Avoid Winter Foot and Ankle Woes

The season for ice, snow and sub-zero cold is here and with it comes the risk for serious foot and ankle problems for men and women of all ages.

Ankle sprains and Achilles tendon problems are very common in winter due to slips on icy sidewalks and from injuries that often occur when playing basketball and other indoor court

sports. 

Very often ankle sprains are not taken seriously and may not heal properly. This can result in long-term ankle instability and increases the risk for joint damage and eventual arthritis. Initial treatment for ankle sprains should include rest, ice, compression and elevation to decrease pain and reduce swelling. Compression with an elastic bandage, splint or brace may be used for stability and to optimize healing. The ability to walk or put weight on the joint depends on the severity of the sprain, as determined by the podiatric surgeon when assessing ligament damage caused by the injury.

Even minor sprains should be protected by bracing for several days. In most cases, it takes at least three weeks for an ankle sprain to heal and up to eight weeks for severe sprains.

Another winter malady, frostbite in the toes, is best treated by rapidly re-warming the affected extremities at the first sign of severe cold and numbness. 

Nearly half of all frostbite cases involve the foot or ankle and, in my experience, rapid re-warming is effective in preventing tissue damage. Therefore, at the first sign of possible frostbite it’s imperative to seek prompt treatment and apply controlled heat right away with warm towels and warm water.

Cold weather impairs circulation, especially in women who smoke and drink caffeinated beverages. Blood vessels can shut down in the feet, causing the toes to turn white and blister. Just as with frostbite, it’s critical to keep the extremities warm and insulated to avoid exposure to the cold.

Winter is also a good time to think about corrective foot surgery if you’re not as active as during warm-weather months. For those who would benefit from surgery to correct bunions, hammertoes or persistent heel pain, scheduling the procedure in January or February will allow enough time for post-operative rest and to resume normal activities when the weather gets warmer. 

Considering Bunion Surgery?

Bunions are caused by a common hereditary deformity of the big-toe joint that can be repaired with appropriate treatment by a foot and ankle surgeon. Even a previous bunion surgery that was unsuccessful can be corrected and the joint restored to proper alignment.

Joint misalignment, not just wearing tight shoes, causes the pain and large bump on the inside of the big toe.  Although wearing tight shoes can severely aggravate the condition, it is not the main cause.  Bunions, therefore, should be corrected or re-corrected by realigning the big toe joint, not by simply removing the bump. Those who may have had unsuccessful bunion surgery should consider another procedure to properly correct the deformity.  Delaying proper correction can allow the joint to become severely arthritic resulting in fewer and less desirable treatment options.  Early treatment and correction is critical.

As with any surgery, be careful to choose a specialist who routinely performs the type of surgery you require.  Dr. Keith Card specializes in repairing bunions to proper joint alignment to keep you walking pain free. 

Plantar Fasciitis or Heel Pain Syndrome Explained

Have you been ignoring that nagging heel pain that has you hobbling all the way to the shower in the morning?  Most heel pain is the result of tearing or damage to a ligament called the plantar fascia.  The most common symptom is pain located on the bottom of the heel or into the middle portion of the foot.   The pain is most intense after periods of rest such as sleeping or sitting for a prolonged period of time.  The pain generally eases or resolves with activity such as standing or walking but may return after several hours of continuous activity.  In severe cases the pain does not ease or resolve.

The medical term for pain on the bottom of the heel is plantar fasciitis.  This term comes from the anatomical name of this particular ligament, The Plantar Fascia and itis, which means inflammation.  The bottom of the foot is called the plantar surface much like the palmar surface or palm on the hand.  Fascia is the Latin word for band and is used to describe broad and thin sheet-like connective tissue.  In this case the fascia is similar to a ligament in that it connects the heel bone to the bones of the toes. So to make a short story long, plantar fasciitis is “inflammation of a broad but thin ligament on the bottom of the foot.” 

The purpose of this ligament or fascia is to maintain the curved shape of the bones that form the arch of the foot in the same way that that a taunt bowstring maintains the arched shape of a wooden archery bow.  A portion of this fascia attaches to the bottom of each toe where the toe connects to the ball of the foot.  These five portions (one from each toe) then converge onto the bottom of the heel much like a triangle with the base at the toes and apex at the heel.  The narrowest and possibly weakest portion of the ligament is where the fibers of the plantar fascia attach to the bottom of the heel bone. 

The inflammation and subsequent pain is caused when the plantar fascia is strained beyond its limits and the tissue fibers begin to tear.   As you walk or stand your body weight is transferred down the leg to the top of the arch shaped bones of the foot.   This force without the fascia would tend to cause the arch bones to collapse.  If the force through the fascia is stronger than the fibers can withstand, the fascia will begin to tear.  This can occur due to carrying heavy weights, shock loading the feet such as in running or jumping, or standing and walking for long periods until the muscles of the legs and feet begin to fatigue resulting in more force being transferred to the plantar fascia.  This tearing occurs most frequently where the plantar fascia is at its narrowest point attaching to the heel bone.  Frequently a “bone spur” forms at the attachment to the heel bone.  This spur is formed by a process of tearing and healing over a long period of time.  The spur is not typically a cause of the pain but rather a sign that the damage has been ongoing.

Treatment for plantar fasciitis is generally straightforward but is often frustratingly slow.  The most important thing is to strengthen the plantar fascia to the point that it can easily handle the stress that you put on it.   This is typically done through a long process of exercises and stretches to strengthen and facilitate elasticity in the fascia until it no longer tears with use.   An ice pack or a frozen bottle of water to the bottom of a bare foot can reduce inflammation and speed the healing process.   Oral anti-inflammatory medications may ease the pain for a period of time but typically is not sufficient to solve the problem of the tearing.  Shoe inserts may also help ease the forces to the plantar fascia by helping to support the arch.  

If your pain is severe or not alleviated with the above self-treatments you should see your doctor to confirm the diagnosis and initiate more aggressive therapy.   Patient specific exercises or physical therapy may be required to sufficiently strengthen the fascia.   A night splint or boot like device that is designed for wear at night may be prescribed to facilitate stretching.  Prescription medicines or even a steroid injection may ease the pain for a period of time until sufficient strength is achieved in the plantar fascia.   Custom made shoe inserts and weight loss can also reduce the strain on the plantar fascia leading to a reduction in symptoms.  A walking cast may be prescribed in severe cases. 

The surgical treatment of plantar fasciitis is generally done after several months of failure of the above treatments.  Because heel pain is caused by tearing of the plantar fascia rather than the presence of the bone spur, removing a spur without strengthening the plantar fascia will not solve the problem. 

If you are experiencing heel pain like described above, here are some simple tips you can try:

1. Stop going barefoot and throw away old or worn-out shoes.

2. Apply an ice pack to the painful area after activities.

3. Do some stretching in the morning even before getting out of bed and before exercise.  Movements that stretch the calf muscles are also helpful for heel pain.

4.  Take a few days of rest from strenuous activities if possible.

5.  Many foot cushions or arch supports sold in stores can be helpful but are not usually adequate to fully resolve solve the pain.  Ask your doctor which ones may be right for your foot or if you need more stable arch supports.

When foot discomfort occurs, early treatment usually results in the best chance for complete healing and a speedy return to your regular activities.  If these tips do not get you gliding painlessly into your morning routine, it's time to see Dr. Card for a more thorough evaluation of your foot pain.

Health Education Series with Dr. Card

Join Dr. Card at the Women's Health Institute this week!

Ouch, My Foot!
A Discussion on Plantar Fasciitis and General Foot Care
Dr. Keith Card, DPM
Tuesday, September 27, 5:30-6:30 pm

Women's Health Institute (a service of Carson Tahoe)
1470 Medical Parkway
For more information, call (775) 445-5168 or www.carsontahoewomen.com.

Come with questions.  Leave with answers.

The Dangers of Ignoring Reoccurring Ankle Sprains

I know that many people don't want to head to the doctor for ankle sprains.  Sprains can often be treated with rest, ice, and a simple ace bandage.  However, if you have had multiple ankle sprains, you may have a more serious problem.  Repeated ankle sprains and other ankle injuries can lead to ankle arthritis and should be treated aggressively.

 

Ankle arthritis differs from hip or knee arthritis in that it usually results from trauma rather than the everyday wear and tear associated with old age. It has been reported that arthritis after a single or multiple injuries is the leading cause for end stage ankle arthritis. Most people don’t realize that reoccurring ankle sprains can eventually lead to severe pain and difficulty walking.

In a recent study of people with end stage arthritis in their ankles, 87% resulted from a specific or repeated injury and less than 1% was attributed to general wear and tear type osteoarthritis. Another study showed that 18% of the patients suffering from end stage ankle arthritis have a history of chronic instability, which can result in repeated ankle sprains. 

If you have ankle pain or frequent sprains, there are non-surgical options available through new and advanced ankle bracing.  Several surgical options are available as well.  Don’t ignore recurrent ankle sprains!

What To Do For Your Morning Foot Pain

Have you been ignoring that nagging heel pain that has you hobbling all the way to the shower in the morning?

Most heel pain is the result of inflammation of a ligament called the plantar fascia that runs along the bottom of the foot from the heel to the toe area. The inflammation of this ligament is called plantar fasciitis.  When the plantar fascia is strained beyond its normal limits, the soft tissue fibers of the fascia begin to tear.  This occurs especially where it attaches to the heel bone leading to inflammation, pain, and possibly the growth of a bone spur. (Spurs typically do NOT cause heel pain but rather are a sign of the inflammation.) 

Here are a few suggestions for your heel pain:

1. Stop going barefoot and throw away old or worn-out shoes.
2. Start applying an ice pack to the painful area after activities.
3. Do some stretching in the morning even before getting out of bed.  Most exercises that stretch the calf muscles are helpful.
4. Take a few days of rest from strenuous activities if possible.
5. Many foot cushions or arch supports sold in stores may be helpful but will not usually solve the cause of the pain.

 When foot discomfort occurs, early treatment usually results in the best chance for complete healing and a speedy return to your regular activities.    Call Dr. Card if these tips do not get you gliding painlessly into your morning routine.

Shape-Up Shoes: Do They Really Work?

I am asked by patients nearly every day regarding the newest shoes that claim to tighten your tummy, firm your buns, improve your posture, and alleviate pain. Are there any actual health benefits from these toning shoes or is it all hype?  Can shoes really do all that?

The common design element among the 15 or so brands currently marketing these “toning shoes” is a rocker sole which induces an element of instability.  This instability theoretically requires the wearer to activate more muscles and thus provide greater health benefits than walking in traditional shoes.

The rocker sole is certainly not a new concept. Doctors and therapists have been using shoes with a “rocker” type sole for decades in treating various foot ailments. It is only in the past decade that these types of shoes have been marketed to the public.  In fact the toning shoe is the fastest growing new trend in the shoe market since the seventies and has expanded to more than $1 billion annually in sales.  This recent popular trend began with the introduction of the MBT brand of shoes. 

MBT (Masai Barefoot Technology) is a Swiss company formed after an engineer observed the Masai Tribe in northern Africa and noted a lack of foot problems among the tribe despite a general avoidance of shoes.  His theory that the rolling walk in soft sandy soil native to the area where this tribe walked was the key to their foot health.  He designed the sole of his shoes to mimic this type of walking.  Since people in developed countries typically walk on much harder surfaces, MBT created a shoe to incorporate a soft curved sole that mimics the walking pattern of the Masai in soft dirt.  MBT was the first to popularize the toning shoe and with a $100-300 price tag, other shoe manufactures saw huge potential profit margins.  Many shoemakers jumped into this new market and developed their own models backed by enormous advertising budgets making claims that make Dorothy’s ruby slippers seem much less magical by comparison.

The current science reveals a little less steam than in Kim Kardashian’s recent Super Bowl commercial for Sketchers Shape-ups. 

The scientific studies are very mixed on the benefits of toning shoes.  First, several researchers have investigated the claims of increased muscle activation.  The American Council on Exercise found no increased muscle activity in toning shoes while other studies conducted by shoe manufacturers have shown small increases in muscle use.   Scientists have also looked at the second and likely more important issue of balance and instability while wearing this type of shoe.  There is consensus among the research that toning shoes do impact balance and that wearers of them tend to be less steady on their feet.  This could be considered a benefit to some and a potentially severe risk to others.  A third area of research is the effect toning shoes have on joint motion where considerable evidence indicates that these shoes do slightly change the amount of motion in the hip, knee, ankle, and other foot joints.   What the joint motion studies cannot say is if the change in motion is beneficial. 

So what does this research mean for you?  First, the claimed benefit of easy weight loss and getting into shape through new or increased muscle activation without effort is hype.  Those calories must still be worked off.  The potential weight loss benefit from increased muscle activity will likely wane after getting used to walking in these shoes.  The second issue of balance is a critical one.  Anyone at risk for falling should never wear this type of shoe.  Several class action lawsuits are currently pending for severe injuries sustained in toning shoes.  The third issue of joint motion increased by toning shoes is specific to each individual.  If you already have arthritis in a particular joint and a shoe increases the motion there, that can substantially increase your pain.   However, if a certain shoe minimizes the motion in an arthritic joint, this may decrease pain.  Because each model of shoe has a different rocker pattern and each patient has individual needs, it is impossible to make generalizations whether or not the changes in joint motion will be detrimental or beneficial.  

In summary there are potential benefits along with some substantial risks from wearing toning shoes.  It is important to remember that there are no shortcuts to good health.  Regular exercise and a healthy diet are much more important than what you have on your feet.   Check with your doctor prior to starting a new exercise program or if you have pain while walking.   While there may be some benefit to wearing toning shoes, care must be taken both in wearing them and in believing all of those fantastic claims. 

About Dr. Keith Card

Dr. Keith Card is a podiatrist with Tahoe Fracture and Orthopedic Medical Clinic.  He has office locations in Carson City and Gardnerville.

Dr. Card received his BS in Exercise Physiology from the University of Utah and his Doctor of Podiatric Medicine degree from the Temple University School of Podiatric Medicine in Philadelphia, PA.  He completed a four-year comprehensive surgical foot and ankle residency program at the University of Pennsylvania, PENN Presbyterian Medical center. This training included extensive vascular surgery and diabetic limb salvage, trauma management, joint replacement, and plastic surgery techniques applied to the foot and ankle.

Dr. Card resides in Carson City with his wife and their three young children.  He and his family are very active in outdoor sports including rock climbing, mountaineering, and cycling. His recreational pursuits have led him to such places as: Iceland, where he cycled solo through the volcanic central highlands and remote west fjords; Ecuador, where he summited the highest active volcano in the world; Cambodia, where he hiked the ancient ruins of Angkor Wat; as well as cycling across the United States from Canada to Mexico along the Pacific Coast Highway.