Thursday, November 21, 2013

Possible Lisfranc injury could end season for NFL quarterback.

Various sources on the internet are reporting that the Tennessee Titans quarterback, Jake Locker suffered a foot injury in the team’s game on Sunday against the Jacksonville Jaguars.
It was announce that locker hurt his foot in the second quarter and is highly doubtful to play against the Colts on Sunday.
It is reported that Locker said “I don’t know exactly how it happened, but when I got up from that run I could feel it.
A Lisfranc injury, name after the French surgeon Jacques Lisfranc de St. Martin is damage to the foot that causes metatarsals to be dislocated from the tarsal bones. This usually involves the ligament that holds the medial cuneiform to the second metatarsal base. These injuries can range from a ligament rupture to multiple bone dislocations at the tarso-metatarsal joints.  The patient usually have an injury of twisting or crushing of the foot such as motor vehicle accidents.

Usually the patient remembers the injury but is possible that the patient may not be aware at the time of the injury that he has been hurt.

Figure 3

Figure 1
Figure 2

The patient from figure 1 had no idea how he injured his foot but he has significant and multiple injuries.
The patient from figure 2 definitely knew he had an injury.
The patient in figure 3 knew he had injured himself and sometimes injuries such as these are not recognized in the emergency room.
For significant injuries such as figure 1 and 2 an open reduction with fixation is required to put the bone back where they are supposed to be and to allow healing. The following two pictures are examples of severe injuries requiring surgery to fix the fractures.

Figure 4
Figure 5

A less complex repair is seen below and is used for primarily ligament rupture and less extensive fractures.

Figure 6

In all of the cases shown bone healing is the limiting factor for returning to activities.
When it is reported that this injury can be season ending for Locker, it comes as no surprise. It is usually 6 to 8 weeks of non weight bearing required for healing to complete for these injuries.
The podiatric surgeons at Gulfcoast foot and ankle care are well versed at the diagnosis and treatment of midfoot fractures.
 If you have an injury and would like to be treated at Gulfcoastfoot and ankle call 239 566 8800 for an appointment.

Tuesday, September 10, 2013

Dr. Oz turns into a woman for a day

Dr. Oz goes undercover as a shoe salesman!  Dr. Oz dons a skirt to convince women that they need to wear sensible shoes to maintain good foot health.  Read more here about the girlish transformation.

Monday, August 26, 2013

Fin Foot

Foot Pain after Scuba Diving- posted by Dr. Brooke Austin

It could be a condition called “Fin Foot”

 "I  was diving recently and after the last dive I noticed that my big and little toes were sore. Within a few hours they looked bruised and were extremely painful, I could hardly walk. I was wearing the same boots and open-heel fins that I’ve worn before. I am used to diving in colder water because of where I live. It took several days for the bruising and pain to go away. Could this have been Decompression Sickness (DCS)?”

This was unlikely to be DCS due to the location and the symptoms you described. It is not typical for DCS to isolate in specific digits. Your presentation suggests a condition known as reactive hyperemia or "fin foot".
This usually occurs in the aftermath of a period of reduced blood flow to an area of the body. When circulation is fully restored following constriction of blood flow the blood vessels dilate and can become engorged with blood. This can cause discoloration ranging from dark red to the bruised appearance you described as well as exquisite pain.

If our fin straps are too tight or we have forced our foot into the foot pocket too firmly we can create a steady mechanical pressure on the blood vessels. This is colloquially known as ‘fin foot’. Colder water can also contribute to the constriction of the blood vessels adding to the reduced blood flow to the area. Usually this condition does not require medical intervention other than pain management. Typically staying off the affected foot as much as possible, elevating the foot and applying warm compresses will help keep the affected area comfortable.
Working with your local dive professional or podiatrist to confirm proper fit of your equipment may be in order as well.  If your symptoms do not resolve within a few days or progressively get worse then you should seek medical attention immediately. Call our office at (239) 304-5161.

Tuesday, July 16, 2013

Beware of flip-flops

Posted by Dr. Brooke Austin

Flip-flops — the airy sandal held on the foot solely by a simple band between the two biggest toes — are back in full force. And that means foot problems.

Flips-flops come in a variety of styles and many women wear them both with their casual attire and with formal wear. But, while the popular footwear provides basic protection against hot pavement and catching athlete’s foot, flip-flops offer nothing in the way of foot support. They offer no arch support, heel cushioning or shock absorption. People who sport flip-flops for extended periods of time can suffer foot pain, tendinitis, plantar fasciitis and even stress fractures — not to mention blisters, stubbed toes and more serious injuries.

Wearing flip-flops forces the wearer to scrunch his or her toes to grip the flip-flip band at the wrong time in the gait cycle. The action shortens natural stride and forces the foot, hip and leg muscles to work harder, which can result in other muscles shutting down. For example, hammer-toes, a condition in which the toes are bent in a claw-like position, are the result of years of compensation from the small foot muscles.

The lack of arch support in most flip-flops can cause plantar fasciitis, inflammation of the thick band of tissue along the bottom of the foot that causes a stabbing pain, especially in the heel. Other injuries include shin splints and metatarsalgia, which causes pain and inflammation in the ball of the foot. People with flatter arches are more prone to such overuse injuries because they require more support for their muscles and ligaments.

One of the most serious problems is overuse injuries such as stress fractures of the metatarsals, the five long bones that reach out to the toes. A stress fracture happens after constant, repetitive stress to the bones. Because flip-flops leave the feet unprotected and exposed to the elements, wearers are more prone to cold toes, sunburns, stubbed toes and blisters. Serious injury can occur when people wear flip-flops for inappropriate tasks, such as mowing the lawn. You don’t have to quit wearing your stylish flip-flops, but take these precautions for when you do wear them:

• Limit wearing flip-flops to short periods of time. When you know you will be walking a great distance, change into appropriate walking shoes with proper support.

• Don’t use a flip-flop as an athletic shoe. They are designed to walk only on flat surfaces. People who run or jump in flip-flops risk sprained ankles, fractures and severe ligament injuries.

• Don’t wear flip-flops to cut the grass or operate equipment. They dramatically increase the risk of stubbed toes, lacerations and puncture wounds, or having a heavy object hit your foot.

• Avoid driving in flip-flops. According to the American Automobile Association, flip-flops increase the risk of car accidents because they impair a driver’s control if they come off the foot and lodge under the brake or gas pedal. Put on a suitable pair of shoes to drive.

Our office sells Orthaheel sandals which resemble a flip flop but have a built in arch support.

Please call today for you appointment 239-566-8800.

Monday, July 8, 2013

Fireworks injury results in woman losing her foot

Posted by Dr. Brooke Austin

Just as they do every year to celebrate the Fourth of July, sisters-in-law Lorena and Kristina Perez went to West Lawn Park on the South Side to watch neighborhood fireworks with their family and friends.

But as a set of four fireworks were launched into the air, one of them instead went straight to the ground, exploding at the feet of the Perez women.
Kristina’s left foot was blown off, according to a relative in their group, and Lorena suffered injuries to her left leg. Both were taken by ambulance to Advocate Christ Medical Center in Oak Lawn.
“It seemed like it tipped over and came straight down,” said Fabian Carmona, 37, Lorena’s brother. “I don’t think she saw it coming.”
The Chicago Fire Department responded to several fireworks-related injuries, including burns, July 3 and 4 as unauthorized fireworks displays lit up the sky across the city. The Perez women’s injuries were the most serious, said fire department spokesman Lawrence Langford.
Kristina, 32, had her left leg amputated, and she suffered injuries to her right foot and an arm. Lorena, 36, was treated for a fractured leg and burns to her lower extremities, according to fire officials and a relative.
Kristina Perez, 32, began screaming when the stray firework hit her. “I went to look around and then I realized she was missing her foot,” Carmona said. “She was yelling, screaming. She was saying, ‘Get an ambulance. Get an ambulance.’ "
Lorena, who celebrated her birthday a day earlier, is missing a large area of tissue on her left leg, and a toe was badly burned, Carmona said.
The fireworks were unsanctioned but are an annual tradition in West Lawn Park, Carmona said. The injuries occurred between 10:30 and 11 p.m.
“We do it every year. We hang out at the park and watch them go up,” Carmona said. “I still can’t believe this happened.”
He said he doubts he’ll go to a fireworks display again. “I don’t want to be near that stuff. I am traumatized right now,” he said.
John Cole, who was watching the fireworks with this 11-year-old son, said he rushed over to the Perez women and wrapped a shirt around Kristina’s leg to try to stop the bleeding. He said other people used the lights from their phones to try to help.
Meanwhile other groups, not realizing what had happened, continued to launch more fireworks at the park near West 66th Street and South Keeler Ave.
“It was horrifying,” Cole, 46, said. “It could have happened to any of us.”

Please be careful when it comes to fireworks. If you do sustain an injury please seek medical assistance immediately. 239-566-8800

Thursday, June 27, 2013

Amniotic Membrance can save your feet!!!

Posted by Dr. Brooke Austin

Nerve disease caused by type-2 Diabetes accounts for half of all amputations in the U.S., but a new treatment is helping patients keep their limbs.  And it comes from a pregnant woman!

The amniotic fluid membrane comes from donors from an FDA approved laboratory.

People with diabetes are more likely to have a foot, toe, or leg amputated than other people.  It happens because diabetics have blood vessel disease, which reduces blood flow to the feet, and nerve disease, that reduces sensation in the feet.  These two conditions together cause sores and infections that may lead to amputation.  Despite changes in care over the years, foot, toe, and leg amputations are still common.  Research has been able to show links between risk factors like high blood pressure and high blood glucose and a person’s chance of having a lower-extremity amputation.  However, more research needs to be done in order to evaluate which patients with diabetes are most at risk. 

We now have amniotic membrane and fluid that is cryopreserved. So it can be used on anybody at anytime and anywhere. We don't have to have a live birth to collect it, and it can be harvested in very clean, sterile conditions. We inject it in and around the wound, and it enhances the healing.

A diabetic ulcer happens when diabetics lose sensation in their feet.  It’s called neuropathy, and it happens gradually.  Because of the loss of sensation Diabetics may get a cut and don’t even know it.  That cut could then become infected and the wound can erode through the skin and down to the bone.  Even a small diabetic ulcer can become life or limb-threatening.  The membrane has mesenchymal stem cells, which have all of the nutritional materials the tissue needs to heal.  It stimulates the body very aggressively to start to create healthy tissue. 

If you are Diabetic, or know someone who is make sure they have their feet checked at least once per year by a podiatrist. Prevention is key.

Call the office today for a comprehensive Diabetic foot exam or to learn more about Amniotic membrane.  239-566-8800

Thursday, April 25, 2013

Jerry Seinfeld Shares Struggle with Heel Pain at NYCPM

This is not his first time with foot problems.
He was seen by a podiatrist in California and referred to the doctor (a Professor Emeritus of Biomechanics) who owns the orthotic lab that we have used for over 30 years. He had so much relief he did a promotion for this lab and was appointed to a post on a foot health board. We still use the lab and still have the advertisement. If you watch his reruns you will rarely see his feet as he perfomed in sneakers or socks!

Comedian Jerry Seinfeld visited the New York College of Podiatric Medicine (NYCPM) yesterday to express his gratitude to APMA member Joseph D'Amico, DPM, for ending his 30-year struggle with heel pain. Dr. D'Amico, a former chair of the orthopedics department at the school and a long time instructor, succeeded where numerous other medical professionals failed by identifying the biomechanical basis of Seinfeld's problem.

Seinfeld told his story to a small group of NYCPM faculty members. When speaking about his eponymous award-winning sitcom, Seinfeld said, "I have a hard time watching the reruns because I see the shoes on my feet and remember how painful that experience was."

To show his appreciation for the outstanding care he received from Dr. D'Amico, Seinfeld made a donation to the Gait Laboratory for Biomechanical Research at the school, as well as an additional donation to fully fund the Richard O. Schuster Memorial biomechanics seminar.

Tuesday, April 16, 2013

Kobe Bryant Achilles tendon Injury

Posted  by Dr. Brooke Austin

Kobe Bryant's Achilles heel is his actual Achilles heel. Late in the Lakers' game against the Golden State Warriors, the Los Angeles Lakers guard suffered the worst injury of his career, one that could have franchise-changing repercussions. 

Friday night at the Staples Center, with just three minutes left in the game's final quarter, Bryant collapsed on the floor after being fouled by the Warriors' Harrison Barnes. After making his two free throws, which ended up accounting for the game's margin of victory in the 118-116 win, Bryant left the game already aware that his season was most likely over.

An MRI on Saturday confirmed what Bryant and the Lakers' trainers already suspected: Bryant tore his Achilles tendon, an injury that required surgery that will sideline Bryant for at least the next 6-9 months. So not only is Bryant out for the season, this could potentially threaten the 34 year old future Hall of Famer's career, or at least his career with the Lakers.
The Achilles tendon is the largest tendon in the human body. It is located at the back of the ankle joint and can be felt as a large, cord-like structure attaching to the back of the foot. Since tendons serve to attach muscles to bone, the Achilles tendon also attaches the large calf muscles, the gastrocnemius and soleus, to the back of the heel bone, the calcaneus.
The muscle mass and strength of the gastrocnemius and soleus muscles are greater than all of the other muscles of the lower leg combined. Therefore, the pull of these muscles on the Achilles tendon is very large since these muscles help balance the body while standing, push the body forward during walking, spring the body forward during running, and spring the body upward during jumping. Because of the large amount of stress which the Achilles tendon is subjected to during running and jumping activities, the Achilles tendon is prone to injury.
The most common form of injury to the Achilles tendon is called Achilles tendonitis, which is an inflammatory condition causing pain in the Achilles tendon. Achilles tendonitis generally occurs in people who are active in sports activities. Types of sports that commonly are associated with Achilles tendonitis are basketball, tennis, running, football, soccer, volleyball and other running and jumping sports.
Achilles tendonitis tends to occur more frequently in older athletes than in younger athletes. As a person ages into their thirties and especially into their forties and fifties, the ligaments and tendons of the body tend to lose some of their stretchiness and are not as strong as before. This predisposes older individuals who are active in running and jumping activities, to tendon injuries such as Achilles tendinitis. However, Achilles tendonitis can also occur in teenagers who are very active in running and jumping sports.
If you suspect you may have an Achilles tendon injury please call today for a complete evaluation. We have in-office x-ray and ultrasound for prompt diagnosis and treatment.
Call 239-566-8800 for your appointment today.

Friday, April 5, 2013

"Brittle Bones"

Posted by Dr. C. Robert Dushack

To the men and women of southwest aware!

     According to the National Osteoporosis foundation, a woman’s risk of breaking a hip due to osteoporosis is equal to her risk of breast, ovarian and uterine cancer combined; a man age 50 or older is more likely to break a bone due to osteoporosis than he is to get prostate cancer.  If this doesn't grab your attention, then nothing will.  Especially considering that the median age in the Naples area is 64.2 years.  Now, imagine what is happening to those two little things (feet) that are supporting your body weight.  Hmmm...just a thought.
    Anyway, we here at Gulf Coast Foot and Ankle Center want the people of Southwest Florida to remain as healthy and active as possible.  Osteoporosis can lead to multiple debilitating conditions, and there are many controllable and non-controllable factors that can lead to this.  "The best form of prevention is an educated patient."  For that reason, here are a few as listed again by the National Osteoporosis Foundation:

Uncontrollable Risk Factors

  • Being over age 50. 
  • Being Female. 
  • Menopause. 
  • Family History. 
  • Low Body Weight/Being Small and Thin. 
  • Broken Bones or Height Loss

Controllable Risk Factors

  • Not Getting Enough Calcium and Vitamin D.
  • Not Eating Enough Fruits and Vegetables.
  • Getting Too Much Protein, Sodium and Caffeine.
  • Having an Inactive Lifestyle.
  • Smoking. 
  • Drinking too much alcohol.
  • Losing Weight.

* Your foot and ankle specialist not only can help with the conditions and symptoms associated with the sequelae related to osteoporosis, but often times are instrumental in the discovery and diagnosis of the condition.  Please call us for a complete evaluation at Gulf Coast Foot and Ankle Center Tel# (239)-566-8800

Wednesday, April 3, 2013

Stress Fractures can lead to gruesome injury like Kevin Ware

Posted  by Dr. C. Robert Dushack

Stress fracture (definition) according to the Mayo Clinic -
    Stress fractures are tiny cracks in a bone. Stress fractures are caused by the repetitive application of force, often by overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also arise from normal use of a bone that's been weakened by a condition such as osteoporosis. Stress fractures are most common in the weight-bearing bones of the lower leg and foot.  Track and field athletes are particularly susceptible to stress fractures, but anyone can experience a stress fracture. If you're starting a new exercise program, for example, you may be at risk if you do too much too soon.
    I mention this because I am seeing it a lot in our patients down here participating in activities such as golf and tennis for example.  This condition is associated with a multitude of symptoms, some of which I will relay to you.  My biggest concern with this condition is that it will progress into a full blown fracture.  Many of you may have been watching the NCAA basketball tournament, which left spectators stunned as a Louisville players leg fractured on national television in a seemingly normal and harmless situation.  Well, I'm not sure if it was the case in this situation, but many times it is a pre-existing condition or weakness that allows this to occur.  If anyone is interested, here is a link to a video of the actual injury (Warning: Graphic)
   We here at Gulf Coast Foot and Ankle Center are always cognizant of these potentially underlying conditions, and are diligent in the prevention of more debilitating injuries.  That is why I must stress that pain, especially new pain, no matter how harmless it may seem, is your body's only way of letting you know that something is wrong!  It is imperative that you listen to your body, and take appropriate action.  Sometimes this just means rest.  Other times, it may require professional care.  PLEASE be aware that no situation is to small to seek a professional opinion, and nobody should ever feel embarrassed or weak because of this.  You only get one body and one life, and ultimately you are responsible for both.  We here at Gulf Coast Foot and Ankle Center are vividly aware of this, and can guide you and assist you with this responsibility.
   Now, here are those symptoms that I mentioned (per the Mayo Clinic):

Symptoms of a stress fracture include:
  • Swelling
  • Pain
  • Tenderness in a specific spot
  • Increased swelling and pain with activity
  • Decreased swelling and pain with rest
  • Earlier onset of pain with each successive workout
  • Continued pain at rest as the damage progresses
At first, stress fractures may be barely noticeable. But pay attention to the pain. Proper self-care and treatment can keep the stress fracture from worsening.

*Please don't let these symptoms progress!  Call us at Gulf Coast Foot and Ankle Center at 239-566-8800 for a thorough foot and ankle examination.

Balance for stroke patients

Use of an ankle foot orthosis (AFO) within six weeks of stroke results in better balance outcomes and earlier independent ambulation than if AFO use is delayed, according to research from the Netherlands.
Investigators from Roessingh Research & Development in Enschede randomized 18 patients to receive AFOs at either the time of inclusion in the study (within six weeks of stroke) or eight weeks later. Both groups received the same rehabilitation, with a focus on balance and ambulation, the only difference being that the “late” group did the first eight weeks of rehabilitation without an AFO while the “early” group did all rehabilitation while wearing AFOs. Balance measures were assessed every two weeks for 16 weeks.
The doctors at Gulfcoast Foot & Ankle Centers can make a custom made AFO to not only help with your rehabilitation but also prevent falls. Call for an appointment and evaluation today.

Naples 566-8800
Physicians Regional Medical Center Office 304-5161
Bonita Springs 949-3399

Tuesday, April 2, 2013

Silver-Thera Stocking Electrode & Micro-Z Mini

Posted by  Dr. Brooke Austin

Do you suffer from chronic foot and leg pain? Do your feet burn, tingle, have sensation of pins and needles?  Have you been diagnosed with  painful Diabetic Peripheral Neuropathy?

The doctors at Gulfcoast Foot and Ankle Center  have found a non-invasive way to provide chronic pain relief, rapid wound healing and edema reduction while you sleep!

The innovative Silver-Thera Stocking is a knitted garment made up of highly conductive silver fibers which conduct energy (electrotherapy) to the foot and leg. Energy is delivered to the tissue through the stocking by the Micro-Z mini electrode. The therapy promotes microcirculation by introducing a very small electrical DC charge of energy into the cells, tissue and blood vessels. This can aid in edema reduction and increase microcirculation for pain relief and wound healing.

Finally, we can offer our patients a drug-free pain relief system!!!

The Silver-Thera stockings and Micro-Z Mini work great for painful Diabetic peripheral neuropathy or any other chronic foot and leg pain.

Please call the office today for an evaluation and to see if you are a candidate for this exciting new treatment option. We have 3 office locations in Naples and Bonita Springs!!! 
Please call 239-566-8800 for an appointment, mention this blog and receive $50 off your stockings.


Thursday, March 28, 2013

Help for chronic pain, neuropathy and diabetic neuropathy!

We want to thank Dr. Brooke Austin for bringing us information on the Micro Z Silver Thera Stockings that will help so many of our patients who suffer from chronic pain, neuropathy and diabetic neuropathy. This is going to make so many of our patients so much more comfortable and improve the quality of their day to day life.
Great Job! Dr. Austin

Prevent Amputations

Amputations among People with
Diabetes Can Be Reduced by 50%

Every 30 seconds somebody in the world is amputated as a consequence of foot complication due to diabetes. A new study at Sahlgrenska Academy confirmes that shoe inserts, podiatry, regular checkups and other simple interventions can reduce the number of amputations by more than 50%.
Orthotic researchers at Sahlgrenska Academy, University of Gothenburg, have studied diabetic foot complications ever since 2008. They have focused on protecting the foot from overloading the foot sole in order to minimize the risk of ulcers , which may eventually lead to amputation.