Posts for tag: Dr. Joseph Menn
Have you ever dropped a heavy box on the top of your foot? Have you ever stepped into a small hole, falling, and twisting your foot? These two common accidents can result in midfoot or Lisfranc fracture-dislocation. Lisfranc injuries (named from the French doctor that first described the injury) occur at the midfoot. This area is a cluster of bones and joints that form an arch on the top of the foot between the ankles and toes. In total, five long bones extend to the base of the toes meet four bones projecting towards the rear of the foot. These bones are held into position by ligaments that stretch across and down the foot. The bone extending to the second toe is extremely important as it acts as a stabilizing force in the area but lacks ligaments to secure it to the first long bone. These two long bones may shift, break, or dislocate in a twisting fall.
Lisfranc fracture-dislocations are often mistaken for sprains. The top of the foot may be swollen and painful with some bruising. If the injury is severe, you may not be able to place any weight on the foot. Lisfranc injuries are often difficult to see on X-ray and can have serious complications if left untreated. It is important to see a podiatrist if rest, ice, and elevation do not reduce the pain and swelling within a day or two. At the doctor’s office, a podiatrist will evaluate the foot through a detailed physical exam and image study. If initial x-rays do not show an injury, a CTor MRI may be needed.
Treatment for a Lisfranc injury depends on the severity of the injury. If the bones have are still in alignment, a cast is typically used in addition to not placing any weight on the foot for six weeks. Unfortunately, surgery is often needed to stabilize the bones and hold them in place after they have become dislocated. Pins, wires, or screws may be used to restore normal position. After surgery, a cast and non weight bearing to the foot for six to eight weeks is typical. In both situations, arch support and a rigid soled shoe are commonly used until all symptoms have disappeared.
It is important to seek appropriate medical advice when rest, ice, and elevation do not resolve pain. It is equally important to follow doctor’s orders and refrain from activities until instructed. The podiatrists at Coastal Podiatry Associates are trained in Lisfranc fractures and will help their patients return to normal activity as quickly as possible.
Septic arthritis is an extremely painful infection of a joint where germs infiltrate a joint and cause damage that leads to severe pain, warmth, and swelling. Bacteria and other microorganisms are the cause of septic arthritis and commonly target the knee, hip, or ankle. In the United States, 20,000 cases are reported each year in mostly young children and older adults. Septic arthritis is considered a medical emergency, as the microorganisms can destroy the joint in a few short days or can spread to other areas of the body.
There are four main causes of septic arthritis. The first is called contiguous spread. This occurs when a preexisting bone infection travels down the bone and reaches a joint. Direct implantation of bacteria can occur when a puncture or stab wound occurs in the joint. Heamtogenous source of septic arthritis develops when an infection enters the bloodstream from another area of the body and reaches a joint. The last cause takes place after joint surgery and is due to contamination.
Septic arthritis typically causes extreme discomfort and difficulty using the affected joint. Signs and symptoms can include fever, severe pain especially when moving the joint, swelling, joint warmness, and redness. Medications for other types of arthritis may mask the pain and fever. It is important to seek a doctor if these signs develop. It is especially important if signs and symptoms of infection such as fever and chills occur, as this may indicate a severe infection. To diagnosis septic arthritis, a doctor will consider the clinical presentation, vital signs, x-rays, and blood labs. Generally, septic arthritis is treated with joint aspiration, removal of infected tissue, and antibiotics.
Ankle sprains are so common that many people never seek medical care. One simple misstep can cause the ankle to twist at just the wrong angle leading to pain for days. Two important questions to ask after spraining an ankle include; when is it appropriate to see a podiatrist and what can be expected during the visit?
During the most common ankle sprains, the outer ligaments of the ankle are injured due to an excessive stretching force. This can happen by awkwardly planting the foot while walking, stepping, or running. In these situations, the foot rolls in and forces the ankle to move away from the body. Ankle sprains can cause pain, swelling, bruising, and weakness. This pain intensifies with movement or touching of the ankle joint.
For mild sprains, the RICE principle should offer enough treatment. RICE stands for rest, ice, compression, and elevation. RICE combined with a reduction in activity and over the counter anti-inflammatory medications such as ibuprofen may offer full relief. If pain, swelling, and weakness last longer than a week, it is important to seek medical attention. The podiatrists at Coastal Podiatry Associates are trained to evaluate ankle injuries. They will examine the ankle to make sure that a serious injury, such as an ankle fracture has not occurred. In the office, they will evaluate the ankle’s range of motion, strength, and locate the area of maximum tenderness. They may use x-ray or MRI to ensure their diagnosis and check for bone or ligament damage. Depending on the severity of the sprain, a doctor might recommend a brace, splint, or crutches to keep pressure off the ankle joint. Physical therapy may be needed to help regain full range of motion and strength.
A common cause of weakness and an inability to stand on one’s toes is due to Posterior Tibial Tendon Dysfunction (PTTD). The posterior tibial tendon is one of the most important tendons in the lower leg. This tendon starts in the calf, extends behind the inside of the ankle, and attaches to multiple bones in the middle of the foot. This muscle and tendon combo help lift the inside part of the foot as well as plantarflex the foot. Plantarflexion is a movement that increases the angle between the foot and the shin like pushing down on a car’s gas pedal.
The posterior tibial tendon is constantly used. It helps hold up the arch of the foot and during walking it provides support when stepping off the toes. If this tendon becomes inflamed, over stretched, or torn many things can happen. First pain and swelling is typically noticed on the inside of the ankle. Soreness over the arch can occur, especially with activity. This soreness can increase leading to a loss of the foot’s arch. General weakness and an inability to stand on the toes can also occur. Posterior tibial tendon dysfunction occurs most often in women over 50 years of age but can also be brought on by obesity, diabetes, previous surgery or trauma, local steroid injections, or an inflammatory disease.
A podiatrist will reach the conclusion of PTTD through a history and physical examination. During the physical exam it is common to have the patient stand on their bare feet facing away from the physician. This allows the physician to notice how the foot functions. From behind, it will look as though you have too many toes showing. A podiatrist may also ask the patient to stand on their toes or do a single heel raise. During a single heel raise, the heel will normally rotate inward. The absence of this sign indicates PTTD. The treatment a podiatrist recommends will depend on how far the condition has progressed. The ultimate goal is to return the tendon to normal functioning and to prevent permanent flatfoot. In the early stages, PTTD is treated with ibuprofen, shoe inserts, or immobilization of the foot. If early treatments do not work surgery may be needed.
By Dr. Joseph Menn of Coastal Podiatry Associates, Myrtle Beach SC.
A diabetic foot ulcer is an open sore or wound commonly found on the bottom of the foot. Diabetes is the leading cause of nonaccidental leg and foot amputations in the US. According to the American Podiatric Medical Association, about 14-24% of diabetics who develop a foot ulcer will eventually need amputation.
Ulcers can form due to many factors including a lack of feeling in the foot, poor circulation, foot deformities, irritation, and trauma. Anyone that has diabetes can develop a foot ulcer. People who use insulin are more likely to develop an ulcer, along with people that have diabetes-related kidney, eye, and heart disease. Being overweight, using alcohol and tobacco also increase the risk of developing a foot ulcer. The most common factors to developing a foot ulcer are neuropathy and vascular disease. Neuropathy is a reduced or complete lack of ability to feel pain in the feet due to nerve damage. In those with diabetes, this is most commonly caused by elevated blood glucose levels over time and can occur without pain or one being aware of the problem. Vascular disease can complicate an ulcer by reducing the body's ability to heal and increase the risk of infection. Again, high blood glucose can reduce the body's ability to prevent infection and slow healing.
The primary goal in treating a foot ulcer is to obtain healing as soon as possible to prevent an infection. A podiatric physician is specially trained in ulcer treatment and should be visited immediately after an ulcer is noticed. In treating an ulcer a podiatrist will normally work to prevent infection, remove pressure from the area (called off-loading), remove dead skin and tissue (called debridement), use a medication or dressing to the ulcer, and manage blood glucose or other health problems. Keeping the ulcer from becoming infected is of extreme importance. This can be done by keeping blood glucose levels under tight control, keeping the ulcer clean and bandaged, washing the ulcer daily, and wearing appropriate shoes. Most of the wounds that are not infected can be treated without surgery, however if all treatment fails surgery might be needed.
By Dr. Joseph Menn of Coastal Podiatry Associates, Myrtle Beach SC