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!
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!
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!