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

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 Big Toe Arthritis

Special Report on Big Toe Arthritis Each day, with every step you take, your big toe bears a tremendous amount of stress -- a force equal to about twice your body weight. Most of us don't realize how much we use our big toe. We tend to take it for granted, unless a problem develops. One problem that afflicts the big toe is called hallux rigidus, a condition where movement of the toe is restricted to varying degrees. This disorder can be very troubling and even disabling, since we use the all-important big toe whenever we walk, stoop down, climb up, or even stand. If you have pain and/or stiffness in your big toe, you may have this condition. What is Hallux Rigidus? Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the big toe, and with time it gets increasingly harder to bend the toe. "Hallux" refers to the big toe, while "rigidus" indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis (a wearing out of the cartilage within the joint that occurs in the foot and other parts of the body). Because hallux rigidus is a progressive condition, the toe's motion decreases as time goes on. In its earlier stage, motion of the big toe is only somewhat limited -- at that point, the condition is called "hallux limitus." But as the problem advances, the toe's range of motion gradually decreases until it potentially reaches the end stage of "rigidus" -- where the big toe becomes stiff, or what is sometimes called a "frozen joint." Other problems are also likely to occur as the disorder progresses. Early signs and symptoms include: • Pain and stiffness in the big toe during use (walking, standing, bending, etc.) • Pain and stiffness aggravated by cold, damp weather • Difficulty with certain activities (running, squatting) • Swelling and inflammation around the joint • As the disorder gets more serious, additional symptoms may develop, including: • Pain, even during rest • Difficulty wearing shoes because bone spurs (overgrowths) develop. Wearing high-heeled shoes can be particularly difficult. • Dull pain in the hip, knee, or lower back due to changes in the way you walk • Limping, in severe cases What Causes Hallux Rigidus? Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis -- the kind that results from "wear and tear" -- often develops in people who have defects that change the way their foot and big toe functions. For example, those with fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux rigidus. In some people, hallux rigidus runs in the family and is a result of inheriting a foot type that is prone to developing this condition. In other cases, it is associated with overuse -- especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often have to stoop or squat. Hallux rigidus can also result from an injury -- even from stubbing your toe. Or it may be caused by certain inflammatory diseases, such as rheumatoid arthritis or gout. Your foot and ankle surgeon can determine the cause of your hallux rigidus and recommend the best treatment. Diagnosis of Hallux Rigidus The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best time to see a foot and ankle surgeon is when you first notice that your big toe feels stiff or hurts when you walk, stand, bend over, or squat. If you wait until bone spurs develop, your condition is likely to be more difficult to manage. In diagnosing hallux rigidus, the foot and ankle surgeon will examine your feet and manipulate the toe to determine its range of motion. X-rays are usually required to determine how much arthritis is present as well as to evaluate any bone spurs or other abnormalities that may have formed. Treatment: Non-Surgical Approaches If your condition is caught early enough, it is more likely to respond to less aggressive treatment. If fact, in many cases, early treatment may prevent or postpone the need for surgery in the future. That's why it is important to see your foot and ankle surgeon when you first begin to notice symptoms. Treatment for mild or moderate cases of hallux rigidus may include one or more of these strategies: • Shoe modifications. Shoes that have a large toe box should be worn, because they put less pressure on your toe. Stiff or rocker-bottom soles may also be recommended. Most likely, you'll have to stop wearing high heels. • Orthotic devices. Custom orthotic devices may improve the function of your foot. • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to help reduce pain and inflammation. Supplements such as glucosamine-chondroitin sulfate and some vitamins and minerals may also be helpful. • Injection therapy. Injections of corticosteroids in small amounts are sometimes given in the affected toe to help reduce the inflammation and pain. • Physical therapy. Ultrasound therapy or other physical therapy modalities may be undertaken to provide temporary relief. When is Surgery Needed? In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery that can be undertaken to treat hallux rigidus. These surgical procedures fall into two categories: Some procedures reconstruct and "clean up" the joint. The foot and ankle surgeon removes the arthritic damage from the joint as well as any accompanying bone spurs, and then alters the position of one or more bones in the big toe. These procedures are designed to preserve and restore normal alignment and function of the joint as well as reduce or eliminate pain. More aggressive procedures are used when the joint cannot be preserved. These may involve fusing the joint, or removing part or all of the joint and, in some cases, replacing it with an implant, such as is done for the hip or knee. These procedures eliminate painful motion in the joint and provide a stable foot. The procedure that is used to correct hallux rigidus depends on many factors, including the cause of the condition and the severity, as well as the patient's age, occupation and activity level. Your foot and ankle surgeon is trained to select a surgical procedure best suited to your particular condition and needs. If surgery is performed, the length of the recovery period will vary, depending upon the procedure or procedures performed. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com