Diabetic Foot Ulcers are Scarier Than Sharks

As a podiatrist, one of the most dangerous and scary conditions I deal with is a diabetic foot ulcer. There are around 30 million Americans with diabetes and every one of them has a 25% chance of developing a foot ulcer in their lifetime. Once you have a diabetic foot ulcer you are in a medical crisis. I know it is not often represented this way. Most of my patients don't understand the grave nature of a diabetic foot ulcer. Many factors contribute to this underestimation of the morbidity and mortality of a diabetic foot ulcer. Fear, denial, lack of understanding and the failure of the medical community to explain how deadly serious this condition is, have all added up to a severe lack of urgency. I hate scare tactics. Our news media uses fear to get our attention about all kinds of very unlikely events, such as shark attacks. Diabetes, however, is very real. It is the 7th leading cause of death in the US. While sharks accounted for just 6 deaths in 2015, diabetes accounted for over 75,000! In fact, if you have a diabetic foot ulcer you have a 5 year mortality rate of 45%. This means that almost half the people with a diabetic foot ulcer today will have passed away by 2021. Prostate cancer, breast cancer and Hodgkin's lymphoma, all have much better 5 year survival rates. Think about that, forms of cancer are actually a better diagnosis than a diabetic foot ulcer. Why am I telling you this? I promise my motives are not to ruin your day. Quite the opposite. I want to sound the warning bell. You probably don't have to worry too much about the sharks in the water, but your foot ulcer or your mom's foot ulcer is deadly serious and by ignoring it or delaying care you make yourself or your loved one that much more vulnerable to this devastating disease. They say a ounce of prevention is worth a pound of cure. Nowhere is that adage more appropriate than with diabetic foot ulcers. If you or someone you love is among the 30 million American diabetics, treat your disease proactively and aggressively. Manage your blood sugar with diet and exercise. Get help from your primary care doctor or an endocrinologist...or both. Get your feet checked by a podiatrist, often. Wear properly fit shoes and inspect your feet daily. If you do have a diabetic foot ulcer take it very seriously. Listen to your doctor. It is much more dangerous than a shark. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center http://www.sarasotafootcarecenter.com

New Running Shoes That Really Work

While I get no financial support from the Hoka shoe company, I wanted to share my personal experience. I recently started wearing the Hoka Bondi 3. These shoes are what I would call a "maximalist" shoe. They are thick, slightly heavy and rugged. That said, they are the most comfortable running shoes I have ever worn. Full disclosure, I am not a marathoner. I run for exercise, typically, less than 3 miles per run. Even at this low mileage, I was having knee pain and low back pain. I have a neutral to suppinated foot type and I do wear custom orthotics. People with this foot type are known to strike the ground hard with transfer of energy to the low back. Typically, my running takes place on sidewalks, not the most forgiving of surfaces. Enter the Hoka Bondi 3. They are slightly heavy (2.2 pounds for size 13s). Now, my old sneakers were 2.0 pounds, so we are not talking about a huge change. They feel thick. When you walk in them initially, they feel almost "squishy," but you get used to it very quickly. On my first run, I felt an immediate difference. No knee or back pain. I felt like I was running on clouds, seriously. 4 of the 5 doctors in my practice use them at this point. If you would like to try them, they cost about $150 and the fit true to size. Check out a pair and see what you think. I will not be going back. I am a believer. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

I Broke My Toe

For a healthy guy, I have had more foot conditions that I would care to admit. I always tell myself that is makes me a more empathetic foot doctor, but I promise I am not doing this stuff on purpose. A few months ago, I was walking barefoot by a pool and I kicked something by accident. I could feel and hear my little toe break. It was not fun. I went through the full 6 week healing course and while I could not plan it this way, it really did make me appreciate fractures so much more. Of the 28 bones in your foot, 19 are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot). Fractures of the toe and metatarsal bones (broken toes) are common and require evaluation by a specialist. A foot and ankle surgeon should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room. What is a Fracture? A fracture is a break in the bone. Fractures can be divided into two categories: traumatic fractures and stress fractures. Traumatic Fractures Traumatic fractures (also called acute fractures) are caused by a direct blow or impact -- like seriously stubbing your toe. Traumatic fractures can be displaced or nondisplaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated). Treatment of a traumatic fracture depends on the location and extent of the break and whether it is displaced. Surgery is sometimes required. Signs and symptoms of a traumatic fracture include: •You may hear a sound at the time of the break. •"Pinpoint pain" (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours. •Deviation (misshapen or abnormal appearance) of the toe. •Bruising and swelling the next day. It is not true that "if you can walk on it, it's not broken." Evaluation by the foot and ankle surgeon is always recommended. Stress Fractures Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. Or they may be caused by an abnormal foot structure, deformities, or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored, because they will come back unless properly treated. Symptoms of stress fractures include: •Pain with or after normal activity •Pain that goes away when resting and then returns when standing or during activity •"Pinpoint pain" (pain at the site of the fracture) when touched •Swelling, but no bruising Is it a Fracture or a Sprain? Sprains and fractures have similar symptoms, although sometimes with a sprain, the whole area hurts rather than just one point. Your foot and ankle surgeon will be able to diagnose which you have and provide appropriate treatment. Certain sprains or dislocations can be severely disabling. Without proper treatment they can lead to crippling arthritis. Consequences of Improper Treatment Some people say that "the doctor can't do anything for a broken bone in the foot." This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example: •A deformity in the bony architecture which may limit the ability to move the foot or cause difficulty in fitting shoes. •Arthritis, which may be caused by a fracture in a joint (the juncture where two bones meet), or may be a result of angular deformities that develop when a displaced fracture is severe or hasn't been properly corrected. •Chronic pain and long-term dysfunction. •Non-union, or failure to heal, can lead to subsequent surgery or chronic pain. Treatment of Toe Fractures Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself and may include these options: •Rest. Sometimes rest is all that is needed to treat a traumatic fracture of the toe. •Splinting. The toe may be fitted with a splint to keep it in a fixed position. •Rigid or Stiff-Soled Shoe. Wearing a stiff-soled shoe protects the toe and helps keep it properly positioned. •"Buddy Taping." "Buddy taping" the fractured toe to another toe is sometimes appropriate, but in other cases it may be harmful. •Surgery. If the break is badly displaced or if the joint is affected, surgery may be necessary. Surgery often involves the use of fixation devices, such as pins. Treatment of Metatarsal Fractures Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges. For example, sometimes a fracture of the first metatarsal bone (behind the big toe) can lead to arthritis. Since the big toe is used so frequently and bears more weight than other toes, arthritis in that area can make it painful to walk, bend, or even stand. Another type of break, called a Jones fracture, occurs at the base of the fifth metatarsal bone (behind the little toe). It is often misdiagnosed as an ankle sprain, and misdiagnosis can have serious consequences since sprains and fractures require different treatments. Your foot and ankle surgeon is an expert in correctly identifying these conditions as well as other problems of the foot. Treatment of metatarsal fractures depends on the type and extent of the fracture, and may include: •Rest. Sometimes rest is the only treatment needed to promote healing of a stress or traumatic fracture of a metatarsal bone. •Avoid the Offending Activity. Because stress fractures result from repetitive stress, it is important to avoid the activity that led to the fracture. Crutches or a wheelchair are sometimes required to offload weight from the foot to give it time to heal. •Immobilization, Casting, or Rigid Shoe. A stiff-soled shoe or other form of immobilization may be used to protect the fractured bone while it is healing. •Surgery. Some traumatic fractures of the metatarsal bones require surgery, especially if the break is badly displaced. •Follow-Up Care. Your foot and ankle surgeon will provide instructions for care following surgical or non-surgical treatment. Physical therapy, exercises and rehabilitation may be included in a schedule for return to normal activities. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Chronic Venous Insufficiency and Varicose Veins

Do you or someone you care about have swollen, discolored legs? If you answered yes, you may be dealing with chronic venous insufficiency. What is chronic venous insufficiency? When your leg veins cannot pump enough blood back to your heart, you have chronic venous insufficiency (CVI). CVI is also sometimes called chronic venous disease, or CVD. When you are in the upright position, the blood in your leg veins must go against gravity to return to your heart. To accomplish this, your leg muscles squeeze the deep veins of your legs and feet to help move blood back to your heart. One-way flaps, called valves, in your veins keep blood flowing in the right direction. When your leg muscles relax, the valves inside your veins close. This prevents blood from flowing in reverse, back down the legs. The entire process of sending blood back to the heart is called the venous pump. When you walk and your leg muscles squeeze, the venous pump works well. But when you sit or stand, especially for a long time, the blood in your leg veins can pool and increase the venous blood pressure. Sitting or standing for a long time can stretch vein walls because they are flexible. Over time, in susceptible individuals, this can weaken the walls of the veins and damage the vein valves, causing CVI. What are the symptoms? If you have CVI, your ankles may swell and your calves may feel tight. Your legs may also feel heavy, tired, restless, or achy. You may feel pain while walking or shortly after stopping. CVI may be associated with varicose veins. Varicose veins are swollen veins that you can see through the skin. They often look blue, bulging, and twisted. Large varicose veins can lead to skin changes like rashes, redness, and sores. CVI can also cause problems with leg swelling because of the pressure of the blood pooling in the veins. Your lymphatic system may also produce fluid, called lymph, to compensate for CVI. Your leg tissues may then absorb some of this fluid, which can increase the tendency for your legs to swell. In severe cases, CVI and the leg swelling can cause ulcers to form on the lower parts of the leg. What causes CVI? Over the long-term, blood pressure that is higher than normal inside your leg veins causes CVI. This can lead to damage to the valves, which can further worsen the problem. Factors that can increase your risk for CVI include a family history of varicose veins, being overweight, being pregnant, not exercising enough, smoking, and standing or sitting for long periods of time. Although CVI can affect anyone, your age and sex can also be factors that may increase your tendency to develop CVI; women older than 50 most often get CVI. What tests will you need? First your physician asks you questions about your current general health, past medical history, and symptoms. In addition, your physician conducts a physical exam. Together these are known as a patient history and exam. Your physician may measure the blood pressure in your legs and will examine the varicose veins. To confirm a diagnosis of CVI, the physician may order a duplex ultrasound test. Duplex ultrasound uses painless sound waves higher than human hearing can detect. Duplex ultrasound allows your physician to measure the speed of blood flow and to see the structure of your leg veins. How is CVI treated? CVI is usually not considered a serious health risk. Your physician will focus his or her treatment on decreasing your pain and disability. Compression stockings: For mild cases of CVI, your physician may recommend compression stockings. Compression stockings are elastic stockings that squeeze your veins and stop excess blood from flowing backward. In this way, compression stockings can often also help heal skin sores and prevent them from returning. You may need to wear compression stockings daily for the rest of your life. Topical Creams: The dark skin discoloration and thinning of the skin can be treated with topical creams applied to the area daily. This will keep the skin protected and lessen the effect of the discoloration. You can help avoid leg swelling and other symptoms by occasionally raising your legs and avoiding standing for long periods of time to decrease the pressure in the veins. When you do need to stand for a long period, you can flex your leg muscles occasionally to keep the blood flowing. You can also help lessen the symptoms of CVI by maintaining your ideal body weight or losing weight if you are overweight. More serious cases of CVI may be treated with injections, called sclerotherapy, or with surgical procedures. Fewer than 10 percent of people with CVI require surgery to correct the problem. Surgical treatments include ablation, vein stripping, bypass surgery, valve repair, and angioplasty or stenting of a vein. Your podiatrist will send you to a vascular surgeon if surgery is something you need. Committed to you health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Gout and Your Feet

As we are finally past the holiday season, I wanted to post an article about gout. This painful condition is always more frequent during the winter season of eating. What is gout, specifically? Gout is a disorder that results from the build-up of uric acid in the tissues or a joint -- most often the joint of the big toe. An attack of gout can be miserable, marked by the following symptoms: • Intense pain that comes on suddenly -- often in the middle of the night or upon arising. • Redness, swelling, and warmth over the joint -- all of which are signs of inflammation. What Causes Gout? Gout attacks are caused by deposits of crystallized uric acid in the joint. Uric acid is present in the blood and eliminated in the urine, but in people who have gout, uric acid accumulates and crystallizes in the joints. Uric acid is the result of the breakdown of purines, chemicals that are found naturally in our bodies and in food. Some people develop gout because their kidneys have difficulty eliminating normal amounts of uric acid, while others produce too much uric acid. Gout occurs most commonly in the big toe because uric acid is sensitive to temperature changes. At cooler temperatures, uric acid turns into crystals. Since the toe is the part of the body that is furthest from the heart, it's also the coolest part of the body -- and, thus, the most likely target of gout. However, gout can affect any joint in the body. The tendency to accumulate uric acid is often inherited. Other factors that put a person at risk for developing gout include: high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, and certain medications and vitamins. For example, the body's ability to remove uric acid can be negatively affected by taking aspirin, some diuretic medications ("water pills"), and the vitamin niacin (also called nicotinic acid). While gout is more common in men aged 40 to 60 years, it can occur in younger men and also occurs in women. Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. Some foods contain more purines than others and have been associated with an increase of uric acid, which leads to gout. You may be able to reduce your chances of getting a gout attack by limiting or avoiding the following foods and beverages: shellfish, organ meats (kidney, liver, etc.), red wine, beer, and red meat. Diagnosis In diagnosing gout, the foot and ankle surgeon will take your personal and family history and examine the affected joint. Laboratory tests and x-rays are sometimes ordered to determine if the inflammation is caused by something other than gout. Treatment Initial treatment of an attack of gout typically includes the following: • Medications. Prescription medications or injections are used to treat the pain, swelling, and inflammation. • Dietary restrictions. Foods and beverages that are high in purines should be avoided, since purines are converted in the body to uric acid. • Fluids. Drink plenty of water and other fluids each day, while also avoiding alcoholic beverages, which cause dehydration. • Immobilize and elevate the foot. Avoid standing and walking to give your foot a rest. Also, elevate your foot (level with or slightly above the heart) to help reduce the swelling. The symptoms of gout and the inflammatory process usually resolve in three to ten days with treatment. If gout symptoms continue despite the initial treatment, or if repeated attacks occur, see your primary care physician for maintenance treatment that may involve daily medication. In cases of repeated episodes, the underlying problem must be addressed, as the build-up of uric acid over time can cause arthritic damage to the joint. When is Surgery Needed? In some cases of gout, surgery is required to remove the uric acid crystals and repair the joint. Your foot and ankle surgeon will determine the procedure that would be most beneficial in your case. Enjoy desserts, but in moderation, and if you wake up with a red, hot, swollen, painful foot, call us! Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Are You Embarrassed by Your Feet?

Feeling embarrassed or ashamed of your feet is very common. According to a study of 500 women in 2008 by the American Podiatric Medical Association, more than 50% of women say their feet embarrass them "always, frequently, or sometimes." Let's be honest about feet. Many things can go wrong with the skin, the bone structure and the nails. Feet sweat...a lot and they often smell. Many people refuse to wear open shoes due to embarrassment. The good news is that many of these issues are fixable. Rough, dry, cracked skin can easily be treated with urea based creams. Red, splotchy rashes can be treated with hydrocortisone creams or antifungals, depending on the situation. Thick, discolored nails can be treated with a variety of antifungals, from topical liquids to oral pills to laser therapy. Crooked or otherwise deformed toes can be addressed surgically if there is pain associated, which is often the case. The recovery time for these procedures varies, but in many instances you can walk in a protective cast/boot the first day after surgery. Sweaty/smelly feet can be treated with topical antiperspirants. Of course, I make all of this sound easy. I am a foot doctor, after all. To me, it is literally "just a day at the office." If you are suffering from any of these issues, or if your feet embarrass you for a reason I missed, there is help available. You don't have to just live with it. Also, for any women who are concerned about the size of your feet, I promise you that men don't even notice. I am a foot doctor. I look at women's feet. It is a reflex. I have never judged a women for having big feet. Never. I hope this helps you feel pretty with Valentine's Day right around the corner. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center http://www.sarasotafootcarecenter.com

Do Your Feet Have to Hurt?

The answer is, no. However, feet are complex structures made up of 28 bones, 33 joints, a host of tendons, ligaments, muscles, nerves and blood vessels all wrapped in skin. Any of these can cause pain. Oh yeah, and you probably have two of them, so that doubles the risk! When you think about what you ask of your feet it is amazing that they don't hurt much more than they do. Most of us are carrying around extra pounds. Many of us cram our feet into shoes that we don't belong in. Combine that with floor surfaces like tile and concrete that we have no business walking or standing on for hours and you get a glimpse at the stresses that you take for granted every single day. The average American takes 6 thousand steps per day. Our diets require that we take many more steps than that if we don't want to gain weight. So how do we do it? How do we increase our activity so we can stay at a healthy weight, while protecting our feet in the process? The human body is basically a biological machine. How do you get the most mileage out of that other familiar machine, your car? Preventative maintenance, proper tires (shoes) and a good alignment are the keys to getting the most out of both of these machines. Buy a properly fit pair of shoes for your foot type. Invest in your health and buy a pair of orthotics if you need them for proper alignment. Go to see a podiatrist to help you with this. Just because some yahoo in a shoe store is wearing a white coat doesn't mean he knows anything about your feet. Remember, these people are in sales. They have not taken any kind of oath to protect your health. They are in business to make money, not heal people. Your feet don't have to hurt. You can exercise, lose weight and live the active, pain free lifestyle you want, but you can't do it for free. It is going to take an investment of time and money. Remember, if you need something, you pay for it whether you buy it or not. You pay for it in pain, time away from work or play, or just by worrying. Break the cycle. Get moving and stay fit starting today. Committed to your health, Dr. Craig Conti

Beware of Junk Science for Heel Pain

Recently, I read an article about a new and improved method to strengthen the plantar fascia. This article talks about using a step or a sturdy box and performing a heel lift type of movement. According to the article, which can be found in the New York Times and all over the internet, this new technique promises faster and better relief of plantar fasciitis. The article even states that this was proven in a published research paper in the Scandinavian Journal of Medicine and Science in Sports. Please don't believe the headlines! I took the time to read the actual paper in the above named journal. It is a classic case of junk science. First off, there were only 48 patients total. This is a small number, especially when you have to split the patients into two groups. Now you are comparing only 24 people. Next, both groups wore orthotic shoe inserts. The only difference was one group stretched and the other performed this heel lift maneuver. There was no group that wore orthotics alone and did neither the stretching or the heel lift. We can not ascertain the importance of the orthotic by itself. Thirdly and in my opinion, most importantly, the stretching arm of the study was woefully substandard. The stretching they had the participants perform was pathetic to the point of being comical. Finally, the results of this study are purely based on non-blinded, self reported, questionnaire data. The results were tabulated at 1 month, 3 month, 6 month and 12 month intervals. No difference, let me repeat that, NO DIFFERNECE was found at the 1 month, 6 month or 12 month interval. No difference. The only difference was found at the 3 month interval. This is an incredibly weak study. The editors of the newspapers that publish this rubbish should be ashamed. If any one of them took the time to read the original paper they could see this is garbage. I have personally had plantar fasciitis and I have been treating it in my patients for over 10 years now. There is no doubt that proper stretching of the gastrocnemius muscle group, (one of the muscles that makes up the calf) is vital to the treatment of plantar fasciitis. In fact, a surgical procedure that is often employed to help with plantar fasciitis is to cut a portion of the calf muscle in order to weaken it, not strengthen it! This can also be said for the fascia itself. While only 5-10% of patients ever need surgery for plantar fasciitis, the surgery does not involve bolstering or strengthening of the fascia. In fact, the surgery consists of cutting 75% of the fascia in order to weaken it's pull on the heel bone. If you, or someone you love is having sharp, stabbing pain in the heel, get to your nearest podiatrist. We treat this condition every day. The internet is a great place for information, but that information must be verified. Don't believe the headlines. Trust the experts. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center http://www.sarasotafootcarecenter.com

Foot Pain and Football

Well, it is that time of the year again. The big game is finally this Sunday. With all the talk of deflated footballs we have not talked much about pain and injury. This time of year all football players are in some type of pain. If you watched Aaron Rodgers deal with his calf pain and Richard Sherman play with his injured elbow, you know what I mean. Of course, here at Sarasota Foot Care Center we are a little more interested in the injuries that happen below the waist. From turf toe, to metatarsalgia, to fractures, strains and sprains...the foot is a source of all kinds of limiting pain. If you have foot pain that is keeping you on the sidelines, so to speak, don't wait. This blog, as well as, our website are a great source of basic information. Once armed with this information, if you still have pain make an appointment and we will get you back in the game! Committed to your health, Dr. Craig Conti Sarasota Foot Care Center http://www.sarasotafootcarecenter.com

Special Report on DVT

What is Deep Vein Thrombosis? The blood supply of the leg is transported by arteries and veins. The arteries carry blood from the heart to the limbs; veins carry blood back to the heart. The leg contains superficial veins, which are close to the surface, and deep veins, which lie much deeper in the leg. Deep vein thrombosis (DVT) is a condition in which a blood clot (a blockage) forms in a deep vein. While these clots most commonly occur in the veins of the leg (the calf or thigh), they can also develop in other parts of the body. DVT can be very dangerous and is considered a medical emergency. If the clot (also known as a thrombus) breaks loose and travels through the bloodstream, it can lodge in the lung. This blockage in the lung, called a pulmonary embolism, can make it difficult to breathe and may even cause death. Blood clots in the thigh are more likely to cause a pulmonary embolism than those in the calf. Causes of DVT Many factors can contribute to the formation of a DVT. The more risk factors a person has, the greater their risk of having a DVT. However, even people without these risk factors can form a DVT. Blood or vein conditions: •Previous DVT •Varicose veins •Blood clotting disorders •Family history of DVT or blood-clotting disorders Other medical conditions: •Heart disease •Chronic swelling of the legs •Obesity •Inflammatory bowel disease •Cancer •Dehydration •Sepsis Women's health issues: •Hormone replacement therapy •Birth control pills containing estrogen •Pregnancy or recent childbirth Other: •Age over 40 years old •Immobility (through inactivity or from wearing a cast) •Recent surgery •Trauma (an injury) •Smoking Signs and Symptoms of DVT in the Leg Some people with DVT in the leg have either no warning signs at all or very vague symptoms. If any of the following warning signs or symptoms are present, it is important to see a doctor for evaluation: •Swelling in the leg •Pain in the calf or thigh •Warmth and redness of the leg Diagnosis DVT can be difficult to diagnose, especially if the patient has no symptoms. Diagnosis is also challenging because of the similarities between symptoms of DVT and those of other conditions such as a pulled muscle, an infection, a clot in a superficial vein (thrombophlebitis), a fracture, and arthritis. If DVT is suspected, the doctor will immediately send the patient to a vascular laboratory or a hospital for testing, which may include a blood test, Doppler ultrasound, venogram, MRI, or angiogram. Treatment of DVT If tests indicate a clot is present, the doctor will make a recommendation regarding treatment. Depending on the location of the clot, the patient may need hospitalization. Medical or surgical care will be managed by a team of physicians which may include a primary care physician, internist, vascular (blood vessel) surgeon, or hematologist (blood disease specialist). Treatment may include: •Medication. A blood-thinning medication is usually prescribed to help prevent additional clots from forming. •Compression stockings. Wearing fitted hosiery decreases pain and swelling. •Surgery. A surgical procedure performed by a vascular specialist may be required. Complications of DVT An early and extremely serious complication of DVT is a pulmonary embolism. A pulmonary embolism develops if the clot breaks loose and travels to the lung. Symptoms of a pulmonary embolism include: •Shortness of breath •Chest pain •Coughing up blood •A feeling of impending doom A long-term consequence of DVT is damage to the vein from the clot. This damage often results in persistent swelling, pain and discoloration of the leg. Preventative Measures For those who have risk factors for DVT, these strategies may reduce the likelihood of developing a blood clot: •Take blood-thinning medication, if prescribed. •Reduce risk factors that can be changed. For example, stop smoking and lose excess weight. •During periods of prolonged immobility, such as on long trips: •Exercise legs every 2 to 3 hours to get the blood flowing back to the heart. Walk up and down the aisle of a plane or train, rotate ankles while sitting, and take regular breaks on road trips. •Stay hydrated by drinking plenty of fluids; avoid alcohol and caffeine. •Consider wearing compression stockings. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Chronic Ankle Instability

Chronic Ankle Instability Do you frequently sprain your ankles? Do you feel like your ankles are weak? Is your gait (walking pattern) unsteady? Is balance an issue? If you answered “yes” to any of these questions you may suffer from chronic ankle instability. What is Chronic Ankle Instability? Chronic ankle instability is a condition characterized by a recurring "giving way" of the outer (lateral) side of the ankle. This condition often develops after repeated ankle sprains. Usually the "giving way" occurs while walking or doing other activities, but it can also happen when you're just standing. Many athletes, as well as others, suffer from chronic ankle instability. People with chronic ankle instability often complain of: • Repeated turning of the ankle, especially on uneven surfaces or when participating in sports • Persistent (chronic) discomfort and swelling • Pain or tenderness What Causes It? Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely. When you sprain your ankle, the connective tissues (ligaments) are stretched or torn. The ability to balance is often affected. Proper rehabilitation is needed to strengthen the muscles around the ankle and "retrain" the tissues within the ankle that affect balance. Repeated ankle sprains often cause -- and perpetuate -- chronic ankle instability. Having an ankle that gives way increases your chances of spraining your ankle repeatedly. Each subsequent sprain leads to further weakening (or stretching) of the ligaments -- resulting in greater instability and the likelihood of developing additional problems in the ankle. Evaluation and Diagnosis If your ankle feels wobbly or unstable and gives way repeatedly, or if you've had recurring ankle sprains, see a foot and ankle surgeon to have your condition evaluated and treated. Chronic ankle instability that is left untreated leads to continued instability, activity limitations, arthritis, and tendon problems. In evaluating and diagnosing your condition, the foot and ankle surgeon will ask you about any previous ankle injuries and instability. Then he or she will examine your ankle to check for tender areas, signs of swelling, and instability of your ankle as shown in the illustration. X-rays, CT scans, or MRIs may be helpful in further evaluating the ankle. Treatment Options Treatment for chronic ankle instability is based on the results of the examination and tests, as well as on the patient's level of activity. Non-surgical treatment may include: • Physical therapy. Physical therapy involves various treatments and exercises to strengthen the ankle, improve balance and range of motion, and retrain your muscles. As you progress through rehabilitation, you may also receive training that relates specifically to your activities or sport. • Bracing. Some patients wear an ankle brace to gain support for the ankle and keep the ankle from turning. Bracing also helps prevent additional ankle sprains. • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to reduce pain and inflammation. In some cases, the foot and ankle surgeon will recommend surgery based on the degree of instability or lack of response to non-surgical approaches. Surgical options mainly involve repair or reconstruction of the damaged ligament(s). However, other soft tissue or bone procedures may be necessary depending on the severity of your condition and whether you have other problems in the foot or ankle. The length of the recovery period will vary, depending on the procedure or procedures performed. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Bone Healing

How Does a Bone Heal? All broken bones go through the same healing process. This is true whether a bone has been cut as part of a surgical procedure or fractured through an injury. The bone healing process has three overlapping stages: inflammation, bone production, and bone remodeling. •Inflammation starts immediately after the bone is fractured and lasts for several days. When the bone is fractured there is bleeding into the area, leading to inflammation and clotting of blood at the fracture site. This provides the initial structural stability and framework for producing new bone. •Bone production begins when the clotted blood formed by inflammation is replaced with fibrous tissue and cartilage (known as "soft callus"). As healing progresses, the soft callus is replaced with hard bone (known as "hard callus"), which is visible on x-rays several weeks after the fracture. •Bone remodeling, the final phase of bone healing, goes on for several months. In remodeling, bone continues to form and becomes compact, returning to its original shape. In addition, blood circulation in the area improves. Once adequate bone healing has occurred, weightbearing (such as standing or walking) encourages bone remodeling. How Long Does Bone Healing Take? Bone healing is a complex process. Speed and success differ among individuals. The time required for bone healing can be affected by many factors, including the type of fracture and the patient's age, underlying medical conditions, and nutritional status. Bone generally takes 6 to 8 weeks to heal to a significant degree. In general, children's bones heal faster than those of adults. The foot and ankle surgeon will determine when the patient is ready to bear weight on the area. This will depend on the location and severity of the fracture, the type of surgical procedure performed, and other considerations. What Helps Promote Bone Healing? If a bone will be cut during a planned surgical procedure, some steps can be taken pre-and post-operatively to help optimize healing. The surgeon may offer advice on diet and nutritional supplements that are essential to bone growth. Smoking cessation, and adequate control of blood sugar levels in diabetics, are important. Smoking and high glucose levels interfere with bone healing. For all patients with fractured bones, immobilization is a critical part of treatment, because any movement of bone fragments slows down the initial healing process. Depending on the type of fracture or surgical procedure, the surgeon may use some form of fixation (such as screws, plates, or wires) on the fractured bone and/or a cast to keep the bone from moving. During the immobilization period, weightbearing is restricted as instructed by the surgeon. Once the bone is adequately healed, physical therapy often plays a key role in rehabilitation. An exercise program designed for the patient can help in regaining strength and balance and assist in returning to normal activities. What Can Hinder Bone Healing? A wide variety of factors can slow down the healing process. These include: •Movement of the bone fragments; weightbearing too soon •Smoking, which constricts the blood vessels and decreases circulation •Medical conditions, such as diabetes, hormone-related problems, or vascular disease •Some medications, such as corticosteroids and other immunosuppressants •Fractures that are severe, complicated, or become infected •Advanced age •Poor nutrition or impaired metabolism How Can Slow Healing be Treated? If the bone is not healing as well as expected or fails to heal, the foot and ankle surgeon can choose from a variety of treatment options to enhance the growth of bone, such as continued immobilization for a longer period, bone stimulation, or surgery with bone grafting or use of bone growth proteins. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Accessory Navicular Syndrome

What is the Accessory Navicular? The accessory navicular (os navicularum or os tibiale externum) is an extra bone or piece of cartilage located on the inner side of the foot just above the arch. It is incorporated within the posterior tibial tendon, which attaches in this area. An accessory navicular is congenital (present at birth). It is not part of normal bone structure and therefore is not present in most people. What is Accessory Navicular Syndrome? People who have an accessory navicular often are unaware of the condition if it causes no problems. However, some people with this extra bone develop a painful condition known as accessory navicular syndrome when the bone and/or posterior tibial tendon are aggravated. This can result from any of the following: • Trauma, as in a foot or ankle sprain • Chronic irritation from shoes or other footwear rubbing against the extra bone • Excessive activity or overuse Many people with accessory navicular syndrome also have flat feet (fallen arches). Having a flat foot puts more strain on the posterior tibial tendon, which can produce inflammation or irritation of the accessory navicular. Signs and Symptoms of Accessory Navicular Syndrome Adolescence is a common time for the symptoms to first appear. This is a time when bones are maturing and cartilage is developing into bone. Sometimes, however, the symptoms do not occur until adulthood. The signs and symptoms of accessory navicular syndrome include: • A visible bony prominence on the midfoot (the inner side of the foot, just above the arch) • Redness and swelling of the bony prominence • Vague pain or throbbing in the midfoot and arch, usually occurring during or after periods of activity Diagnosis To diagnose accessory navicular syndrome, the foot and ankle surgeon will ask about symptoms and examine the foot, looking for skin irritation or swelling. The doctor may press on the bony prominence to assess the area for discomfort. Foot structure, muscle strength, joint motion, and the way the patient walks may also be evaluated. X-rays are usually ordered to confirm the diagnosis. If there is ongoing pain or inflammation, an MRI or other advanced imaging tests may be used to further evaluate the condition. Treatment: Non-Surgical Approaches The goal of non-surgical treatment for accessory navicular syndrome is to relieve the symptoms. The following may be used: • Immobilization. Placing the foot in a cast or removable walking boot allows the affected area to rest and decreases the inflammation. • Ice. To reduce swelling, a bag of ice covered with a thin towel is applied to the affected area. Do not put ice directly on the skin. • Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed. In some cases, oral or injected steroid medications may be used in combination with immobilization to reduce pain and inflammation. • Physical therapy. Physical therapy may be prescribed, including exercises and treatments to strengthen the muscles and decrease inflammation. The exercises may also help prevent recurrence of the symptoms. • Orthotic devices. Custom orthotic devices that fit into the shoe provide support for the arch, and may play a role in preventing future symptoms. Even after successful treatment, the symptoms of accessory navicular syndrome sometimes reappear. When this happens, non-surgical approaches are usually repeated. When Is Surgery Needed? If non-surgical treatment fails to relieve the symptoms of accessory navicular syndrome, surgery may be appropriate. Surgery may involve removing the accessory bone, reshaping the area, and repairing the posterior tibial tendon to improve its function. This extra bone is not needed for normal foot function. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Oseteoarthritis (OA) of the Foot

What is Osteoarthritis? Osteoarthritis is a condition characterized by the breakdown and eventual loss of cartilage in one or more joints. Cartilage, the connective tissue found at the end of the bones in the joints, protects and cushions the bones during movement. When cartilage deteriorates or is lost, symptoms develop that can restrict one's ability to easily perform daily activities. Osteoarthritis is also known as degenerative arthritis, reflecting its nature to develop as part of the aging process. As the most common form of arthritis, osteoarthritis affects millions of Americans. Many people refer to osteoarthritis simply as arthritis, even though there are more than 100 different types of arthritis. Osteoarthritis appears at various joints throughout the body, including the hands, feet, spine, hips, and knees. In the foot, the disease most frequently occurs in the big toe, although it is also often found in the midfoot and ankle. Signs and Symptoms People with osteoarthritis in the foot or ankle experience, in varying degrees, one or more of the following: • Pain and stiffness in the joint • Swelling in or near the joint • Difficulty walking or bending the joint Some patients with osteoarthritis also develop a bone spur (a bony protrusion) at the affected joint. Shoe pressure may cause pain at the site of a bone spur, and in some cases blisters or calluses may form over the surface of the bone spur. Bone spurs can also limit the movement of the joint. Causes Osteoarthritis is considered a "wear and tear" disease because the cartilage in the joint wears down with repeated stress and use over time. As the cartilage deteriorates and gets thinner, the bones lose their protective covering and eventually may rub together, causing pain and inflammation of the joint. An injury may also lead to osteoarthritis, although it may take months or years after the injury for the condition to develop. For example, osteoarthritis in the big toe is often caused by kicking or jamming the toe, or by dropping something on the toe. Osteoarthritis in the midfoot is also often caused by dropping something on it, or by a sprain or fracture. In the ankle, osteoarthritis is usually caused by a fracture and occasionally by a severe sprain. Sometimes osteoarthritis develops as a result of abnormal foot mechanics. People who have flat feet or high arches are at increased risk for developing osteoarthritis in the foot. A flat foot causes less stability in the ligaments (bands of tissue that connect bones), resulting in excessive strain on the joints, which can cause arthritis. A high arch is rigid and lacks mobility, causing a jamming of joints that creates an increased risk of arthritis. Diagnosis In diagnosing osteoarthritis, the foot and ankle surgeon will examine the foot thoroughly, looking for swelling in the joint, limited mobility, and pain with movement. In some cases, deformity and/or enlargement (spur) of the joint may be noted. In addition to the foot examination, x-rays may be ordered to help the doctor diagnose osteoarthritis and evaluate the extent of the disease in the foot and ankle. Treatment: Non-Surgical Options To help relieve symptoms, the surgeon may begin treating osteoarthritis with one or more of the following non-surgical approaches: • Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the inflammation and pain. Occasionally a prescription for a steroid medication is needed to adequately reduce symptoms. In addition, certain nutritional supplements may provide some longer-term benefit. • Orthotic devices. Custom orthotic devices (shoe inserts) are often prescribed to provide needed support to improve the foot's mechanics or cushioning that may help minimize pain. • Bracing. Bracing, which restricts motion and supports the joint, can reduce pain during walking and help prevent further deformity. • Immobilization. Protecting the foot from movement by wearing a cast or removable cast-boot may be necessary to allow the inflammation to resolve. • Steroid injections. In some cases, steroid injections are applied to the affected joint to deliver anti-inflammatory medication. • Physical therapy. Exercises to strengthen the muscles, especially when the osteoarthritis occurs in the ankle, may give the patient greater stability and help avoid injury that might worsen the condition. When is Surgery Needed? If non-surgical treatment fails to adequately reduce the pain associated with osteoarthritis, surgery may be recommended. The goal of surgery is to decrease pain and improve function. The foot and ankle surgeon will consider a number of factors when selecting the procedure best suited to the patient's condition and lifestyle. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Rheumatoid Arthritis (RA) of the Foot

What is Rheumatoid Arthritis? Rheumatoid arthritis (RA) is a disease in which certain cells of the immune system malfunction and attack healthy joints. RA causes inflammation in the lining (synovium) of joints, most often the joints of the hands and feet. The signs of inflammation can include pain, swelling, redness, and a feeling of warmth around affected joints. In some patients, chronic inflammation results in damage to the cartilage and bones in the joint. Serious damage can lead to permanent joint destruction, deformity, and disability. How Does RA Affect the Foot and Ankle? When joints become inflamed due to RA, the synovium thickens and produces an excess of joint fluid. This overabundance of fluid, along with inflammatory chemicals released by the immune system, cause swelling and damage to the joint's cartilage and bones. Foot problems caused by RA most commonly occur in the forefoot (the ball of the foot, near the toes), although RA can also affect other areas of the foot and ankle. The most common signs and symptoms of RA-related foot problems -- in addition to the abnormal appearance of deformities -- are pain, swelling, joint stiffness, and difficulty walking. Deformities and conditions associated with RA may include: • Rheumatoid nodules (lumps) -- these cause pain when they rub against shoes or, if they appear on the bottom of the foot, pain when walking • Dislocated toes • Hammertoes • Bunions • Heel pain • Achilles tendon pain • Flatfoot • Ankle pain How is RA Diagnosed? Usually a patient has already been diagnosed with RA prior to visiting the foot and ankle surgeon. However, occasionally a patient first receives a diagnosis of RA from the foot and ankle surgeon. RA is diagnosed on the basis of a clinical examination as well as blood tests. To further evaluate the patient's foot and ankle problems, the surgeon may order x-rays and/or other imaging tests. Treatment by the Foot and Ankle Surgeon While treatment of RA focuses on the medication prescribed by a patient's primary doctor or rheumatologist, the foot and ankle surgeon will develop a treatment plan aimed at relieving the pain of RA-related foot problems. The plan may include one or more of the following options: • Orthotic devices. The surgeon often fits the patient with custom orthotic devices to provide cushioning for rheumatoid nodules, minimize pain when walking, and give needed support to improve the foot's mechanics. • Accommodative shoes. These are used to relieve pressure and pain and assist with walking. • Aspiration of fluid. When inflammation flares up in a joint, the surgeon may aspirate (draw out) fluid to reduce the swelling and pain. • Steroid injections. Injections of anti-inflammatory medication may be applied directly to an inflamed joint or to a rheumatoid nodule. • Surgery. Often the pain and deformity associated with RA in the foot is relieved through surgery. The foot and ankle surgeon will select the procedure best suited to the patient's condition and lifestyle. Rheumatoid arthritis in the foot and ankle can cause considerable pain and deformity, making walking difficult. Through the treatment approaches selected by the foot and ankle surgeon, substantial relief can be obtained. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Puncture Wounds of the Foot

What is a Puncture Wound? Puncture wounds and cuts are not the same. A puncture wound has a small entry hole caused by a pointed object -- for example, a nail that you step on. In contrast, a cut is an open wound that doesn't produce a "hole" but rather a long tear in the skin. Puncture wounds require different treatment from cuts because these small holes in the skin can disguise serious injury. Puncture wounds are common in the foot, especially in warm weather when people go barefoot. But even though they occur frequently, puncture wounds of the foot are among the most inadequately treated conditions. That's a big concern, because if not properly treated, infection or other complications can develop. Getting proper treatment within the first 24 hours is especially important with puncture wounds because they carry the danger of embedding the piercing object ("foreign body") under the skin. Research shows that complications of puncture wounds could be prevented if the patient seeks professional treatment right away. Foreign Bodies in Puncture Wounds A variety of foreign bodies can become embedded in a puncture wound. Nails, glass, toothpicks, sewing needles, insulin needles, and seashells are some common offenders. In addition, pieces of your own skin, sock, and shoe can be forced into the wound during a puncture, as well as dirt and debris from the object. By their nature, all puncture wounds are dirty wounds because they involve penetration of an object that isn't sterile. Regardless of what the foreign body is, anything that remains in the wound increases your chances of developing other problems, either in the near future or down the road. Severity of Wounds There are different ways of determining the severity of a puncture wound. Depth of the wound is one way to evaluate how severe the wound is. The deeper the puncture, the greater the likelihood that complications, such as infection, will develop. Many patients cannot judge how far their puncture extends into the foot. Therefore, if you've stepped on something and the skin was penetrated, seek treatment as soon as possible. The type and the "cleanliness" of the penetrating object also determine the severity of the wound. Larger or longer objects can penetrate deeper into the tissues, possibly causing more damage. The dirtier an object, such as a rusty nail as opposed to a sewing needle, the more dirt and debris are dragged into the wound, which may increase the chance of infection. Another thing that can determine wound severity is whether you were wearing socks and shoes or were barefoot. Particles of socks and shoes can get trapped in a puncture wound. Treatment of Puncture Wounds The key to proper treatment is this: A puncture wound must be cleaned properly and monitored throughout the healing process to avoid complications. Even if you have gone to an emergency room for immediate treatment of your puncture wound, see a foot and ankle surgeon for a thorough cleaning and careful follow-up. The sooner you do this, the better -- within 24 hours after injury, if possible. The foot and ankle surgeon is trained to properly care for these injuries and will make sure your wound is properly cleaned and no foreign body remains. He or she may numb the area, thoroughly clean inside and outside the wound, and monitor your progress. In some cases, x-rays may be ordered to determine whether something remains in the wound or if bone damage has occurred. To treat or prevent infection, antibiotics may be prescribed. Once you return home, be sure to carefully follow the foot and ankle surgeon's instructions to prevent complications. See "Puncture Wounds: What You Should Do" table below for more information. Avoiding Complications Infection is a common complication of puncture wounds that can lead to serious consequences. Sometimes a minor skin infection evolves into a bone or joint infection, so you should be aware of signs to look for. A minor skin infection may develop in 2 to 5 days after injury. The signs of a minor infection that show up around the wound include soreness, redness, and possibly drainage, swelling, and warmth. You may also develop a fever. If these signs have not improved, or if they reappear in 10 to 14 days, a serious infection in the joint or bone may have developed. Other complications that may arise from inadequate treatment of puncture wounds include painful scarring in the area of the wound or a hard cyst where the foreign body has remained in the wound. Although the complications of puncture wounds can be quite serious, early proper treatment can play a crucial role in preventing them. Puncture Wounds: What You Should Do •Seek treatment right away. •Get a tetanus shot if needed (usually every 5 years). •See a foot and ankle surgeon within 24 hours. Follow your doctor's instructions: •Keep your dressing dry. •Keep weight off of the injured foot. •Finish all your antibiotics (if prescribed). •Take your temperature regularly. •Watch for signs of infection (pain, redness, swelling, fever). •Call your doctor if you have any of these signs. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Turf Toe (Sesamoid Injuries)

What is a Sesamoid? A sesamoid is a bone embedded in a tendon. Sesamoids are found in several joints in the body. In the foot, the sesamoids are two pea-shaped bones located in the ball of the foot, beneath the big toe joint. Acting as a pulley for tendons, the sesamoids help the big toe move normally and provide leverage when the big toe "pushes off" during walking and running. The sesamoids also serve as a weightbearing surface for the first metatarsal bone (the long bone connected to the big toe), absorbing the weight placed on the ball of the foot when walking, running, and jumping. Sesamoid injuries -- which can involve the bones, tendons, and/or surrounding tissue in the joint -- are often associated with activities requiring increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet. In addition, people with high arches are at risk for developing sesamoid problems. Frequently wearing high-heeled shoes can also be a contributing factor. Types of Sesamoid Injuries in the Foot There are three types of sesamoid injuries in the foot: •Turf toe. This is an injury of the soft tissue surrounding the big toe joint. It usually occurs when the big toe joint is extended beyond its normal range. Turf toe causes immediate, sharp pain and swelling. It usually affects the entire big toe joint and limits the motion of the toe. Sometimes a "pop" is felt at the moment of injury. •Fracture. A fracture (break) in a sesamoid bone can be either acute or chronic. An acute fracture is caused by trauma -- a direct blow or impact to the bone. An acute sesamoid fracture produces immediate pain and swelling at the site of the break, but usually does not affect the entire big toe joint. A chronic fracture is a stress fracture -- a hairline break usually caused by repetitive stress or overuse. A chronic sesamoid fracture produces longstanding pain in the ball of the foot beneath the big toe joint. The pain, which tends to come and go, generally is aggravated with activity and relieved with rest. •Sesamoiditis. This is an overuse injury involving chronic inflammation of the sesamoid bones and the tendons involved with those bones. Sesamoiditis is caused by increased pressure to the sesamoids. Often, sesamoiditis is associated with a dull, longstanding pain beneath the big toe joint. The pain comes and goes, usually occurring with certain shoes or certain activities. Diagnosis In diagnosing a sesamoid injury, the foot and ankle surgeon will examine the foot, focusing on the big toe joint. The surgeon will press on the big toe, move it up and down, and may assess the patient's walking and evaluate the wear pattern on the patient's shoes. X-rays are ordered, and in some cases, additional imaging studies -- such as a bone scan or MRI -- may also be needed. Treatment: Non-Surgical Approaches Non-surgical treatment for sesamoid injuries of the foot may include one or more of the following options, depending on the type of injury and degree of severity: •Padding, strapping, or taping. A pad may be placed in the shoe to cushion the inflamed sesamoid area, or the toe may be taped or strapped to relieve that area of tension. •Immobilization and nonweightbearing. The foot may be placed in a cast or removable walking cast. Crutches may be used to prevent placing weight on the foot. •Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the pain and inflammation. •Physical therapy. Sometimes the rehabilitation period following immobilization includes physical therapy, such as exercises (range-of-motion, strengthening, and conditioning) and ultrasound therapy. •Steroid injections. In some cases, cortisone is injected in the joint to reduce pain and inflammation. •Orthotic devices. Custom orthotic devices that fit into the shoe may be prescribed for long-term treatment of sesamoiditis to balance the pressure placed on the ball of the foot. When is Surgery Needed? Surgery is generally reserved for the most severe sesamoid injuries which fail to respond to non-surgical treatment over a long period of time. In these cases, the foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Malignant Melanoma of the Foot

What is Malignant Melanoma? Melanoma is a cancer that begins in the cells of the skin that produce pigmentation (coloration). It is also called malignant melanoma because it spreads to other areas of the body as it grows beneath the surface of the skin. Unlike many other types of cancer, melanoma strikes people of all age groups, even the young. Melanoma in the Foot Melanoma that occurs in the foot or ankle often goes unnoticed during its earliest stage, when it would be more easily treated. By the time melanoma of the foot or ankle is diagnosed, it frequently has progressed to an advanced stage, accounting for a higher mortality rate. This makes it extremely important to follow prevention and early detection measures involving the feet as well as other parts of the body. Causes Most cases of melanoma are caused by too much exposure to ultraviolet (UV) rays from the sun or tanning beds. This exposure can include intense UV radiation obtained during short periods, or lower amounts of radiation obtained over longer periods. Anyone can get melanoma, but some factors put a person at greater risk for developing this type of cancer. These include: •Fair skin; skin that freckles; blond or red hair •Blistering sunburns before the age of 18 •Numerous moles, especially if they appeared at a young age What Should You Look For? Melanoma can occur anywhere on the skin, even in areas of the body not exposed to the sun. Melanoma usually looks like a spot on the skin that is predominantly brown, black, or blue -- although in some cases it can be mostly red or even white. However, not all areas of discoloration on the skin are melanoma. There are four signs -- known as the ABCDs of melanoma -- to look for when self-inspecting moles and other spots on the body: •Asymmetry: Melanoma is usually asymmetric, which means one half is different in shape from the other half. •Border: Border irregularity often indicates melanoma. The border -- or edge -- is typically ragged, notched, or blurred. •Color: Melanoma is typically a mix of colors or hues, rather than a single, solid color. •Diameter: Melanoma grows in diameter, whereas moles remain small. A spot that is larger than 5 millimeters (the size of a pencil eraser) is cause for concern. If any of these signs are present on the foot, it is important to see a foot and ankle surgeon right away. It is also essential to see a surgeon if there is discoloration of any size underneath a toenail (unless the discoloration was caused by trauma, such as stubbing a toe or having something fall on it). Diagnosis To diagnose melanoma, the foot and ankle surgeon will ask the patient a few questions. For example: Is the spot old or new? Have you noticed any changes in size or color? If so, how rapidly has this change occurred? The surgeon will also examine the spot to determine whether a biopsy is necessary. If a biopsy is performed and it reveals melanoma, the surgeon will discuss a treatment plan. Prevention and Early Detection Everyone should practice strategies that can help prevent melanoma --or at least aid in early detection, so that early treatment can be undertaken. Precautions to avoid getting melanoma of the foot and ankle, as well as general precautions, include: •Wear water shoes or shoes and socks -- flip flops do not provide protection! •Use adequate sunscreen in areas that are unprotected by clothing or shoes. Be sure to apply sunscreen on the soles as well as the tops of feet. •Inspect all areas of the feet daily -- including the soles, underneath toenails, and between the toes. •If you wear nail polish, remove it occasionally so that you can inspect the skin underneath the toenails. Avoid UV radiation during the sun's peak hours (10 a.m. to 4 p.m.), beginning at birth. While sun exposure is harmful at any age, it is especially damaging to children and adolescents. •Wear sunglasses that block 100% of all UV rays -- both UVA and UVB. •Wear a wide-brimmed hat. Remember, early detection is crucial with malignant melanoma. If you see any of the ABCD signs -- or if you have discoloration beneath a toenail that is unrelated to trauma -- be sure to visit a foot and ankle surgeon as soon as possible. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Diabetic Arthritic Foot (Charcot Foot)

What is Charcot Foot? Charcot foot is a sudden softening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking the foot eventually changes shape. As the disorder progresses, the arch collapses and the foot takes on a convex shape, giving it a rocker-bottom appearance, making it very difficult to walk. Charcot foot is a very serious condition that can lead to severe deformity, disability and even amputation. Because of its seriousness, it is important that patients with diabetes -- a disease often associated with neuropathy -- take preventive measures and seek immediate care if signs or symptoms appear. Symptoms The symptoms of Charcot foot can appear after a sudden trauma or even a minor repetitive trauma (such as a long walk). A sudden trauma includes such mishaps as dropping something on the foot, or a sprain or fracture of the foot. The symptoms of Charcot foot are similar to those of infection. Although Charcot foot and infection are different conditions, both are serious problems requiring medical treatment. Charcot foot symptoms may include: • Warmth to the touch (the foot feels warmer than the other) • Redness in the foot • Swelling in the area • Pain or soreness What Causes Charcot Foot? Charcot foot develops as a result of neuropathy, which decreases sensation and the ability to feel temperature, pain or trauma. When neuropathy is severe, there is a total lack of feeling in the feet. Because of neuropathy, the pain of an injury goes unnoticed and the patient continues to walk -- making the injury worse. People with neuropathy (especially those who have had it for a long time) are at risk for developing Charcot foot. In addition, neuropathic patients with a tight Achilles tendon have been shown to have a tendency to develop Charcot foot. Diagnosis Early diagnosis of Charcot foot is extremely important for successful treatment. To arrive at a diagnosis, the surgeon will examine the foot and ankle and ask about events that may have occurred prior to the symptoms. X-rays are also essential for diagnosis. In some cases, other imaging studies and lab tests may be ordered. Once treatment begins, x-rays are taken periodically to aid in evaluating the status of the condition. Treatment Following the surgeon's treatment plan for Charcot foot is extremely important. Failure to do so can lead to the loss of a toe, foot, leg or life. Treatment for Charcot foot consists of: •Immobilization Because the foot and ankle are so fragile during the early stage of Charcot, they must be protected so the soft bones can repair themselves. Complete non-weightbearing is necessary to keep the foot from further collapsing. The patient will not be able to walk on the affected foot until the surgeon determines it is safe to do so. During this period, the patient may be fitted with a cast, removable boot or brace, and may be required to use crutches or a wheelchair. It may take the bones several months to heal, although it can take considerably longer in some patients. •Custom shoes and bracing Shoes with special inserts may be needed after the bones have healed, to enable the patient to return to daily activities -- as well as help prevent recurrence of Charcot foot, development of ulcers and possibly amputation. Bracing is required in cases with significant deformity. •Activity modification A modification in activity level may be needed to avoid repetitive trauma to both feet. A patient with Charcot in one foot is more likely to develop it in the other foot, so measures must be taken to protect both feet. •Surgery In some cases, surgery may be required. The foot and ankle surgeon will determine the surgical procedure best suited for the patient based on the severity of the deformity and the patient's physical condition. Preventive Care The patient can play a vital role in preventing Charcot foot and its complications by following these measures: •Diabetes patients should keep blood sugar levels under control. This has been shown to reduce the progression of nerve damage in the feet. •Get regular check-ups from a foot and ankle surgeon. •Check both feet every day -- and see a surgeon immediately if there are signs of Charcot foot. •Be careful to avoid injury, such as bumping the foot or overdoing an exercise program. •Follow the surgeon's instructions for long-term treatment to prevent recurrences, ulcers and amputation. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Lateral Ankle (Peroneal) Tendons

What are the Peroneal Tendons? A tendon is a band of tissue that connects a muscle to a bone. In the foot, there are two peroneal tendons. They run side-by-side behind the outer ankle bone. One peroneal tendon attaches to the outer part of the midfoot, while the other tendon runs under the foot and attaches near the inside of the arch. The main function of the peroneal tendons is to stabilize the foot and ankle and protect them from sprains. Types of Peroneal Tendon Injuries Peroneal tendon injuries may be acute (occurring suddenly) or chronic (developing over a period of time). They most commonly occur in individuals who participate in sports that involve repetitive ankle motion. In addition, people with higher arches are at risk for developing peroneal tendon injuries. The following are the three basic types of peroneal tendon injuries: Tendonitis is an inflammation of one or both tendons. The inflammation is caused by activities involving repetitive use of the tendon, overuse of the tendon or trauma (such as an ankle sprain). Symptoms of tendonitis include: •Pain •Swelling •Warmth to the touch Acute tears are caused by repetitive activity or trauma. Immediate symptoms of acute tears include: •Pain •Swelling •Weakness or instability of the foot and ankle As time goes on, these tears may lead to a change in the shape of the foot, in which the arch may become higher. Degenerative tears (tendonosis) are usually due to overuse and occur over long periods of time -- often years. In degenerative tears, the tendon is like taffy that has been overstretched until it becomes thin and eventually frays. Having high arches also puts you at risk for developing a degenerative tear. The signs and symptoms of degenerative tears may include: •Sporadic pain (occurring from time to time) on the outside of the ankle •Weakness or instability in the ankle •An increase in the height of the arch Subluxation occurs when one or both tendons have slipped out of their normal position. In some cases, subluxation is due to a condition in which a person is born with a variation in the shape of the bone or muscle. In other cases, subluxation occurs following trauma, such as an ankle sprain. Damage or injury to the tissues that stabilize the tendons (retinaculum) can lead to chronic tendon subluxation. The symptoms of subluxation may include: •A snapping feeling of the tendon around the ankle bone. •Sporadic pain behind the outside ankle bone. •Ankle instability or weakness. Early treatment of a subluxation is critical, since a tendon that continues to sublux (move out of position) is more likely to tear or rupture. Therefore, if you feel the characteristic snapping, see a foot and ankle surgeon immediately. Diagnosis Because peroneal tendon injuries are sometimes misdiagnosed and may worsen without proper treatment, prompt evaluation by a foot and ankle surgeon is advised. To diagnose a peroneal tendon injury, the surgeon will examine the foot and look for pain, instability, swelling, warmth and weakness on the outer side of the ankle. In addition, imaging studies such as an MRI or ultrasound may be needed to fully evaluate the injury. An ankle sprain may sometimes accompany a peroneal tendon injury. The surgeon is trained to look for signs of this and other related injuries. Proper diagnosis is important because prolonged discomfort after a simple sprain may be a sign of additional problems. Treatment Treatment depends on the type of peroneal tendon injury. Options include: •Immobilization. A cast or splint may be used to keep the foot and ankle from moving and allow the injury to heal. •Medications. Oral or injected anti-inflammatory drugs may help relieve the pain and inflammation. •Physical therapy. Ice, heat or ultrasound therapy may be used to reduce swelling and pain. As symptoms improve, exercises can be added to strengthen the muscles and improve range of motion and balance. •Bracing. The surgeon may provide a brace to use for a short while or during activities requiring repetitive ankle motion. Bracing may also be an option when a patient is not a candidate for surgery. •Surgery. In some cases, surgery may be needed to repair the tendon or tendons and perhaps the supporting structures of the foot. The foot and ankle surgeon will determine the most appropriate procedure for the patient's condition and lifestyle. After surgery, physical therapy is an important part of rehabilitation. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com