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Posts for: June, 2020

                         

Midfoot osteoarthritis (OA) is an often underdiagnosed cause of disabling foot pain, particularly in older patients. Although some people do present to the office with findings of arthritis but no associated symptoms, the prevalence of symptomatic midfoot arthritis is estimated at 12% among individuals older than 50 yrs. Assuming this estimation, slightly over 1 in 10 patients over the age of 50 will have symptoms associated with osteoarthritis of the midfoot!

A little anatomical background into this…

The midfoot is responsible for transferring the load from the hindfoot to the forefoot during the push-off phase of the gait cycle. Inherently, midfoot stability is a crucial aspect of normal gait. Untreated midfoot arthritis can lead to significant midfoot arch collapse, instability and progressive degeneration of other surrounding joints, resulting in a cycle of pain and inability to walk.

The primary strategy of treating midfoot OA is alleviating pain by enhancing midfoot stability and reducing the loads imposed at the inflamed joints. Anti-inflammatory medication both oral and topical have been proven to help. Targeted injection therapy into the affected joints is also effective to reduce pain. However, providing an enhanced structural support for the arthritic foot is the most effective conservative treatment for these patients.

Stiff sole shoes with a “rocker-bottom” modification are a longstanding choicein reducing pain. From a patient perspective, the main disadvantage of this treatment is the lack of freedom to change footwear beyond one specific pair of shoes.

Full length or ¾ length carbon fiber orthotics, which we can help fabricate at LI Advanced Podiatry offer an alternative option to stiff-soled footwear with rocker bottoms for patients with midfoot OA. They can be transferred between footwear of proper size and shape. Most importantly, studies are showing the effectiveness that these devices in your shoes have, to reduce pain, improve pressures on surrounding joints and improve the gait cycle.

Sometimes, arthritis may be so advanced, more invasive options such as surgery are required. Although a vast majority do improve with the conservative options, procedures such as primary joint fusions are required for the later stages of midfoot arthritis. Make your appointment today for a careful evaluation and see if our devices, medications and surgical options can help you get back into motion quickly and pain free!


By Dr David Ehrlich
June 22, 2020
Category: Foot Care

                                   

Metatarsal fractures are some of the most common types of foot injuries. The metatarsals are the long bones which span from the midfoot and lead to the toes. There are five metatarsals, and a fracture or “break” in these bones can be a devastating injury and lead to pain and decreased activity.

However, not all fractures are created equally. When the fracture is “non-displaced”, this means that the bones are still in proper alignment. These types are fractures can often be treated conservatively with walking boots, casting, or stiff-soled surgical shoes. The pain associated with non displaced fractures is generally mild and can be relieved by non steroidal anti inflammatory drugs such as Motrin. It is also critical to keep the affected foot elevated and ice the area to minimize swelling. X-rays are taken routinely to monitor fracture healing and transition the patient back to sneakers at the appropriate time.

                                 

A metatarsal stress fractures is a small crack in the bone as a result of repetitive stress or trauma. These types of fractures are common in runners and fitness enthusiasts. Stress fractures can even be so subtle that they do not show up on x-ray. Management of metatarsal stress fractures is almost always conservative. The key is to not return to exercise too early before the bone heals, which can take 6-8 weeks depending on the individual.

If a metatarsal fracture is “displaced” this means that the two ends of the fracture are not aligned properly and that the fracture may need to be fixed surgically. Depending on the fracture pattern, the surgeon may use plates, screws, or wires to fixate the fracture. However, the decision to proceed with surgery is always one that is made mutually with our patients, and we take into account their health, activity level, and overall goals.

Each of the five metatarsal bones are unique and there are numerous types of fracture that can occur based on the mechanism of injury. Because metatarsal fracture management is so nuanced, you should seek the opinion of the experts at Advanced Podiatry!


Many don’t realize skin cancer can occur on the feet from unprotected sun exposure, and they overlook applying sunscreen to the area. 
 
Skin cancer of the foot is prevalent and can even be fatal if not caught early. While all types of skin cancer, including squamous cell and basal cell carcinoma, can be found on the foot, the most common is the most serious form, Melanoma. Symptoms can be as subtle as an abnormal looking mole, or freckle found anywhere on the foot, and often go unnoticed without routine foot examinations.
 
Early diagnosis is key to effective treatment of the condition, but because people aren’t looking for the early warning signs, or taking the same precautions they do for other areas of the body, skin cancer in this region often is missed entirely. Also, it is hard to see all the surfaces of one’s feet, even for flexible people. 
 
We at Advanced Podiatry of Manhasset, Huntington, Plainview, and Maspeth advise our patients to regularly inspect their feet, including the soles, in between their toes, and even under their toenails, for any changing moles, or spots; and to have any suspicious areas properly examined and biopsied by one of our expert podiatrists at  Advanced Podiatry of Manhasset, Huntington, Plainview, and Maspeth.

           

Do you ever experience significant pain under the ball of the foot, most commonly under the base of the second toe.

The plantar plate may be the culprit: a firm fibro-cartilaginous ligament composed of type 1 collagen, this ligament functions to withstand the wear and tear of daily life activities. Although small, this  strong ligamentis vital to stability of the metatarsophalangeal joints. If it is sprained or torn, it can lead to digital deformities such as crossover toe, floating toe or eventotal dislocations of the joint! Small tears of this ligament, even with the absence of any visible hammertoes can be notoriously painful and cumbersome to treat.  Women who commonly wear heals are particularly at risk.

 

To accurately identify this often misdiagnosedetiology of pain in the ball of the foot, our podiatrists are trained to perform certain highly sensitive exams that can diagnose this problem right here  in our treatment rooms. In addition, we will often confirm the diagnosis with an ultrasound or MRI to gauge both the severity but also identify any other injuries.

If caught early, your pain can be relieved with taping/strapping methods/orthotics/shockwave therapy and physical therapy. When these injuries are severe or do not respond to conservative treatment, a surgical procedure may be required. Recent literature is promising that our newer techniques are more effective, reproducible and less invasive for a safe and timely return to shoe gear of your choosing.

If you are concerned you may have a plantar plate rupture and wish to be evaluated, the doctors at Advanced Podiatry will make sure to choose the appropriate treatment for you!

  

By Dr Arden Smith
June 01, 2020
Category: Heel Pain
Tags: Heel Pain  
All of our Advanced Podiatry offices have had many reports of heel and arch pain from patients stuck at home as a result of the COVID-19 pandemic.
 
Nonsuportive footwear - or lack of footwear - may be to blame for the upsurge in cases. Adults are shifting routines and adapting to new working environments; and it’s easy to neglect proper care and support of their feet.
 
The top priority when treating heel and arch pain, is to reduce the mechanical strain on the plantar fascia, often with custom foot orthotics, splints for stretching, and supportive footwear. Most cases of heel pain respond well to conservative (nonsurgical) treatment, including anti-inflammatory measures and stretching. However, our expert podiatrists at Advanced Podiatry of Manhasset, Huntington, Plainview, and Maspeth are well trained to provide advanced, cutting edge treatments, including EPAT therapy, ultrasound guided injection therapy, and surgical intervention for more complex cases.
 
Foot and heel pain is never normal, so see one of our expert podiatrists at Advanced Podiatry of Manhasset, Huntington, Plainview, and Maspeth right away.
 



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Advanced Podiatry of Manhasset at the Americana

(631) 427-3678 Huntington NY
(516) 869-3300 Manhasset NY
(718) 639-0499 Maspeth NY
(516) 681-8866 Plainview NY

Manhasset, NY Office
Advanced Podiatry
2110 Northern Blvd.
Suite-208
Manhasset, NY 11030
(516) 869-3300

Huntington, NY Office
Advanced Podiatry
181 Main St.
Suite-207
Huntington, NY 11743
(631) 427-3678

Maspeth, NY  Office
Advanced Podiatry
70-01 Grand Ave
Maspeth, NY 11378
(718) 639-0499

Plainview, NY Office
Advanced Podiatry
875 Old Country Rd
Plainview, NY 11803
(516) 681-8866