems – If you are putting unequal pressure on the joints of the hips and knees than you’re prone to meniscus tears and degenerative arthritis of the longer limb.
• Ligament Damage – If you are limping while walking to compensate for the length difference than your longer leg is prone to increased knee flexion, which can lead to torn ligaments of the knee.
• Dislocation – If you are an active person than you have a greater chance of dislocating your hip. The uneven alignment and impact on your joints during activities may not support the ball and socket joint of your hip properly, so you become prone to dislocation and further injury.

If you think or know you have a leg length discrepancy, than make an appointment at Austin Foot and Ankle Specialists so we can assess your situation and prevent any further injury, while helping you live a more comfortable lifestyle!

If you are one of the estimated 79 million Americans in this pre-diabetic state, consider it an opportunity to take control of your health!  You have not quite yet crossed the threshold to diabetes, but unless you take steps to improve your diet and activity you may find yourself doing daily finger sticks and taking medications. The type of diabetes we are talking about has previously been known as ‘adult onset diabetes’.  While there can be a variety of precipitating events, it is widely accepted that a combination of weight gain and poor diet over a lifetime destroys your body’s ability to properly control your blood sugars.  Look at pre-diabetes as you opportunity to take control of your health and start living better.

Some individuals have effectively eliminated the symptoms of their diabetes by changing diet and daily activity levels.  Most recently comedian Drew Carey, host of ‘The Price is Right’, was reported to have dropped 80 pounds and eliminated the need for his diabetic medications.   Limiting the simple sugars found in pizza and bread along with regular cardiovascular workouts were the key to his transformation.  While not a common result, his experiences exemplify the power of diet and lifestyle modification.  Keep an eye on your health with yearly checkups and take the steps today to prevent problems later.  Here at Austin Foot and Ankle Specialists we are ready to fix your foot problems and keep you active.

Until next time, keep those feet happy and healthy Austin!

            If you have high arched feet than you may have a condition called Cavus Foot. High arches can become apparent at various ages such as, at birth from a congenital abnormality or later in age from neurological disorders, trauma, or other medical conditions. High arches can exist unilaterally or bilaterally depending on the source of your condition.

What is the significance of having a high arched foot?

            Your high arched foot (Cavus Foot) causes your body to disperse the majority of your body weight on the ball, outer aspect and heel of your foot. This is a major problem because when you are standing or walking there is a smaller area on the bottom of your foot that absorbs the shock of impact from your body weight. Therefore, these areas of your heel and mid-tarsal joints are prone to complications from the increased pressure they endure on a daily basis, which can also cause adverse effects to the rest of your body as well.

What kinds of complications or effects result from a high arched foot?

• Ankle Instability and Ankle Sprains
• Pain in the ball of the foot (Metatarsalgia) and/or in the sole and heel (Plantar Fasciitis)
• Achilles Tendon injury
• Muscle and Ligament Injuries
• Calluses, Claw Toes and Hammertoes
• Pain and Degeneration of Joints of the Lower Extremity
• Stress Fractures to Bones of the Foot, specifically Jones Fractures.
• Other Issues, such as, Shoes usually don’t fit properly and Decreased exercise, which may lead to other health problems

- This is just a short list of complications, but as you can see, many problems can arise as a result of your high arches.

So how can you be certain that you have high arched feet?

Start by assessing whether or not you are experiencing some common symptoms of high arched feet, which include:

• Pain in the ball of the foot and heel
• Calluses amongst these high impact areas
• Stiffness along the middle portion of your foot
• Pain in the joints of the lower extremity, especially within the ankle region
• Cramping and soreness in the arch area or outer foot
• Pain at the outside ankle
• Frequent ankle sprains

- You can also dip the bottom of your feet in water and then step on a dry piece of paper. If there is a thinly defined wet imprint near the middle of your foot and dark imprints near the heel and ball of your foot then you are more likely to have high arched feet.

However, you should see a podiatrist in order to assess the severity of your high arches and what precautionary/treatment measures can be taken to relieve your symptoms.

Here are some precautionary / treatment measures that you can take or your Austin Foot and Ankle podiatrist may recommend:

• Wear properly fitted shoes with a good arch and cushioning support.
• Try to maintain a healthy body weight in order to decrease the pressure on your feet.
• Attempt low impact exercises such as, using an elliptical rather than a treadmill.
• Invest in prescribed, custom foot orthotic devices that help absorb shock, distribute weight evenly and support your foot properly.
• Surgery may be necessary if condition is severe.

The pain and conditions associated with your high arches may be hindering your daily lifestyle, but that is not a reason to give up on the activities that you love. Rather, you should take the proper measures to treat your high arches with care in order to avoid any future problems.   

We cannot emphasize the importance of proper sugar control enough if you have noticed from our previous blogs.   When blood sugars are high, the blood vessels and nerves supplied by them become damaged.  These vessels and nerves in your hands, feet, kidneys, and eyes are some of the smallest in your body and thus the first ones affected by this disease.  For this reason, anyone diagnosed with diabetes is recommended to see an ophthalmologist (eye doctor) and podiatrist (foot doctor) once a year in addition of frequent visits with their primary care doctor. The American Diabetes Association outlines the entirety of your healthcare team.

A recent study was published in Endocrine Today, a publication focused on specialists dealing with metabolism.  Because diabetes is a disease of metabolism we see at Austin Foot and Ankle Specialists, we watch for news pertinent to our patients. This study found that all other measurements of body weight, diet, etcetera, countries that allowed high fructose corn syrup to be used in food products have a 20% higher incidence of diabetes within their population!  Every person responds different to foods and sugars, but this study points to one particular food additive that can especially tax the body.  While it will take further studies before the FDA takes steps to address it, you do not have to have pre-diabetes or diabetes in order to eat better.   Make it a point to take a look at the nutritional information on the foods you eat.  Include more fruits and vegetables in your daily diet and avoid sugary or processed foods.  A conscious effort to eat better now can pay dividends in the future.

Until next time, keep those feet and ankles happy and healthy, Austin!

There are a variety of things you can do to pamper that special someone’s feet.  Anyone can appreciate a nice warm soak at the end of a long workday.  Just remember to dry the feet well, especially between the toes, when they are through.  Then have them kick back as you treat them to a spa quality massage.

When it comes to massage, lotions with an oil component, massage oil, or a plain old bottle of baby oil are best.  Remember not to overdo it and be sure to keep a towel or two handy in case you use a little too much.  Use your thumbs to slowly massage the bottom of the foot from the heel to the toes.  Try to use long, slow strokes to avoid tickling your partner.  Focusing on the heels, arches, and balls of the feet will feel best as they are the easiest spots to be over used. Be sure to work the massage through the toes and the top of the foot for completeness.  The massaging motion can help facilitate blood flow to nourish and repair the feet.

Once you have the feet ‘warmed up’, work on moving around the joints to eliminate any stiffness or aches that may have set in.  Grasping the heel of the foot slowly move it up and down as well as in and out.  Keep the motions slow and simple to avoid over extending or causing any discomfort.  You can further the in and out motions in the middle of the foot and up and down motions at the toes.  Repeat as warranted and think about sharing a foot message after V-day is over.

Until next time, keep your feet and ankles happy and healthy, Austin!

Any type of shoe can compliment or alter the mechanics of your foot. When it comes to high heels, the calf muscles become shortened.  Over time this continued shortening causes other muscles groups to overcompensate.   This type of action contributes to the formation of foot deformities including bunions and hammertoes.   Most foot deformities are a result of inherited foot mechanics that alter proper foot function. Any shoe that gives one muscle group advantage over another, like high heels, can aggravate the foot mechanics. For this reason, anyone can develop hammertoes. 

Hammer toes, or hammer digits, are a result of the tendons creating contractions of the toes.  A hammertoe can be both uncomfortable and unsightly.  Depending on which tendon shortens, the toes can become contracted at different points.  This is most often visualized by where the corn forms.  These painful skin formations rarely resolve without addressing the underlying bony deformity. A thorough evaluation by your Austin podiatrist will provide an accurate diagnosis of the type of hammertoe you have.

Hammertoes that can be straightened out are flexible.  Those that have been present for a long time and cannot be straightened out are rigid.  When placed in accommodative shoes that prevent rubbing and irritation, either type may not bother you. It is when these deformities become painful that your podiatrist may suggest surgical correction. Our new Three Lakes Surgical Center is equipped to accommodate these surgies and get you home the same day.  It doesn’t matter if the surgery requires implants or is a simple tendonplasty our staff is ready to make sure you have positive experience!

 Be careful out there in those high heels and keep Austin Foot and Ankle Specialists in mind when your feet start to hurt.  Until next time, keep those feet happy and healthy Austin! 

What are Platelet Rich Plasma (PRP) Injections?

            Platelet rich plasma injections are a new, up and coming treatment that utilizes your own blood platelets to stimulate the natural healing process and promote tissue regeneration for muscle, tendon or ligament injuries. The Platelet Cells in your blood contain important growth factors, which signal the body’s healing response mechanism to act at the site of injury. Unfortunately, our body’s response towards healing injured ligaments and tendons takes longer due to the poor blood supply to these areas. Therefore, this method of injecting high concentrations of platelet rich plasma into the site of your injury should theoretically, enhance the healing process.

Some Common Orthopedic Conditions or Injuries that PRP’s can be used for include:

• Plantar Fasciitis
• Achilles Tendonitis and Tendinosis
• Ankle Sprains
• Muscle Tears and Strains
• Ligament Injuries
• Tendon Injuries
• Joint Arthritis
• Joint Pain
• Tennis Elbow
• Golfer’s Elbow
• Knee MCL Tears

What are the Benefits of Using PRP Injections for Your Injury?

• Far Less Expensive than Surgery
• Uses Your Own Blood! So, there is No Risk of Rejecting the Treatment
• Non-Invasive Surgery
• No Stitches, Therefore, No Scars!

            PRP Injections are being used all over the world, including Professional Sports! Famous athletes from different sports, such as Golf, Football and Baseball attest to the benefits from using PRP Injections. Some Examples include NFL Athletes, Hines Ward and Troy Polamalu from the Pittsburgh Steelers, who gave credit to the PRP Injections that allowed them to recover from their injuries and play in the 2009 Super Bowl. Not Satisfied? How about Golf Phenomenon, Tiger Woods, who used PRP Injections to recover from a Knee Injury, which enabled him to play in all four Majors this past year. Athletes from professional baseball teams such as the Houston Astros, LA Clippers, and New York Mets have all had great success with PRP injections to recover from chronic, non-healing injuries in the shoulder and elbow joints.

PRP Injections are becoming increasingly popular amongst the sports medicine and orthopedic community, so if you are looking to try a new treatment option to return to your sport or active lifestyle as quickly as possible, then PRP Injections may just be for you!