Advice on Foot Care

A recent review of literature by Dr. Robert J. Johnson and colleagues, an orthopedic surgeon and professor emeritus at the University of Vermont, revealed a number of myths about skiing. The following is a list of common misconceptions about skiing and ski injuries.

• Untrue: Blown-out knees have replaced broken legs.
• Untrue: Toe & heel piece settings of the binding must be the same to properly function.
• Untrue: Relax if you think you are going to fall.
• Untrue: You can decrease the risk of an anterior cruciate ligament injury by lowering the release settings on your bindings.
• Untrue: Exercise can prevent skiing injuries.
• Untrue: Very short skis don’t need bindings which release.
• Untrue: Formal ski instruction will make you safer.
• Untrue: Alpine skiing is one of the most dangerous sports.

• Run in a trail shoe, even if you don’t run on trails. Trail running shoes offer more protection and tread and are better for slippery surfaces. More on shoes
• Wear wicking socks. Avoid wearing cotton to reduce blistering and to keep your feet warmer. More on wicking socks.
• Wear proper fitting shoes. Shoes which are too tight may cause jamming at the toes, blistering, nail damage and nerve impingement. This can occur when summer running shoes are paired with thicker or heavier socks to keep the feet warm during the winter. Mild foot swelling during the summer months is common and this can result in a loose fit during the winter. Loose fitting shoes can result in heel slippage and heel blisters. More on choosing running shoes.
• Avoid tight foot wear in cold weather. Tight fitting shoes decrease circulation and can cause pain, discomfort and cramping.
• Stick to flat surfaces. In cold weather, your body does not react as quickly as it does in warmer weather and it becomes more difficult to adjust to uneven terrain. Running on uneven terrain or sloped surfaces increase your risk of muscle strains and sprains. More on running injuries.
• Avoid wearing old running shoes. It’s common to choose older, worn out running shoes in the winter because there is a high likelihood of them becoming dirty. Wearing shoes with 400+ miles increase the risk of foot and ankle problems, such as plantar fasciitis and tendonitis.
• Warm up slowly. In colder weather, your muscles take longer to warm-up. Your chances of injury increase when you do not take the time to warm-up properly.
• Cross Train. You may want to take a break from running, or alternate your running days with other sports during the winter, especially if you are experiencing any foot or ankle discomfort. Overuse injuries tend to occur more frequently in the winter. More on foot injuries in runners.

A new study from Loyola University found that tennis players who specialize early in a single sport are more prone to injury. The researchers analyzed 519 players in 3,366 U.S. junior tennis matches. The players started playing tennis at an average  of 6 years of age, started competing at 9 years of age and started to specialize in only tennis at 10 years of age. The medium number of hours practiced per week was 16-20 hours and 93% competed 10 months per year. Those players who specialized in only tennis were more likely to withdraw from a tournament for medical reasons. Common injuries in young players include ankle sprains, hip injuries, patellar tracking issues (knee cap instability), muscle strains, spine stress fractures and wrist tendonitis, but rarely tennis elbow.

Loyola University Health System Press Release

A Morton’s neuroma is an inflamed, thickened nerve in the ball of the foot. The common symptoms are pain, tingling and numbness in the ball of the foot and shooting to the 2nd and 3rd toes. It’s common to experience a feeling of walking on a lump or bunched up sock. Common treatments include rest, ice, anti-inflammatory medications, padding, rigid shoes, orthotics and steroid injections. Continue Reading »

It is well documented that musculoskeletal conditions, such as carpal tunnel syndrome, Dupuytren’s contracture and trigger finger, occur in association with thyroid disease. Most disorders occur with hypothyroidism, but there have been occurrences with thyrotoxicosis as well. Although there is limited research to support a clear association between hypothyroidism and plantar fasciitis, it is theorized that low thyroid levels will increase the susceptibility for the development of plantar fasciitis. Continue Reading »

A recent study found that restless leg syndrome, RLS, may be more common in women and Caucasians. Women are more likely to have the symptoms of RLS because they are more likely to be iron deficient. Iron deficiency is a known risk factor for restless leg syndrome. Pregnancy can also worsen the symptoms of RLS. The reasoning why RLS is more prevalent among caucasians is unknown. Those with RLS experience leg discomfort, pain, abnormal sensations in their legs and an intense urge to move their legs. This neurological disorder is suspected to affect more than 12 million Americans.

A study in the Clinical Journal of Sports Medicine suggests that hyaluronic acid injections may accelerate ligament healing. Hyaluronic acid is a component of ligamentous tissue and as a long carbohydrate chain which attracts water, it adds resiliency to ligaments. In the study, 158 patients with 1st or 2nd degree acute ankle sprains were randomly divided into two groups. One group was given a hyaluronic acid injection in addition to the standard ankle sprain treatment of rest, ice, compression and immobilization (RICE). The second group was given a placebo injection and the RICE treatment recommendation. Both groups had improvements after 1 week, but the patients who received the hyaluronic acid injections had significant improvements in both pain and walking and were able to return to sports within 11 days. The placebo group returned to sports after 17 days. Hyaluronic acid was well tolerated and shown to be both safe and effective in this study.

Clin J Sport Med 17(4):251-257, Jul 2007.

Abstracts presented at the 47th Annual Meeting of the Infectious Disease Society of America (IDSA) outlined information about a deadly infection caused by MRSA. Methicillin Resistant Staphylococcus Aureus (MRSA) is a bacteria that has developed resistance to antibiotics commonly used to treat staphylococcus. An even more deadly strain of MRSA has emerged, the USA600 strain is much more lethal than other strains. This strain results in death in half of those infected, which is a five times higher death rate than those infected with other strains of MRSA. Researchers are continuing their study of the USA600 strain to gain a better understanding of it’s unique nature. Another abstract presented at the meeting reviewed 438,865 visits to the Emergency Department over a 9 year period. Over 1,300 patients had positive MRSA cultures, with almost 70% of those infections associated with wounds. The increase of MRSA infections between 2000 and 2008 was 211%. Infections with MRSA were more common during the summer months and during early Fall, indicating a seasonality to the infection.

47th Annual Meeting of the Infectious Disease Society of America

Pain under the heel at the first step in the morning is the most characteristic symptom associated with plantar fasciitis. Plantar fasciitis is the tearing, inflammation and degeneration of the plantar fascia, an important connective tissue structure in the bottom of the foot. The plantar fascia is similar in structure to a ligament and is composed of collagen, elastin, glycosaminoglycans (GAGs), fibroblasts and water. Type I collagen adds to the fascia’s considerable strength and the elastin increases elasticity, as the name implies. Glycosaminoglycans are long chains of repeating sugar units which attract water and function to resist pressure. Continue Reading »

The plantar fascia is a thick, fibrous, connective tissue band which extends along the bottom of the foot. The structural make up of the plantar fascia consists of collagen, elastin, glycosaminoglycans and water. The primary cells are fibroblasts, which synthesize collagen. The primary component of the fascia is type I collagen which adds to the strength of the structure. Elastin is a protein which gives the fascia some elasticity as well as increasing it’s function in dynamic arch support when walking. Glycosaminoglycans, GAGs, are long chains of repeating sugar units that attract water and add resiliency to the ligamentous structure. Continue Reading »

Plantar fasciitis is a condition which results from microscopic tears within the plantar fascia. The plantar fascia, a ligament-type structure in the foot, is one of the most important structures in the foot due to it’s role in supporting the arch. Despite it’s strength, excess stress in combination with abnormal mechanics of the foot can result in small tears within the fascia. In the illustration to the left, a tear in the plantar fascia is highlighted. An up-close view shows a microscopic image of the tearing in the ligamentous structure. Continue Reading »

The plantar fascia is a connective tissue band which extends from the heel bone to the ball of the foot. The plantar fascia is designed to support a tremendous amount of weight. Continue Reading »

Plantar fasciosis is the degeneration (deterioration) of the plantar fascia as a result of repetitive stress. The plantar fascia is a broad, thick, fibrous band that extends from the base of the calcaneus (heel bone) to the base of the toes. The fascia is composed of a dense network of highly organized collagen fibers, which gives it the strength necessary to support the tremendous force placed through the arch when walking. During the push off or propulsive phase of walking, the plantar fascia tightens like a cable, increasing the arch height, shortening the foot and helping to create a rigid lever which increases the efficiency of motion as the body is propelled forward. Continue Reading »

The next five posts will detail the development of plantar fasciitis, the most common cause of heel pain, it’s progression to plantar fasciosis and how the structure of the plantar fascia corresponds to the condition.

• Plantar Fasciosis Explained
• Strength of The Plantar Fascia
• Plantar Fascia Tear
• Breakdown of the Plantar Fascia
• Why do I Have Morning Heel Pain

More information and images on plantar fasciitis.

The most serious complication of a deep blood clot in the leg, is the clot breaking off, traveling to the lungs and causing a pulmonary embolism. A pulmonary embolism blocks the main artery of the lung and causes shortness of breath, chest pain, rapid breathing and in severe cases sudden death. A new study challenges the conventional wisdom that pulmonary emboli originate from blood clots in the legs. The study, published in the October issue of the Archives of Surgery, found that 85% of patients with pulmonary emboli, had no evidence of blood clots in their legs (deep vein thrombosis). The researchers evaluated the medical records of 247 trauma patients over a three year period. Forty-six  patients were diagnosed with a pulmonary embolism, but only 7 patients with pulmonary emboli were also diagnosed with a deep vein thrombosis. The findings imply that pulmonary emboli may originate in the lungs and these findings could change the treatment protocol. Some experts remain skeptical and feel the study has several short comings, including the screening methods used to diagnose DVTs. They emphasize the need for further research.

Arch Surg. 2009;144(10):928-932.

Ultracet, a combination of tramadol and acetaminophen, has been shown to be as effective as gabapentin (Neurontin) for treating painful diabetic neuropathy. The findings from this study, which was funded by Janssen, marketers of the medication, were presented at the World Diabetes Congress in Montreal. Gabapentin is a common first line treatment for nerve pain in diabetics. In the study, 139 patients with painful diabetic neuropathy were divided into two groups and assigned to receive tramadol/acetaminophen or gabapentin. After 6 weeks, both groups had similar improvements in pain.

Diabetic neuropathy is a nerve disorder caused by metabolic factors associated with diabetes. The condition causes numbness, tingling and other abnormal sensations, generally starting in the toes and progressing up the legs. Painful diabetic neuropathy can cause shooting, stabbing or electrical pain as well as intense burning pain on the bottom of the feet. The pain generally occurs at rest or during sleep, but in more severe cases can be more consistent. About 5% of diabetics will develop painful diabetic neuropathy.

More on diabetic neuropathy.

When Eli Manning was diagnosed with plantar fasciitis, the condition suddenly became a common, household term. Manning had an unusual, acute development of plantar fasciitis due to a combination of his foot placement during his throw and history of arch pain. Manning is not the only player with plantar fasciitis. Tank Johnson, defensive tackle for the Cincinatti Bengals is questionable for Sunday’s game against the Bengals due to plantar fasciitis. Continue Reading »

Colcrys is an oral medication formulated for the treatment and prevention of gout flares. Colcrys is a form of colchicine, which has been used for centuries for the treatment of acute gout attacks. Colchicine is not prescribed often for gout attacks because of the side effects, which include cramping, nausea, diarrhea and vomiting. URL Pharma, Inc. emphasizes that Colcrys’ formulation provides efficacy without the toxicity and has been shown to be well tolerated when paired with uric acid-lowering.

Gout is a painful condition caused by the deposition of needle-like crystals in the joints as a result of elevated levels of uric acid. HIgh levels of uric acid which build up in the blood can result in precipitation of of the uric acid into crystals. This tends to occur in the coolest areas of the body, which makes the great toe one of the most common areas for gouty attacks.

Serotonin reuptake inhibitors, such as Zoloft, Lexapro and Prozac, are commonly used to treat depression and anxiety. Serotonin is a neurotransmitter, a chemical in the brain that relays messages from one area to another. These chemicals travel between brain cells (neurons), relaying messages. As the chemical is released from one side of the brain cell, it travels to a receptor on the next brain cell. The interaction between the chemical and the receptor causes an electrical message to be sent through the nerve. The electrical message sent by serotonin has affects on mood, appetite, sleep, memory, temperature regulation, social behavior and metabolism. Serotonin is usually taken up by the nerve ending it was released from and reused (recycled). Selective serotonin reuptake inhibitors (SSRIs) function by blocking the reuptake of serotonin, increasing the availability of serotonin to bind with the receptor, which results in repeated electrical messages being sent by the receiving brain cell. Continue Reading »

Peripheral arterial disease (PAD) is a common disease, but not well understood by the general population. PAD is atherosclerosis of the peripheral vessels, the vessels in the lower extremities. Atherosclerosis is a disease characterized by the buildup of plaque on artery walls. The plaque is a composed of cholesterol, triglycerides and calcium deposits. The smooth muscle within the artery wall is damaged and the LDL cholesterol becomes oxidized creating a complex inflammatory reaction, inflaming and thickening the artery walls. As the artery walls thicken and narrow, blood flow becomes restricted. When the body exerts itself, more demand is placed on the heart to pump blood through the arteries to reach the periphery. If the arteries are too narrow to support the increased flow of blood, the muscles are unable to receive enough oxygen to function. In the legs, this results in calf pain or cramping when walking. In most cases, the pain resolves with rest. In severe cases, the plaque can break off, causing a clotting reaction and further blocking blood flow in the extremities, causing gangrene. Continue Reading »

Capsaicin is an active compound found in chili peppers and a chemical irritant which produces a burning sensation. Capsaicin is used as a treatment for painful nerve conditions, arthritis and muscle aches. Capsaicin works by binding to a protein in specific nerves which transmit pain and heat sensation. Although capsaicin will cause a burning sensation, it will also deplete the pain and heat neurotransmitter, substance P, which decreases the nerve’s ability to report pain for extended periods of time. Continue Reading »

More information on plantar fasciitis.

Willie Parker is still suffering from turf toe, a hyperextension injury of the great toe joint, and is unsure if he’ll play against the Browns this Sunday. Turf toe is a tear of the capsule and ligaments at the base of the great toe joint. In football, a common mechanism of injury is when a player’s ankle is flexed, his weight is on the ball of his foot and he falls back on his own leg, or another player falls on the leg. The weight of the player on the leg jams the foot down and forces the great toe into a hyperextended position, causing a rupture of the joint tissues. Turf toe can sideline an athlete for weeks, depending on the grade of the injury. Continue Reading »

Last week it was questionable whether Eli Manning, the quarterback for the New York Giants, would start in yesterday’s game against the Raiders. Not only did he start his 83rd straight game for the Giants, he led the Giants to an easy 44-7 victory over the Raiders. Manning took at seat on the sidelines midway through the second quarter after completing 8 of 10 passes for 173 yards and connecting for 2 touchdowns. Continue Reading »

Tom DeLay had to drop out of the Dancing with the Stars competition due to stress fractures in both of his feet. Tom DeLay was the DeLay, Republican majority leader in the U.S. House of Representatives, known for his tough conservative approaches, initially injured his right foot and then on Monday sustained a stress fracture to his left. Stress fractures, incomplete breaks in the bone, are repetitive stress injuries and typically occur in the long bones in the feet. The 2nd and 3rd metatarsal bones are the two most common bones to fracture.  The metatarsal bones are the long bones in the middle of the foot. The pain is usually sharp and develops suddenly, but it is typically not due to a specific injury or trauma. More on stress fractures.