Ankle Sprains & Treatment
Ankle sprains occur to anyone in almost any sport or activity. The majority of ankle sprains occur during contact sports with the top four being: basketball, football, soccer and running. But ankle sprains can occur in other activities such as in dance and even just walking outside on uneven sidewalks. Most of us ignore the sprain and take it easy for the next couple of days. But this type of “treatment” doesn’t treat the inflammatory process behind the sprain.
Inadequate treatment of an ankle sprain can cause the ankle to become prone to sprains and later can develop into lateral ankle instability due to the laxity of the ligaments around the ankle. The anterior talo-fibular ligament is the most sprained ankle ligament contributing to the instability. By taking care of an ankle sprain correctly with proper treatment will help reduce the risk of lateral ankle instability.
This can be prevented by using the simple acronym RICE that stands for:
Rest the injured ankle from any type of weight bearing activity and this is best accomplished by using crutches or even various casting options.
Ice the injured location for about 20 minutes at a time to help reduce swelling and to prevent further injury. A simple ‘frozen bag of peas’ or several ice cubes wrapped in a towel will suffice.
Compression by using a gel wrap or elastic bandage will help support the ankle.
Elevate the injured side by keeping it above the heart level, which helps to reduce both swelling and bruising.
By following the RICE treatment and by taking anti-steroidal anti-inflammatory drugs (NSAIDs) to help with pain management and reduce swelling and inflammation, the injured ankle will have a better chance of recovery and will prevent the risk of developing ankle instability. More severe ankle sprains that involve more ligaments and possibly bone will need the attention of a podiatrist. Trainer or your family doctor, who can evaluate the ankle with other diagnostic tools such as ultrasound and x-rays.
Please email us with any questions of comments.
Monday, November 8, 2010
Thursday, July 1, 2010
Thursday, 1 July 2010:
What Do Summer and Sun Exposure Mean for Your feet?
Summer season is here and everyone is excited about spending some time in the sun. Whether it is just some play time with the kids in the backyard, enjoying the pool, or maybe even planning a vacation with the family and enjoying some peaceful time on a beautiful beach. Although, all of those scenarios seem like a way to spend a great summer, what many people tend to forget is protecting their skin from harmful sun exposure. We have all heard of the importance of protecting our skin from the sun due to the harmful UV radiation and the possibility of skin cancer. Unfortunately, any area of exposed skin is fair game for the cancer of the skin. It is hard to believe that skin cancer can also rise from the skin on our toes, feet, ankles, and legs. The number of individuals who forget to lather up the skin on those areas specially the toes and the feet might surprise you.
After prolonged sun exposure, irregular skin cells grow and begin to differentiate over time. If unattended and untreated, they have the potential of spreading to other parts of the body including other tissues and organs in a process called metastasis. Different types of skin cancer exist including: basal cell carcinoma, squamous cell carcinoma, and malignant melanoma; with basal cell carcinoma being the most common skin cancer amongst all. Melanoma, which rises from skin melanocytes, is the least common and yet the most dangerous type of skin cancer with the ability to metastasize.
Skin cancer presents itself in many forms, some common presentations on the foot include: scaly, shiny, waxy, crusty, or simply a small, red lesion. The areas that one should pay close attention to on the feet in terms of screening for potential skin cancer include but are not limited to the dorsum of the foot, area underneath/surrounding the toenails, and the heels.
Risk factors for skin cancer involve light-complexion and fair skin, family history of skin cancer, age (more common in those over the age of 40), and finally the areas that sunburn easy.
The ABCDE’s of skin lesions, are some important features to look for and they entail: asymmetry, border, color, diameter, and elevation of the lesion. Asymmetry is seen where one half of the lesion has a different appearance/texture compared to the other half. Be on the lookout for irregular borders of the lesion, a star like border is a common example. Color of the lesion should be assessed and any color difference compared to the surrounding skin should be noted. Any lesion with the diameter of 6mm or larger should be brought to your physicians’ attention. Last but not least, any elevation of any lesion is alarming.
Different types of skin cancer whether melanocytic or nonmelanocytic require a different type of treatment with some having surgical excision as the best definitive treatment approach. Early detection is the key with skin cancer as it is with many other health conditions. So, here is our friendly advice: enjoy your summer and your time off with your family, however, do not forget sun protection (at least SPF 30) and regular skin screenings. Try and stay out of the sun when UV rays are most intense, mainly between the hours of 11am and 3:30 pm. If a mole or a skin lesion on your lower extremities looks suspicious to you and fits the ABCDE criteria above, be sure and consult your podiatrist. Finally, have a fun, safe, and an amazing summer!
Sloan Gordon, DPM, FACFAS
713-988-6600
What Do Summer and Sun Exposure Mean for Your feet?
Summer season is here and everyone is excited about spending some time in the sun. Whether it is just some play time with the kids in the backyard, enjoying the pool, or maybe even planning a vacation with the family and enjoying some peaceful time on a beautiful beach. Although, all of those scenarios seem like a way to spend a great summer, what many people tend to forget is protecting their skin from harmful sun exposure. We have all heard of the importance of protecting our skin from the sun due to the harmful UV radiation and the possibility of skin cancer. Unfortunately, any area of exposed skin is fair game for the cancer of the skin. It is hard to believe that skin cancer can also rise from the skin on our toes, feet, ankles, and legs. The number of individuals who forget to lather up the skin on those areas specially the toes and the feet might surprise you.
After prolonged sun exposure, irregular skin cells grow and begin to differentiate over time. If unattended and untreated, they have the potential of spreading to other parts of the body including other tissues and organs in a process called metastasis. Different types of skin cancer exist including: basal cell carcinoma, squamous cell carcinoma, and malignant melanoma; with basal cell carcinoma being the most common skin cancer amongst all. Melanoma, which rises from skin melanocytes, is the least common and yet the most dangerous type of skin cancer with the ability to metastasize.
Skin cancer presents itself in many forms, some common presentations on the foot include: scaly, shiny, waxy, crusty, or simply a small, red lesion. The areas that one should pay close attention to on the feet in terms of screening for potential skin cancer include but are not limited to the dorsum of the foot, area underneath/surrounding the toenails, and the heels.
Risk factors for skin cancer involve light-complexion and fair skin, family history of skin cancer, age (more common in those over the age of 40), and finally the areas that sunburn easy.
The ABCDE’s of skin lesions, are some important features to look for and they entail: asymmetry, border, color, diameter, and elevation of the lesion. Asymmetry is seen where one half of the lesion has a different appearance/texture compared to the other half. Be on the lookout for irregular borders of the lesion, a star like border is a common example. Color of the lesion should be assessed and any color difference compared to the surrounding skin should be noted. Any lesion with the diameter of 6mm or larger should be brought to your physicians’ attention. Last but not least, any elevation of any lesion is alarming.
Different types of skin cancer whether melanocytic or nonmelanocytic require a different type of treatment with some having surgical excision as the best definitive treatment approach. Early detection is the key with skin cancer as it is with many other health conditions. So, here is our friendly advice: enjoy your summer and your time off with your family, however, do not forget sun protection (at least SPF 30) and regular skin screenings. Try and stay out of the sun when UV rays are most intense, mainly between the hours of 11am and 3:30 pm. If a mole or a skin lesion on your lower extremities looks suspicious to you and fits the ABCDE criteria above, be sure and consult your podiatrist. Finally, have a fun, safe, and an amazing summer!
Sloan Gordon, DPM, FACFAS
713-988-6600
Thursday, April 15, 2010
Barefoot Running
It seems that lately everywhere that media exists, there is a discussion of a hot new topic in the area of sports medicine and the current "tweet" is barefoot running. This technique has been utilized by some professional athletes and marathon runners. One particular individual who has become very famous through barefoot running is known as “barefoot Ken Bob”. True barefoot runners believe that barefoot running keeps their feet in their neutral position and therefore helps them with overall biomechanics of the foot, mainly their balance and stability. The strategy and the thought behind this is that all throughout history, our ancestors have been on their bare feet walking, running, working, and providing for their families. It was not until recently that the idea of supportive shoes came around. Later, orthotics were introduced along with their benefits of giving runners the opportunity to sustain less injuries and less pain while having the ability to run longer distances.
From a foot and ankle doctor's point of view, supportive shoes absorb shock from the ground while we run and they provide cushioning against hard surfaces; they increase stability and lessen the chances of injury. Furthermore, the use of custom orthotics perfects the biomechanics of our feet so that pressure is distributed equally and at the right phase of the gait cycle. Those average runners who currently use custom orthotics due to poor biomechanics will not benefit from barefoot running in any sort. In fact, they will only increase their chances of hurting themselves and sustaining an injury while running. On the other hand, those with good biomechanics who currently do not need the support of an orthotic may benefit to a certain level by barefoot running in a safe environment. Barefoot running is not at all suggested for diabetic patients, those suffering from peripheral neuropathy, peripheral vascular disease, heel spurs, previous foot injuries and plantar fasciitis.
There is much debate going on about this topic and until more research and study is done there will be no certain answer. The original research done on barefoot running showed that there is less damaging pressure placed onto the hips, the knees and the ankle joints while the patient walked barefoot on the treadmill compared to when they were walking in supportive shoes. What the article fails to do is to test this strategy on alternate surfaces for the patient.
What each individual needs to keep in mind is that our feet have become accustomed to the arch support, and cushioning provided by shoes. To take that and to suddenly go from great support to no support will exhibit an enormous amount of stress onto our feet; stress that the feet will not be able to handle and will therefore get injured. Forces anywhere from two to eight times of our body weight go through our body as we run, without the support of shoes, we will get hurt due to lack of adequate motion control and stability. If you are an individual who would like to experiment with barefoot running, start in a safe environment and start slowly. Also, keep in mind that certain shoes in the market mimic the mechanics of barefoot running and could possibly be a good starting point. Barefoot running is really like starting over and is a process that needs to be “eased into” in order to allow the body to adapt to the new forces being exerted onto it.
As physicians and podiatrists, we are most concerned about our patient’s health and want what is best for them. Further biomechanical studies are certainly needed to determine the best remedy for our professional runners. Until then, we will advise to our patients what we have been trained for and that is to have support at all times while walking and running to prevent injuries. Always remember the general rule of doing things in moderation and to consult a physician before starting any exercise regimen.
For further questions, call us at 713-999-6600 or view us online at www.myfootdoc.com.
From a foot and ankle doctor's point of view, supportive shoes absorb shock from the ground while we run and they provide cushioning against hard surfaces; they increase stability and lessen the chances of injury. Furthermore, the use of custom orthotics perfects the biomechanics of our feet so that pressure is distributed equally and at the right phase of the gait cycle. Those average runners who currently use custom orthotics due to poor biomechanics will not benefit from barefoot running in any sort. In fact, they will only increase their chances of hurting themselves and sustaining an injury while running. On the other hand, those with good biomechanics who currently do not need the support of an orthotic may benefit to a certain level by barefoot running in a safe environment. Barefoot running is not at all suggested for diabetic patients, those suffering from peripheral neuropathy, peripheral vascular disease, heel spurs, previous foot injuries and plantar fasciitis.
There is much debate going on about this topic and until more research and study is done there will be no certain answer. The original research done on barefoot running showed that there is less damaging pressure placed onto the hips, the knees and the ankle joints while the patient walked barefoot on the treadmill compared to when they were walking in supportive shoes. What the article fails to do is to test this strategy on alternate surfaces for the patient.
What each individual needs to keep in mind is that our feet have become accustomed to the arch support, and cushioning provided by shoes. To take that and to suddenly go from great support to no support will exhibit an enormous amount of stress onto our feet; stress that the feet will not be able to handle and will therefore get injured. Forces anywhere from two to eight times of our body weight go through our body as we run, without the support of shoes, we will get hurt due to lack of adequate motion control and stability. If you are an individual who would like to experiment with barefoot running, start in a safe environment and start slowly. Also, keep in mind that certain shoes in the market mimic the mechanics of barefoot running and could possibly be a good starting point. Barefoot running is really like starting over and is a process that needs to be “eased into” in order to allow the body to adapt to the new forces being exerted onto it.
As physicians and podiatrists, we are most concerned about our patient’s health and want what is best for them. Further biomechanical studies are certainly needed to determine the best remedy for our professional runners. Until then, we will advise to our patients what we have been trained for and that is to have support at all times while walking and running to prevent injuries. Always remember the general rule of doing things in moderation and to consult a physician before starting any exercise regimen.
For further questions, call us at 713-999-6600 or view us online at www.myfootdoc.com.
Monday, April 5, 2010
Achillest Tendon Injuries
What Really Happened to David Beckham and Can It Happen To You?
On Sunday March 14, 2010, the world’s most elite soccer player lost his chances of entering The World Cup due to a sports injury. This injury was an Achilles tendon rupture, often a career-ending injury for soccer, tennis, football and basketball players.
The Achilles tendon is made up of fibrous tissue bonded together in a ropelike manner. The tendon connects the heel bone to the calf muscle in each individual. It is the largest tendon in our body and is capable of bearing large amounts of weight. The function of the tendon is to pull the heel off the ground and allow the toes to push off the ground in order for us to make a step as the calf muscle tightens. The ‘tendon’ is actually a combination of the three muscles of the lower leg, often called the gastrocnemius complex. The ‘tendon’ is the terminal attachment of the Soleus Muscle, as well as the Medial and Lateral Gastrocnemius muscles. The action of the tendon/muscle group is necessary to allow walking, running, and different activities such as participating in sports. Once an interruption (tear) is made through this band of fibers, a simple task such as walking becomes unbearable. This condition is known as an Achilles tendon rupture. Bruising, swelling, redness, inflammation, pain and sensitivity in the back of the affected leg are just a few of the symptoms to mention that result after a rupture. Patient may also hear a sudden pop as the injury occurs. Often, patients relate being hit with a 2x4 or feeling like they were shot in the back of the leg!
The chances of a rupture increase as the tendon grows weak. This weakness can occur due to aging, medications such as corticosteroids (and some drugs known as Quinolones) as well as conditions like arthritis. With that said, it is important to know that tendo Achilles rupture is most common in middle aged men, especially those known as “weekend warriors” who play an extensive amount of recreational sports such as basketball, soccer, surfing, etc. after a long time of no activity. A sudden fall, a sudden push-off of the foot with the knee straightened can all result in injury.
It is important to seek medical care as soon as the injury happens. Podiatrists are trained to diagnose an Achilles tendon rupture by some important and simple clinical testing techniques. An MRI or ultrasound are then ordered to verify the rupture and determine the level at which the rupture has occurred. Once a rupture is confirmed, surgical and nonsurgical treatment plans are decided by the physician. Both are a long term course of treatment that can last about 6 months. Immobilization, casting, and physical therapy are some standards to achieve the ultimate goal of treatment which is restoring the original length and strength of the tendon.
A word of advice from your sports podiatrist: always RICE after any injury. To RICE is to Rest, Ice, Compress and Elevate the site of injury.
Unfortunately Beckham’s injury crushed his hopes for a chance to win at the world cup and is causing him to miss a big portion of the MLS season. We all wish him a full recovery to return to the sport that he loves most.
Sloan Gordon, DPM
See us on facebook at myfootdoc (become a fan!), twitter and blog: myfootdoc.
On Sunday March 14, 2010, the world’s most elite soccer player lost his chances of entering The World Cup due to a sports injury. This injury was an Achilles tendon rupture, often a career-ending injury for soccer, tennis, football and basketball players.
The Achilles tendon is made up of fibrous tissue bonded together in a ropelike manner. The tendon connects the heel bone to the calf muscle in each individual. It is the largest tendon in our body and is capable of bearing large amounts of weight. The function of the tendon is to pull the heel off the ground and allow the toes to push off the ground in order for us to make a step as the calf muscle tightens. The ‘tendon’ is actually a combination of the three muscles of the lower leg, often called the gastrocnemius complex. The ‘tendon’ is the terminal attachment of the Soleus Muscle, as well as the Medial and Lateral Gastrocnemius muscles. The action of the tendon/muscle group is necessary to allow walking, running, and different activities such as participating in sports. Once an interruption (tear) is made through this band of fibers, a simple task such as walking becomes unbearable. This condition is known as an Achilles tendon rupture. Bruising, swelling, redness, inflammation, pain and sensitivity in the back of the affected leg are just a few of the symptoms to mention that result after a rupture. Patient may also hear a sudden pop as the injury occurs. Often, patients relate being hit with a 2x4 or feeling like they were shot in the back of the leg!
The chances of a rupture increase as the tendon grows weak. This weakness can occur due to aging, medications such as corticosteroids (and some drugs known as Quinolones) as well as conditions like arthritis. With that said, it is important to know that tendo Achilles rupture is most common in middle aged men, especially those known as “weekend warriors” who play an extensive amount of recreational sports such as basketball, soccer, surfing, etc. after a long time of no activity. A sudden fall, a sudden push-off of the foot with the knee straightened can all result in injury.
It is important to seek medical care as soon as the injury happens. Podiatrists are trained to diagnose an Achilles tendon rupture by some important and simple clinical testing techniques. An MRI or ultrasound are then ordered to verify the rupture and determine the level at which the rupture has occurred. Once a rupture is confirmed, surgical and nonsurgical treatment plans are decided by the physician. Both are a long term course of treatment that can last about 6 months. Immobilization, casting, and physical therapy are some standards to achieve the ultimate goal of treatment which is restoring the original length and strength of the tendon.
A word of advice from your sports podiatrist: always RICE after any injury. To RICE is to Rest, Ice, Compress and Elevate the site of injury.
Unfortunately Beckham’s injury crushed his hopes for a chance to win at the world cup and is causing him to miss a big portion of the MLS season. We all wish him a full recovery to return to the sport that he loves most.
Sloan Gordon, DPM
See us on facebook at myfootdoc (become a fan!), twitter and blog: myfootdoc.
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