Posts for: July, 2020
Gout, or gouty arthritis, is a painful and often debilitating condition that commonly affects the foot and ankle. According to the American College of Rheumatology, gout is the most common form of inflammatory arthritis and affects approximately 9.2 million adults in the United States alone. It is caused by a build-up of uric acid that may be deposited in joints and cause pain, redness, and swelling. Uric acid itself is a chemical created when the body breaks down certain substances called purines. Therefore, a high purine diet can lead to elevated uric acid and ultimately the development of gout. Foods that are high in purines include red meat, cheese, shellfish, and alcohol. It is for this reason that gout was historically referred to as “the disease of kings.” Uric acid can also accumulate within the body if the kidneys fail to excrete an adequate amount of uric acid.
Gout often presents as pain, swelling, and redness within or around a joint. It has a predilection for the foot and more specifically the great toe joint, but can affect any joint within the body. The symptoms tend to occur suddenly, without any trauma or inciting factor. Gouty pain occurs as an acute “attack” of severe pain that may then taper down slowly over the next few days. Individuals who have 1 attack of gout are predisposed to having future attacks.
The diagnosis of gout is often made clinically – a doctor can make the diagnosis by taking a complete history and performing a physical exam. X-rays are often obtained, as a prolonged history of gout can cause radiographic changes. Afterall, gout is a form of arthritis. Some doctors may order a uric acid blood test to see if the individual has excess uric acid, or they may order a kidney test to see if the body is able excrete the uric acid that the body produces naturally. However, a normal result of these tests does not rule out the diagnosis of gout.
Luckily, there are multiple effective ways to manage gout. By avoiding foods that are high in purines, one can prevent the buildup of uric acid and thus prevent a gouty attack. Additionally, drinking plenty of fluids can help the kidneys to excrete uric acid from the body. Anti-inflammatory medications such as Colchicine and Indocin help to treat the pain and inflammation associated with gout. During a severe attack, a doctor may administer a cortisone shot into the affected joint. If a patient has suffered multiple gouty attacks despite these interventions, they may consider taking medication such as Allopurinol that prevents the formation of uric acid within the body.
Gout is preventable and treatable, so if you experience any of the symptoms mentioned above, please do not hesitate to make an appointment in one of our offices for consultation.
Intractable plantar keratosis (IPK) is a focused, painful lesion that commonly takes the form of a discrete, focused callus, usually about 1 cm, on the plantar (bottom) aspect of the forefoot.An IPK is actuallya collection of dead skin cells that harden over time and may feel like you are walking with a sharp pebble in your shoe. Typically, IPKs occur beneath one or more lateral metatarsal heads or what we call the “ball of the foot”
Patients may often confuse these lesions with a wart or may think there is a problem with the underlying bone because these lesions can be so painful. As the natural fat pad in this area begins to get thinner with age, you may become more susceptible to these kinds of skin calluses.
There is an underlying cause of why they form and it really involves abnormal biomechanics of the foot. It can indeed be a bony prominence or arthritis under that particular area. But anoften-missed etiology is an “equinus” of the ankle which leads to more pressure being put on the front of the foot during the gait cycle. When equinus is present, our foot compensates with pronation, or really overpronation. This hypermobility in the forefoot leads to abnormal forces and pressure points and leads to the formation of an IPK.
We often can treat these problems conservatively in the office. We address the equinus by providing splints for stretching and correcting the equinus. Also, a custom orthotic (shoe insert) can prevent that excessive pronation and provide some cushioning to the specific sites that bother you. In the office we will also shave down the lesion and may prescribe you some cream to put on daily. In most patients these can resolve in 1-2 months.
If you would like some more information or have something similar in your foot, don’t live in pain. Come in and let the doctors at Advanced Podiatry take a look!
With COVID restrictions lessening and the weather improving, it is now time to get out and enjoy summer! There are a myriad of techniques and tips you can use to get your feet cosmetically and physically optimized so you can enjoy the sun safely. One easy way to improve foot hygiene is by keeping your feet dry. Fungi and bacteria that cause skin conditions such as athlete's foot colonize moist environments like the web spaces of the feet. Aside from being aesthetically displeasing, athlete's foot can cause excessive itching, bleeding, and can spread to other parts of the body. By keeping your feet dry, you can prevent these microorganisms from growing. Be sure to change socks frequently, especially after exercising. After a shower, it is important to dry your feet completely and not leave any droplets in the web spaces. If needed, apply a drying agent such as talcum powder to your feet.
For fellow fitness enthusiasts that tend to increase their physical activity during the summer – be sure to stretch both before and after exercising. Prior to a workout, you should try performing dynamic stretching, which is an active type of movement focused on getting the body warmed up such as high kicks or lunges with core twists. When the workout is over, focus on classic static stretches. The goal of static stretching is to hold the stretch for an extended period of time. This lengthens the muscle-tendon complex that is being stretched and helps to prevent soreness and injury post workout. Examples of static stretching include runner’s stretch for the calf muscles or seated butterfly stretch for the hips This combination of pre exercise dynamic stretching and post exercise static stretching can prevent muscle soreness and common ankle and foot injuries such as plantar fasciitis, shin splints, and achilles tendinitis.
Lastly, when you are applying sunscreen to prepare for a day outside, do not forget to apply to your feet. This is one area that is often neglected, but a sunburn of the foot can be devastating. Although the top part, or dorsum, of the foot is most susceptible to sunburns, it is important to apply lotion to the sole of the foot as well.
The best way to manage foot infections, exercise injuries, and sunburns is through prevention. However, if you do develop any of these common ailments of the foot and ankle, please do not hesitate to contact one of our offices for consultation.