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853 Jefferson Ave
Washington, PA 15301
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Posts for: January, 2012

By contactus
January 30, 2012
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Often times, new mothers are very concerned, as they well should be, about every last detail on their newborn’s body. One of these concerns I often see mothers have is the flattened arch of their child’s feet, or what I call a flatfoot deformity. This is when the normal arch on the inside of the foot (“medial longitudinal arch”) is not present, and the bottom of the foot appears flat all the way from side to side. This is a very keen and critical observation because often the child’s foot shape and structure can be indicative of underlying problems or conditions. Other times flat feet can be just a normal part of the growth and maturity of the newborn child. If your child’s flatfeet are determined to be of this normal pattern type, the flatfeet should fully disappear by age 3 and should have minimal effect on the child’s attainment of milestones, such as standing and walking. Often times an infant just has so much fat padding on the bottom of their feet for a period of time that the fat pad fills in the normal medial arch and the child appears to have flatfeet.

There are so many variations on normal, and conversely so many variations of the abnormal, that it is very important for you to have your newborn, your infant, or your child into my office at the first sign of concern or just for a screening exam if you so choose. There are many abnormalities in foot and leg shape or structure that can be easily treated with such things as casting or bracing, but it is important to catch these and treat these early for the best outcome.

 

When you come in with your child for a podiatry exam, whether out of precaution or for deeper concerns, there are a few things you can expect. I will likely want to see the how the child’s bones are developing, so we will take xrays of the child’s feet and legs as needed. I will also likely run through a series of physical exam tests to assess the child’s joint alignment and ranges of motion of the lower extremities. I will also educate you on the growth and development of your child, because two sets of eyes are always better than one.

 

 

 


By contactus
January 16, 2012
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Ankle sprains, or twisting/rolling your ankle, are very common injuries encountered in our population, due to a wrong step on uneven surfaces such as curbs, potholes, rocks, or an injury related to sports. This, and many other acute injuries like it that we have talked about in the past, will likely lead to swelling and inflammation. The first step in treatment should be as immediate as possible, and that first step is RICE**: Rest, Ice, Compression, Elevation.

                       

As soon as you are able, an ice pack or bag of ice should be applied to the area (with a layer of cloth between your skin and the ice to prevent cold injury to the skin) and held in place with an Ace wrap or elastic bandage to provide compression. These steps help decrease the swelling and internal damage occurring as part of the body’s natural response to the injury. The body part should be elevated higher than your heart to help promote drainage away from the swollen area. This can be done easily by propping your leg on a pile of pillows in bed. The ice should be applied for 20 min on/20 min off as much as you can for the first 48 hours after the injury. Even when not icing, you should provide compression to the area, especially if walking around for an extended period of time. The “rest” part of this treatment, perhaps the most important, means keeping weight-bearing activity to a minimum for the first couple of days, and slowly getting back to normal daily activities as tolerated.

It is very important to make sure your strength and stability have returned before attempting physical activities, as many of these injuries, especially sprained ankles, are common to reoccur due to weakened ligaments leading to instability of your joint.

If you are still experiencing pain, weakness, or instability after about a week, or if you are concerned about the severity of the injury right away, it may be necessary to schedule an appointment with me to further evaluate the injury and provide more treatment options.

**The RICE method of treatment may also be used as first-line treatment for any type of muscle, tendon, or ligament injury where there is pain and swelling involved.


By contactus
January 10, 2012
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I’m sure many of you woke up this week as disappointed as I am that the beloved Steelers’ season has come to an unfortunate and abrupt ending this past weekend. While watching the game, or any of the Steelers’ games for the past few weeks, I am sure you may have heard the announcers talk about QB Ben Roethlisberger’s injury, deemed a “high ankle sprain.” Today, we will briefly discuss what exactly that means and why everyone has been so concerned with the QB’s play while managing this injury.

Any time someone “sprains” their ankle, or rolls it excessively to one side or the other, the ligaments that hold the ankle in place get stretched or possibly even torn or ruptured. As you can imagine, or may have even experienced, this causes a great amount of pain in and around the ankle, and it may include swelling and bruising to the ankle. Even after it heals and you return to function activity, the ankle may feel unstable or wobbly, meaning the ligaments are not as strong as they once were.

A “high ankle sprain” means that the injury occurred above the ankle joint level in a ligament called the “tibio-fibular syndesmosis” or “interosseous membrane.” As the name may imply, this is a ligament connecting the two leg bones, the tibia and the fibula that keeps the bones from spreading apart with each step you take.

                                                        

With the twisting or cutting motion that causes this injury, the two bones can be forced into a degree of separation, thus stretching or possibly tearing this ligament (indicated by black arrow below).

                                                                     

This high ankle sprain injury may not become as bruised and swollen as a normal ankle sprain, which can often disguise the severity of the injury. During normal walking, the tibia and fibula are in slight motion, so the ligament in between them is always being pulled on. You can imagine how an injured ligament would then cause severe pain with each step. You can also imagine how much more force and stress, and therefore pain, is placed on the ligament with the running and cutting motions in an NFL game.

The typical treatment is the same as a normal ankle sprain: RICE = Rest, Ice, Compression, Elevation. The problem is that there is no effective brace to reduce motion around the high ankle area, so it takes nearly twice as long to heal this high ankle sprain and requires a more strict adherence to rest (aka-not walking on the injured leg). In extreme cases, a screw can be surgically put in to connect the tibia and fibula and therefore reduce the stress on the ligament to allow the ligament to heal, but you still cannot walk on the leg then, as the normal motion mentioned above could cause the screw to break.

 

It normally takes more than 6 weeks to return to activity, with symptoms possibly lasting up to 6 months, so I suppose we can all be a little thankful that Big Ben suited up at all this weekend. 


By contactus
January 03, 2012
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Plantar Fasciitis          

 

Are you experiencing heel or arch pain that is worst with your first few steps in the morning? Is the pain worse when putting weight on the painful foot and somewhat relieved by sitting and rubbing the heel? Does this pain tend to go away with time as you walk more and more throughout the day? If you answered yes, there is a distinct possibility that you are suffering from Plantar Fasciitis, and I have a solution to your painful problems.

 

The plantar fascia is a thick band of tissue on the bottom of each of your feet that is attached to the heel bone towards the back of your foot and to your toes toward the front of your foot.

                                            

This band helps provide support to the foot bones and helps maintain normal arches in your feet. If you have a biomechanical malfunction in your feet or if you walk around too often without shoes or in shoes that do not provide appropriate support, this plantar fascial band of tissue can be forced into an abnormally stretched position. You may be able to feel this stretching in the bottom of your foot and arch area as you walk. As the plantar fascia is stretched too far, it begins to weaken and possibly tear. The plantar fascia also tries to pull away from its attachment on the heel bone. This causes inflammation and possibly severe pain, and often makes the bottom of your heel bone feel tender and painful if you were to push on it or squeeze it.

 

There are many treatment options available for plantar fasciitis, depending on severity and the cause of the abnormal plantar fascial stretching in the first place. Initial treatment may include an injection at my office to relieve the pain and reduce the inflammation, followed by anti-inflammatory medications, rest and ice daily. One way to ice the area is to freeze a filled water bottle, then roll the bottom of your foot over the bottle for 15 minutes. This will help ice the area to reduce pain and inflammation, as well as stretch the plantar fascia more naturally. You also want to “warm up” your plantar fascia before your first steps in the morning by stretching your feet and calf muscles before walking. One common method is to roll the bottom of your foot over a tennis ball on the ground for a few moments.

                                       

Other treatments include custom-made orthotic devices, which will help control the function of the foot with each step and stop the abnormal stretching of the plantar fascia. Treatment may also include physical therapy, such as deep-heating ultrasound, massage therapy, strengthening the foot and leg muscles, and stretching exercises to stretch your calf muscles (see my blog about how to stretch your calf muscles on November 29, 2011). In severe and chronic cases, surgery may be necessary, but is certainly not the first option.

 

The most important thing to remember is that YOU DO NOT HAVE TO LIVE WITH FOOT PAIN!! Pain is caused by some abnormal function within the body, and in the case of plantar fasciitis, it is usually an easy, although possibly lengthy, fix. Once you start treatment for plantar fasciitis, including rest, it is very important to stay with the treatment plan until all pain and tenderness is resolved, as this type of injury can easily reoccur. During or after treatment, it is usually a good idea to obtain a pair of custom made orthoses from my office to make sure this nagging heel pain does not continue to flare its ugly head. Please call my office today if you are experiencing this or any other type of foot pain or non-painful problems.