Stress Fractures of the Feet

                    

Stress fractures are "hairline" fractures brought on by repetitive stress to an area, often a foot.  The most common area for this injury to occur are the metatarsal bones or "long bones".

                    

As opposed to traumatic fractures, where there is separation of bone at the fracture site or joint, there is no displacement of the fracture.  Often the fracture cannot be seen on an X-ray until about 10 days after the fracture occurs.  The fracture is visualized only when a bony "callous" forms to help secure and heal the fracture.

                    

Stress fractures rarely require surgery.  Off-loading weight to the site will allow the fracture to heal over time.  This can be accomplished with either a surgical shoe or a walking boot.  Sometimes a bone stimulator or physical therapy may be needed.  If left untreated, the fracture site may become a source of chronic pain or arthritis.

                    

After the fracture heals, attention should be directed at preventing recurrence.  An orthotic, placed in the shoe, should alleviate the stress to the affected area, and prevent the fracture from happening again.  This is particularly effective for athletes.  

                     

If your are experiencing prolonged foot pain, do not delay- you may have a stress fracture.

Pregnancy and Podiatry

                    

One would not normally associate pregnancy with the practice of podiatry.  On further examination though, pregnancy does greatly affect the legs and feet.

                    

As the body prepares for delivery, hormones facilitate stretching of the ligaments throughout the body, including the feet.  As the ligaments relax, the foot loses structural integrity and allows the foot to flatten out.  This can cause general foot pain, particularly in the arches.  It may also cause back aches, and pain in the knees and thighs, as a result of faulty foot structure.  These stretched ligaments may require several months to return to normal, after delivery.  Fortunately, arch supports or orthotics may support the feet and provide the proper alignment to prevent the excessive strain that causes the pain.

                    

Other common problems associated with pregnancy include varicose veins, phlebitis and calcium deficiency.  Plantar warts may appear during the first trimester, but soon disappear after delivery.

                    

Walking, compression stockings, supportive shoes and orthotics could alleviate or control many of the foot and leg problems that pregnancy can cause.

Evan Kelner DPM

Arthritis of the Feet

                     

                    

Arthritis of the feet is such a common condition, it is often overlooked or just ignored.  About 80% of people over 40 years of age have arthritic changes in the feet.  For serious inflammatory arthritic conditions of the feet, such as Rheumatoid Arthritis, medications are needed to keep the disease under control.

                    

The vast majority suffer from degenerative or osteoarthritis.  This condition can range from non-symptomatic to disabling.  Most problems due to osteoarthritis involve stiffness or soreness of the joints, lack of motion, formation of bone spurs, hammertoes and bunions.

                    

For most, wearing well cushioned, lace-up supportive footwear can be enough to keep the feet comfortable.  If that is not adequate, stretching exercises, non-steroidal anti-inflammatory drugs, steroid injections, physical therapy, and topical analgesic creams can all help.  For severe instances of osteoarthritis, such as rigid joints, painful bunions and hammertoes, surgical correction may be indicated.

                    

Many of my patients who suffer from painful foot arthritis benefit from arch supports or orthotics.  These devices relieve the pain by supporting the feet in their proper position and alleviating stress and strain to the joints.  Orthotics may provide long term relief for this chronic problem.

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f you suffer from foot pain, call us today.  Relief may be closer than you think.

Evan Kelner DPM, with offices in Ocean Township and Toms River.  We can be reached at (732) 988-0070 or (732) 286-9200

Leg Cramps at Night                                        

                                

(referenced from Yale's Podiatric Medicine)

                    

During an office visit, it's not unusual for a patient to casually ask me if there is anything they can do about legs cramps when they are in bed at night.

                    

Cramps in the legs usually occur as a result of abnormal muscle positions and impaired circulation.  It manifests as involuntary muscular contractions with pain and partial, or complete, loss of function.  Circulation is usually disrupted.  Other causes of night cramps include deformities of the feet, nutritional deficiency-especially vitamin B deficiency and potassium imbalance.  Night cramps are common in pregnancy, calcium-phosphorus imbalance and fatty metabolism.  Excessive urination is also a common cause.

                    

Unnatural anatomical positions, in certain occupations, result in cramps, aching pains, moderate shortening of the calf muscles or hamstrings.

                     

Treatments naturally depend upon the cause.  Often the control of foot strain and pull on the calfs can be relieved with orthotics, proper foot wear and stretching.  Vitamins and minerals may be helpful.  Quinine capsules, muscle relaxants, and tranquilizers may be helpful, as well as antihistamines such as Benadryl.  Large doses of aspirin also appear to help the condition.  For smokers, cessation of tobacco use may also help.  If symptoms persist, blood chemistry studies may be in order.

                    

If you or a family member is suffering from foot or leg pain, relief may be only a call away.

Evan Kelner DPM

(732) 988-0070 or (732) 286-9200

Visiting The Bata Shoe Museum

                    

This past week while on vacation, my wife and I visited the Bata Shoe Museum in Toronto, Canada.  As a podiatrist, I am acutely aware of the shoes my patients wear, so naturally, I thought a trip to the shoe museum would be an interesting diversion.

                    

We were not disappointed.  The museum provided a rich account of, not only the various types of shoes worn around the world and through the ages, but also how footwear was influenced by culture, tradition, art, history, religion, the elements, and yes, style.  From practical to the improbable, the shoes from various regions and time periods provided great insight into their respective cultures.  Examples of displays ranged from primitive grass lined shoes, women's shoes of ancient China, waterproof seal intestine boots of Inuits, boots worn on the moon and platform shoes of rock stars from the 70's.

                    

Although an interesting experience, my wife and I are both grateful to have been born in the time and place we were!

Evan Kelner DPM

 

 

Plantar Warts

                    

Plantar warts, or warts on the bottom of the feet, are a very common condition.  They are also known as verrucae, and are caused by a DNA virus.  Warts usually affect young people and are often brought on by stress.

                    

They are found on the bottom of the foot.  Plantar warts present as round, hard lesions of thickened skin.  They can be easily mistaken for corns, foreign bodies or plugged up sweat glands.  Warts have their own blood supply, so when picked at or cut, they often bleed.  Depending where on the foot it occurs, the area can be painful with walking or standing.

                    

Warts can be very difficult to resolve, and thus there are many treatments.  Some of the methods used are burning the wart out, freezing it, acid applications, oral treatments and excising it.  If left alone, the wart may grow in size and become even more difficult to resolve.

                    

If you, or someone you know, has what may be a wart, see a professional.  Our office takes pride in becoming part of your health team.  We always stress preventive care and explore conservative treatments first.

                    

We are located at 1398 Highway 35, Ocean Township and 191 Highway 37 W, Toms River.  We can be reached at (732) 988-0070.,

Thickened Toenails - Fungus or Not ?

                   

Often a patient presents to my office complaining of thick fungal toenails.  But is it really a fungus ?  Most people are aware that thickened, darkened toenails often mean fungus of the toenails; a condition called onychomycosis.  However, trauma to the toenail, even seemingly minor trauma, can also cause the toenail to become thick and darkened.

                    

Onychomycosis can be caused by one or more types of fungus, causing the nail to become thickened, darkened, and with hard tissue under the toenail.  Treatment consists of either oral or topical medications.  Resolution is slow, even with the most effective treatments.

                    

If the thickened toenail is caused by trauma, conventional fungus treatments won't work.  Thickened or dystrophic toenails may be caused by direct impact trauma, such as dropping a heavy object on the toe.  Sometimes microtrauma can cause damage of the toenails.  This is mild repetitive trauma that is often associated with stop and go actions, causing the toenail to rub on the sneaker.  This is common with runners, basketball players, and tennis players.  A substance, called keratin, forms under the toenail, causing it to become thickened and dark, mimicking onychomycosis.

                    

The only way to definitively make a diagnosis is with a nail culture, which is analyzed by a lab.

                    

If your toenails are thickened, darkened and uncomfortable, call us today. We can diagnose the problem and give you fast relief.  Our offices stress preventive foot health, especially for at risk patients with diabetes and poor circulation.  We are located at 1398 Highway 35, Ocean,and 191 Highway 37 W, Toms River.  We can be reached at (732) 988-0070 or (732) 286-9200.  For more information , log onto our website at www.drkelner.com