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Department of Orthopaedic Surgery
Columbia University Medical Center

Stress fractures in the foot and ankle happen when muscles become weak due to too much or too little use. Stress fractures cause the muscles to stop cushioning the foot and ankles from the impact of hitting the ground. Since there is nothing to protect the bones of the foot, they absorb the full impact of each step you take. This additional stress causes little cracks, or stress fractures, to form in the bones that are being pressured.

Stress fractures are common in highly active people, especially athletes. Basketball, tennis or and gymnastics are activities where stress fractures occur more frequently. However, anyone can receive a stress fracture. Normally sedentary individuals who suddenly begin an intensive high impact work out may incur a stress fracture. This is because their muscles are not resistant enough to handle and cushion the intensity of the activity. Osteoporosis patients may also suffer stress fractures because the disease weakens the victim’s bones, making it easier for them to wear and tear.

Pain from stress fractures occurs in the site area of the fracture. It may be either constant or intermittent, causing sharp or dull pain accompanied by swelling and/or tenderness. Engagement in any kind of high impact activity will only exacerbate the pain. In fact, it can even cause a full fracture, especially when the area is not fully healed. Full fractures are much more serious, and can prevent you from using your foot at all.

Treatment varies depending on the patient and the degree of his or her injury. The most important treatment is to rest the injured foot. Some fractures may heal quicker with brief rest, while others need a longer rest period and utilizing crutches. In some cases surgery is required to install support pins around the fracture to aid healing.

To prevent stress fractures, be sure to get plenty of Calcium and Vitamin-D in your diet. This helps keep your bones strong and fortifies their resistance. If you begin a new regimen that involves high impact activity, set incremental goals on a weekly basis so you can build up the proper muscular strength. For example, if you wish to walk every day, you could ride a bike on some of those days to take stress off your feet. Also, make sure to wear supportive shoes that provide adequate protection.

If you experience any symptoms of stress fractures, you should stop exercising and rest. If these symptoms do not go relieve themselves, consult with an orthopedic specialist. Taking these measures can help prevent stress fractures to your foot and ankle, and allow you to continue the activities  you enjoy.

 

Monday, 02 June 2014 00:00

What to Know About a Broken Toe

Although most people try to avoid foot trauma such as banging, stubbing, or dropping heavy objects on their feet, the unfortunate fact is that it is a common occurrence. Given the fact that toes are positioned in front of the feet, they typically sustain the brunt of such trauma. When trauma occurs to a toe, the result can be a painful break (fracture). Another type of trauma that can break a toe is repeated activity that places stress on the toe for prolonged periods of time.

Broken toes can be categorized as either minor or severe fractures. Symptoms of minor toe fractures include throbbing pain, swelling, bruising on the skin and toenail, and the inability to move the toe with ease. Severe toe fractures require medical attention and are indicated when the broken toe appears crooked or disfigured, when there is tingling or numbness in the toe, when the injured person experiences fever or chills throughout their body, and when there is an open, bleeding wound present on the toe.

Generally, a minor toe break will heal without long-term complications, but it is important to discontinue activities that put pressure on the toe. It is best to stay off of the injured toe with the affected foot elevated on pillows. Swelling can be alleviated by placing an ice pack on the broken toe for 15 minutes every two hours during the first two days after the fracture. The broken toe should be immobilized by placing a small cotton ball between the injured toe and the toe beside it, then taping the two toes together with medical tape.

Severe toe fractures may be treated with a splint, cast, and in some cases, minor surgery; especially when the big toe has been broken. Due to its position and the pressure it endures with daily activity, future complications can occur if the big toe is not properly treated. Pain associated with minor toe fractures can be managed with over-the-counter pain medications, and prescription pain killers may be necessary for severe toe fractures.

The healing time for a broken toe is approximately four to six weeks. In severe cases where the toe becomes infected or requires surgery, healing time can take up to eight weeks or more. While complications associated with a broken toe are immediately apparent, it is important to note that there are rare cases when additional complications, such as osteoarthritis, can develop over time.

Tuesday, 27 May 2014 20:05

Effect of High-Heels on the Feet

For hundreds of years, women have been wearing various kinds of high-heels for mostly aesthetic reasons. Women who wear high-heels appear to be taller and to have longer and thinner legs, and the wearer’s gait and posture changes. Though high-heels have had an association with femininity and have kept them popular over the years, there are definite health problems caused by wearing them too frequently.

The motion of the ankle joints is limited when heels are worn. The ankle joint is very important to the body when it comes to walking. Because of their location, these joints have a great deal of weight put on them. Thus, it is very important to keep them as healthy as possible. The Achilles tendon is the main tendon in the ankle. Wearing high-heels too often, studies have shown, can cause the calf muscle and Achilles tendon to shorten and stiffen, which can cause problems when shoes without heels are worn.

By putting a great deal of pressure on the ball of the foot, by forcing the toes into a small toe box, high-heels can cause or may worsen many foot problems, such as corns, hammertoe, bunions, Morton’s neuroma and plantar fasciitis.

Not only does wearing very high-heels regularly have negative effects on the feet, the rest of the body can suffer as well. The knees, one of the most important joints in the entire body, can be affected by wearing high-heels.  High-heels causes the knees to stay bent all the time. Also, it can cause them to bend slightly inward as well. Doctors believe that women can suffer from osteoarthritis later in life because of constantly walking like this. By limiting the natural motion of the foot during walking, high-heels also cause an increased in stress on the knees.

Similarly, the back may also be affected by high-heels because it causes the back to go out of alignment. If high-heels are worn constantly, the spine’s ability to absorb shock can cause continued back pain. They can compress the vertebrae of the lower back, and can overuse the back muscles.

However, this is not to say that high-heels can never be worn. If worn occasionally, they will not cause serious problems. They should not be worn every day in order to avoid the long-term physical health problems of the feet, knees, ankles, and back like mentioned above. 

Tuesday, 20 May 2014 14:26

How to Prevent Running Injuries

Many common running injuries are caused by overuse and overtraining. Several common injuries can occur due to running. When the back of the kneecap starts wearing away and starts causing pain in the knee, this is commonly referred to as runner’s knee. Runner’s knee can occur because of decreased strength in the quadricep muscles or shoes that do not offer proper support to the inside of the forefoot. Runner’s knee usually is treated with strengthening exercises focusing on the quad muscle and sports orthotic. To prevent runner’s knee, efforts should be focused on hip strengthening. Physical therapy is also beneficial in helping to learn the best exercises to heal runner’s knee. To prevent runner’s knee, strengthen the quad muscles to keep the kneecap aligned.

Overtraining is one cause of a common running injury called iliotibial band syndrome, which occurs when the iliotibial band gets irritated, causing pain and discomfort to the outside knee area. Another common running injury is known as plantar fasciitis, which occurs when the bone in the foot becomes inflamed and irritated. This injury primarily causes pain in the foot. Causes can include a high arch, incorrect footwear, tight muscles and flat feet. The best way to avoid plantar fasciitis is stretching and proper footwear.

Stress fractures are a common injury for runners. These fractures can occur because of overtraining, lack of calcium or running style. In runners, it is common for stress fractures to occur in several locations including the inner bone of the leg, the thighbone, the bone at the base of the spine and the toe bones in the foot. The best approach to preventing stress fractures are proper footwear maintenance and running on a surface with enough “give” to absorb some of the shock produced during running.

Besides overtraining, other causes of these common running injuries are poorly fitting footwear, irregular biomechanics, and lack of flexibility and strength. The best way to avoid running injuries is to prevent them. Fortunately, each of these common running injuries can be prevented. To avoid running injuries it is highly recommended to wear only footwear that fits properly and that suits your needs. Running shoes are the only protective gear that runners have to safeguard them from injury; therefore, choosing the correct footwear for running is important. It is important, too, to think about other aspects of your running routine like training schedules, flexibility and strengthening, and tailor them to your needs in order to minimize the possibility of injury. Regular stretching before and after running should be considered also when trying to avoid running injuries. Stretching keeps muscles limber resulting in greater flexibility. 

Tuesday, 13 May 2014 14:17

Foot Rehabilitation for Athletes

There is no sport that completely prevents the foot or ankle from becoming injured. In fact, even simple activities such as darts and pool might cause injuries to the foot. When an athlete does suffer from a foot injury, he needs to find a way to get back on his feet right away. Immediate results may be desired, but they are not always possible.

All foot and ankle injuries deserve immediate attention. When the foot or the ankle gets injured, muscles surrounding the bones can weaken or atrophy through disuse. While the bones heal on their own, it takes a more concentrated effort for an athlete to regain full use of his feet and ankles. A doctor may recommend that a person go through a course of physical therapy. The course of physical therapy treatment uses simple, repetitive isometric exercises. The use of the exercises will cause the body to rebuild the muscles and tendons in the area over time and restore the full range of movement.

When selecting ankle and foot rehabilitation services, an athlete needs to find a licensed sports therapist (other physical therapists work with more generalized conditions, and while these kinds of physical therapists are dedicated to their job, they do not necessarily understand the special demands of the athlete). A good sports therapist will take their time with a patient, and make sure that he or she understands the problem and the options available for treatment. As long as the doctor expects a person to return to the sport which he enjoys, the sports physical therapist will recommend the exact exercises a person needs to get back in the game.

Although the professional athlete needs a trained sports therapist, an amateur athlete or the weekend player can benefit from foot rehabilitation services for athletes as well. An ankle or foot injury does not have to cause a person go give up the game he loves entirely, so long as he or she seeks out a sports therapist.

Physical therapy may not always heal certain injuries perfectly, but it will more quickly and effectively help the afflicted person get better.  Less severe injuries may only take a person out of his favorite sport just for a little while, if he or she sees a sports therapist. If a full recovery is possible, it is definitely worth it to check out ankle and foot rehabilitation services. 

Tuesday, 06 May 2014 19:00

What is Gout?

Gout is a form of arthritis that is unusually painful. A slight touch can send shooting pain. The most common area for gout to occur is in the metatarsal phalangeal joint of the big toe. Other areas of the body frequently affected by gout are the knees, elbows, fingers, ankles and wrists.
Gout occurs when there are elevated levels of uric acid in the blood. This condition is called hyperuricemia. Hyperuricemia is a genetically pre-disposed condition about 90% of the time and occurs because the kidneys do not produce the correct amount of uric acid. Children of parents who have had gout will have a 20% chance of developing it themselves. The excess uric acid in the blood forms crystals that deposit in between joints causing friction with movement.

Symptoms of gout caused by this friction include pain, redness, swelling, and inflammation. Fever and fatigue may occur as well, although these symptoms are rare. The pain can be worse during the night when the body’s temperature lowers.

Gout can be diagnosed clinically by a doctor’s observation of the redness, swelling, and pain. More definitive tests can be performed by the doctor as well. Blood tests check for elevated uric acid levels in the blood. The synovial fluid in the joint can also be withdrawn through a needle to be checked for uric acid crystals. Chronic gout can be diagnosed by X-ray.

Treatment given for acute gout diminishes the symptoms. Non-steroid anti-inflammatory drugs such as Colchicine and other corticosteroid drugs will stop the swelling, redness, and inflammation in cases of acute gout. If gout becomes chronic, there are multiple ways to combat it. Lifestyle changes and changes in diet may be necessary, as well as preventative drugs.

Gout can be aggravated by a sedentary lifestyle. Exercise will reduce probability of future cases of gout. Certain foods cause or increase the risk of gout and their consumption should be avoided or kept at a minimum. These foods include red meat, alcohol, sea foods, and drinks sweetened with fructose.

Lifestyle changes and diet that help prevent gout include exercise and certain foods that help decrease the chance of gout recurring. Gout preventative foods include Vitamin C, coffee and some dairy products. New drugs have been discovered that inhibit the body’s production of certain enzymes. These are the enzymes that produce uric acid. Lowering your levels of uric acid will greatly reduce the chances of developing further cases of gout.

Monday, 28 April 2014 00:00

Working on Your Feet

When your feet are overworked your whole body can be affected. Thus, taking care of your feet is a must for overall good health. Standing on the feet all day can cause bunions, callouses and plantar warts. These are all very painful conditions that can be avoided with proper foot care. Good shoe choices and proper posture both contribute to the health of your feet.

Always choose a negative heeled shoe that places the heel slightly lower than the ball of the foot. Shoes designed in this fashion are the best for foot health. And most definitely purchase your shoes from a reputable manufacturer who puts foot health at the forefront of their goals. Having a job that keeps you on your feet all day makes it an especially a good idea to spend the extra money on a good pair of shoes.

The feet were not designed to be enclosed for hours on end. In fact, incorporating some "barefoot" time into your daily routine is not a bad idea to improve overall foot health. There are some other simple things that you can do to help alleviate pain and pressure on the feet from standing all day.

First of all, you can perform some simple foot exercises and even some common yoga moves to improve the function of your feet. A foot work out that incorporates mechanically correct movements will stimulate the blood flow and the muscles of the foot. Also, yoga exercises that stretch the foot out flat on the floor are very beneficial for those who work on their feet, and can help stretch and relax the calf muscles and Achilles tendon. These exercises may be performed every day during your daily routine, perhaps even while you are sitting in your vehicle or standing in line at the grocery store.

If you spend a lot of time on your feet every day, you know what it can be like to have foot pain, and you may begin to think that foot pain is inevitable. It doesn't have to be. Foot stretches and proper footwear can do miracles in alleviating foot pain and preventing further foot problems.

With just a little effort and some education on the proper foot exercises, you can keep your feet healthy and feeling good for years to come. If your feet hurt your whole body will feel the effects over time. Start taking better care of your feet today. They will love you for it!

Tuesday, 15 April 2014 20:47

Flat Feet

Flat feet is a foot condition in which the arch of the foot either drops or is never developed. About 20-30% of the population generally has flat feet because their arch never formed during growth. While it is common in babies and small children, it can become a problem if the arch never develops. For adults, the development of flat feet can be brought upon by injury, or may even be a result of pregnancy due to the increased elasticity; however, in adults the flat footedness is usually permanent.

Having flat feet can sometimes make it difficult to walk due to the stress it places on the ankles. The general alignment of your legs is thrown off because the ankles move more inward which can cause some major discomfort. This also has a big effect on the knees as many people that have flat feet often have arthritis in that area. However, in many cases, flat feet does not cause any pain and it should not be a cause for concern in that case.

For those that run, there are specific shoes to help realign the ankles with a lot more support and less pronation. The weight shifting in this activity is very quick, so that's why it's important to know if you have flat feet early on in your life, in case of injury down the road. 

The wet footprint test can be an indicator to diagnosing flat feet. In this test, the individual would place a flat foot on a surface in order to show a footprint. If there is no indentation or indication of an arch, that person may have flat feet. In all cases, it is best to consult a podiatrist if flat feet is suspected or noticed.

Once flat feet has been diagnosed, it can be treated by walking barefoot in beach-like terrain, or wearing insoles. There are two types of flat feet; one being rigid, where the feet appear to have no arch even when the person is not standing, and the other being flexible where the person appears to have an arch while not standing, but once standing the arch goes away. In the case of flexible flat feet, unless there is pain caused by the condition, there is no need for treatment. However, if it causes pain or in the case of rigid flat feet, exercises and orthotic insoles may be prescribed in order to help the arches develop.

In some cases when the condition is severe and all other methods have been exhausted surgery may be required but this is normally avoided due to a lengthy recovery time and high cost. 

Wednesday, 09 April 2014 20:55

Sport Related Foot and Ankle Injuries

Foot and ankle injuries are common among people who participate in sports. Several factors contribute to this. They include failing to stretch or warm up properly, not wearing the proper type shoe and not taping or providing other types of support for the ankle or foot. The most common foot and ankle injuries suffered by people involved in sport are plantar fasciitis, ankle sprains and Achilles tendon damage or ruptures. If not treated properly they can lead to permanent disability.

Treating these injuries is relatively simple if they are identified and addressed early. Many athletes dismiss the initial aches and pains associated with injury as just soreness or tired muscles. Their first response is usually to try to work through it. This can lead to serious problems. Many minor injuries are made far more serious when athletes continue to put strain and pressure on them. That attitude can change a mild strain into a serious strain and a minor tear into a rupture. Athletes should have unusual aches and pains evaluated by a skilled, licensed medical professional.

Plantar fasciitis is a painful injury. It is inflammation of the plantar fascia, the thick fibrous band of tissue running from the heel to the base of the toes. Left untreated it can lead to a degenerative disease called plantar fasciosis. There are several effective treatments for this ailment. Doctors often proscribe rest, massages, stretching, night splints, physical therapy, anti-inflammatory medication, corticosteroids or surgery usually in that order. The most effective treatment for plantar fasciitis is orthotics like foot supports. Surgery is occasionally used as a last resort, but it comes with the risk of nerve damage and infection and often does not stop the pain.

The Achilles tendon is the largest tendon in the body. It connects the calf muscles to the heel bone. Running, jumping and walking all impact this tendon. Two common injuries to the Achilles tendon are tendonitis and a rupture of the tendon. Tendonitis is inflammation in the tendon often caused by an increase in the amount and intensity of stress placed on it. It can either be treated non-surgically with rest, ice or anti-inflammatory medication or surgery may be required. A rupture (tear) of the Achilles tendon can be treated by placing the lower leg in a cast for several weeks or with surgery. Many physicians feel surgery is the better option because it lowers the risk of re-ruptures. Both methods require 4 to 6 months of rehabilitation.

Ankle sprains are the most common sports related foot and ankle injury. A sprain occurs when the ligament holding the ankle bones and joint stretches beyond its normal range. It can be treated non-surgically with a combination of rest, ice wrapped around the joint for 30 minutes immediately after injury, compression by a bandage and elevating the ankle above the heart for 48 hours. This combination is referred to as RICE. Severe ankle sprains in which the ligaments are torn may require arthroscopic or reconstructive surgery followed by rehabilitation

 

A broken foot is when one of the bones located in the foot fractures, or breaks. About 10% of broken bones occur in the foot.

Bones typically break when an object crushes, bends, or stretches the bone. In the foot, the location of the broken bone is usually indicative of how the break occurred. Toes usually break when something hard and solid is kicked with great force. Broken Heels are usually a result of falling from a great height and landing on the feet. Other broken bones in the feet can occur because of a twisted or sprained ankle. Most of the time, a broken foot results from a sudden accident or injury. Sometimes small cracks can form over time in the bones of the feet from repeated stress. These cracks are called stress fractures and usually only occur in athletes that put a lot of pressure on their feet, like runners, dancers, and gymnasts.

Symptoms of a broken foot typically include pain, swelling, bruising, and redness. Occasionally the pain of a broken foot may be so severe that walking is not an option. However, this depends on the location of the broken bone within the foot. Broken toes are usually less painful than broken heels or other bones within the foot. A foot that is blue, numb, cold, misshapen, cut or deformed can occur in more serious cases of broken feet. Those who are experiencing any of these symptoms, or suspect that they have a broken foot, should seek medical attention in a center where x-rays can be performed. 

Prior to seeking the attention of a doctor, several steps can be taken at home in order to reduce pain and swelling. Stabilization and elevation of the broken foot should be the number one priority. It is important not to move the foot, so any type of homemade splint will work well. However, any splint that causes the foot to become more painful, or cut off blood circulation should be removed. Ice can also decrease swelling and alleviate some of the pain that a broken foot can cause.

In a medical center, treatment for a broken bone will differ depending on which bone in the foot is fractured and depending on what caused the break. Some broken feet will require the patient to use crutches, while others will require splits or casts. More severe cases may require surgery on the foot to repair the broken bone or bones.

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