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 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