Stress Fractures

An incomplete break in the bone caused by overuse is known as a stress fracture. Symptoms can include pain, swelling, and redness. Up to 15% of all sports injuries are stress fractures. A podiatrist needs to perform an examination and look at x-rays of the injury in order to diagnose a stress fracture. Treatments include immobilization of the foot with the use of a cast, medications, and in some cases, orthotic devices to prevent further injury.

If you have questions about stress fractures, we have much more information on our website www.nastfootandankle.com. For an appointment please call our office at 305.220.3636 or visit our website for an appointment request. You can also sign up for our newsletter and request my FREE podiatry book.

Jorge F. Nasr, DPM
11760 Bird Road, Suite 610
Miami, FL 33173
305.220.3636
www.nasrfootandankle.com

Haglund’s Deformity

Another name for Haglund’s Deformity is retrocalcaneal bursitis. The heel bone enlarges in the back area where the Achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe, and can be aggravated by the height or stitching of a heel counter of a particular shoe. Sometimes something as simple as changing your shoes can alleviate the symptoms.

If you have questions about Haglund’s Deformity, we have much more information on our website www.nastfootandankle.com. For an appointment please call our office at 305.220.3636 or visit our website for an appointment request. You can also sign up for our newsletter and request my FREE podiatry book.

Jorge F. Nasr, DPM
11760 Bird Road, Suite 610
Miami, FL 33173
305.220.3636
www.nasrfootandankle.com

Sesamoiditis

The two sesamoids are bones found in the underside of the hallux, or great toe.  Sesamoids act like pulleys providing a smooth surface over which the tendons slide, thus increasing the mechanical force of the tendons. The sesamoids also assist with weightbearing and help elevate the bones of the great toe. Injuries that can occur involving the sesamoids include, but are not exclusive to fractures and sesamoiditis.  When a patient has sesamoiditis the tendons surrounding the sesamoids become inflamed. Sesamoiditis is common condition observed among ballet dancers, runners and baseball catchers

            When a patient comes into the office complaining of pain under the ball of the foot and a physician suspects sesamoiditis, often the first step taken will be to take an x-ray.  It is important that the physician rule out a fracture before any other diagnosis is made.  When the physician determines that the diagnosis must be sesamoiditis based upon the history, x-ray that is negative for a fracture, and a positive physical exam, proper treatment and patient education to help avoid future injury can begin.  Treatments for sesamoiditis may include steroid injections, extraction of excess synovial fluid from around the sesamoids, decreasing activity, wearing lower shoes, and using felt pads to cushion and offload the area.

If you have questions about Sesamoiditis we have much more information on our website www.nastfootandankle.com. For an appointment please call our office at 305.220.3636 or visit our website for an appointment request. You can also sign up for our newsletter and request my FREE podiatry book.

Jorge F. Nasr, DPM
11760 Bird Road, Suite 610
Miami, FL 33173
305.220.3636
www.nasrfootandankle.com

Raynaud’s Disease

Raynaud’s disease is a condition where certain areas of the body, most commonly the nose, toes, and ears, become numb and feel cold to the patient.  A Raynaud’s episode can occur in a situation that involves cold or stress for the patient.  During an episode there is vasoconstriction that occurs in the small vessels which limits the circulation to those areas of the body.  When a patient has an episode, the skin will first turn white, then blue, and finally red as the blood returns to the area.  Women are more likely to have Raynaud’s disease. Raynaud’s disease may occur in association with several other rheumatic diseases, but it may also occur by itself in patients with particularly spastic vasculature.

            When a patient is having symptoms where he or she notices color changes in the hands or feet, a trip to see a physician to diagnose this problem is essential.  If blood supply is cut off for a prolonged period of time, ulcers may develop, so this condition has the possibility of being more serious than just having cold hands or feet.  Treatment for Raynaud’s disease mostly involves dressing appropriately to avoid the extremities becoming too cold.  Medicinal treatment for the condition may involve Alpha blockers, Calcium channel blockers, or vasodilators.  If all conservative treatments fail, a surgical or chemical sympathamemectomy may be used to help treat some of the symptoms.

 If you have questions about Raynaud’s Disease, we have much more information on our website www.nastfootandankle.com. For an appointment please call our office at 305.220.3636 or visit our website for an appointment request. You can also sign up for our newsletter and request my FREE podiatry book.

Jorge F. Nasr, DPM
11760 Bird Road, Suite 610
Miami, FL 33173
305.220.3636
www.nasrfootandankle.com

Diabetic Foot Care

Here is some basic advice for the care of diabetic feet:

• Inspect your feet every day.
• Keep your feet clean and dry.
• Always keep your feet warm.
• Take extra care drying your feet and toes after showering. Pay special attention to the space between your toes.
• Be sure to exercise. Walking is one of the best exercises for diabetics unless you have complications. If you struggle with balance use a cane.
• Always protect your feet and legs. Never walk barefoot.
• Avoid hot water bottles and heating pads.
• Do not overexpose skin to the sun.
• If your skin is dry use moisturizing cream or lotion daily. Do not, however, apply between the toes.
• Cut your toenails straight across and even with the skin on the end of your toes. Do not cut into the corners. If you can’t see or reach your toenails have someone else do it for you.
• Never use razor blades, knives, scissors or medicated corn/wart removers.
• Look for redness, blisters, scratches, cracks between the toes, discoloration or any other change.
• Avoid all actions that diminish circulation such as tobacco use, sitting with legs crossed, and circular elastic garters.
• Change your shoes and socks daily.
• Wear soft leather shoes that conform to the shape of your foot.
• Gradually “break in” new shoes and avoid blisters.
• Call us if you see any changes in your feet.

If you have questions about diabetic foot care, we have much more information on our website www.nastfootandankle.com. For an appointment please call our office at 305.220.3636 or visit our website for an appointment request. You can also sign up for our newsletter and request my FREE podiatry book.

Jorge F. Nasr, DPM
11760 Bird Road, Suite 610
Miami, FL 33173
305.220.3636
www.nasrfootandankle.com

Psoriatic Nails

Sometimes things are not as they seem, and this goes for nails as well.  A patient may come into the office suspecting that they have a fungus, only to find out that they have another condition causing changes in their nails.  Psoriasis is a common autoimmune condition that is most well known for the red plaques with silvery scales it causes on the extensor surfaces of the body.  Psoriasis runs in families, but it is not contagious.  People with psoriatic nails display a characteristic pitting of the nail, look of an oil droplet beneath the nail, and a nail with white debris.  20% of the people with psoriatic nails also have an associated psoriatic arthritis

The first step to treating this nail condition is diagnosis.  Psoriatic nails may appear to be a fungus, even to a well trained podiatrist, so a nail biopsy is always a first step in the diagnosis of the nail pathology. When the diagnosis is finally made, appropriate treatment can begin which may include topical steroid creams or ointments, systemic therapy with drugs such as methotrexate or Humira, or PUVA light therapy.  Surgical removal of the nail is a treatment reserved for recalcitrant cases.

If you have questions about Psoriatic Nails, we have much more information on our website www.nastfootandankle.com. For an appointment please call our office at 305.220.3636 or visit our website for an appointment request. You can also sign up for our newsletter and request my FREE podiatry book.

Jorge F. Nasr, DPM
11760 Bird Road, Suite 610
Miami, FL 33173
305.220.3636
www.nasrfootandankle.com

Complex Regional Pain Syndrome

            The cause of patient pain is not always apparent.  After an ankle sprain, for example, a patient may come into the office with pain out of proportion for the injury that he or she incurred.  When all other causes of pain have been ruled out, a physician may suspect complex regional pain syndrome, or reflex sympathetic dystrophy.  While the most common cause of CRPS is an ankle sprain, crush injuries, surgical incisions, or other trauma can be the cause of CRPS.  CRPS is classified into two types: Type I (RSD) involves pain, temperature changes, limb edema, skin discoloration, and abnormal sweating.  Type II (causalgia) is similar to type I, but it involves a peripheral nerve lesion that can be isolated.  The most common nerve damaged in Type II CRPS is the superficial peroneal nerve.

            Making the diagnosis of CRPS early is essential so that treatment can begin promptly.  One of the best ways to detect CRPS, aside from patient history and clinical signs, is to order a triple phase bone scan.  In a patient with CRPS, there will be increased blood uptake in an area of the limb in question that is apart from the location of the original injury.  When a physician sees this finding, CRPS should be one of the first diagnoses on his list.  Treatment for CRPS should begin as soon as possible to ensure that the patient gets maximal relief.  The limb must not be immobilized and the patient should begin physical therapy immediately. Other therapies for CRPS may also include nerve blocks, oral steroids, and even oral anti-depressants.

If you have questions about Complex Regional Pain Syndrome, we have much more information on our website www.nastfootandankle.com. For an appointment please call our office at 305.220.3636 or visit our website for an appointment request. You can also sign up for our newsletter and request my FREE podiatry book.

Jorge F. Nasr, DPM
11760 Bird Road, Suite 610
Miami, FL 33173
305.220.3636
www.nasrfootandankle.com

Diabetes

Diabetes can affect many parts of the body, especially the feet. According to the American Diabetes Association, about 15.7 million Americans (5.9 percent of the United States population) have diabetes. It is very important that a diabetic gives the feet very special care. A small problem in a healthy person could become a severe one to a diabetic.

Diabetes can affect the feet in a number of different ways. The first is infection, which is one of the most common complications of the diabetic foot. Because diabetes causes reduced immune response, a diabetic patient’s ability to fight infection is decreased. Early treatment of infection is a critical component to success. If neglected, infection of the foot can cause gangrene, ulceration, bone infection, and even amputation.

Another complication of diabetes called neuropathy causes decreased sensation to pain and temperature. This may cause a patient to underestimate a foot problem. It may also be responsible for an absence of perspiration leading to dry, cracking skin that can more easily become infected.

Foot ulcers are local skin defects with inflammation or infection. They can be caused by lack of circulation, infection, lack of protection, and improperly fitting shoes. A break in the skin without proper treatment may become an ulcer. Diabetics are at higher risk for developing foot ulcers.

With a diabetic foot, a wound as small as a blister from wearing a shoe that’s too tight can cause a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When your wound is not healing, it’s at risk for infection. As a diabetic, your infections spread quickly. If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts, and nail problems. Get someone to help you, or use a mirror. Diabetic foot care can be very complicated and good podiatric care is an essential component of managing diabetes.

If you have questions about diabetes, we have much more information on our website www.nastfootandankle.com. For an appointment please call our office at 305.220.3636 or visit our website for an appointment request. You can also sign up for our newsletter and request my FREE podiatry book.

Jorge F. Nasr, DPM
11760 Bird Road, Suite 610
Miami, FL 33173
305.220.3636
www.nasrfootandankle.com

Os Trigonum Syndrome

               When patients present in the clinic complaining of foot, ankle, or heel pain, often the first course of action taken by the physician is to get x-rays of the foot or ankle in questions.  Sometimes it is found that there is an additional bone or “accessory bone” present where the patient is experiencing pain.  Accessory bones are congenital and are often bilateral.  Accessory bones are formed by an additional ossification center that occurs away from the main bone during development.  Accessory bones are often an incidental finding that the patient is only made aware of when they come in for pain and have an x-ray taken.  It is often the case that a patient may be mis-diagnosed with a fracture when it is in fact an accessory bone, but a trained podiatrist will know how to differentiate between the two.  Many people have accessory bones without any pain or other symptomology.  The Os trigonum is an accessory bone that is located behind the talus and it is sometimes bound to the talus with a cartilaginous band.

             Os Trigonum syndrome is a condition that is commonly seen in ballet dancers who are ‘on point’.  Often the impetus for this condition is trauma, like an ankle sprain. The patient comes into the clinic complaining of pain in the back of the ankle or pain when pushing off of the foot when walking.  When a ballet dancer is ‘on point’ he or she forcibly plantarflexes the foot which can cause pressure or crushing on the os trigonum where it sits between the calcaneus and the tibia.  Other cases of this injury occur when the patient is in releve or when he or she is leaping.  This injury can mimic many other conditions, so seeing your podiatrist to be evaluated is essential.

            Treatment for Os Trigonum syndrome is tricky because most dancers do not want to stop dancing in order to get relief of their pain.  Rest is the first line of treatment for os trigonum syndrome, but when a dancer must continue to perform, the next line of defense is often a series of cortisone injections into the area and possibly a course of oral steroids to help decrease the inflammation.  If the injections and rest do not work, immobilization in a short leg cast is often the next step in conservative treatment of this condition.  Finally, when all conservative treatments have been exhausted, surgical removal of this accessory bone may be in order.

If you have questions about Os Trigonum Syndrome, we have much more information on our website www.nastfootandankle.com. For an appointment please call our office at 305.220.3636 or visit our website for an appointment request. You can also sign up for our newsletter and request my FREE podiatry book.

Jorge F. Nasr, DPM
11760 Bird Road, Suite 610
Miami, FL 33173
305.220.3636
www.nasrfootandankle.com

 

Emla

      No one likes to receive a shot, but there are some ways to lessen pain and anxiety when injections or other uncomfortable medical procedures are necessary to treat particular conditions of the foot and ankle.  Emla is a medication that can be applied to intact skin to help numb down to the layer of the dermis to decrease pain associated with injections or other medical procedures.   While it has many applications in podiatry, Emla is often used to numb the skin before a neuroma injection, before debridement of a painful ulcer, or before an injection of local anesthetic is given in order to remove an ingrown nail.  Emla is a mixture of two anesthetics, Lidocaine and Prilocaine.  The active ingredients in Emla work by blocking the nerves signals transmitting the sensation of pain to the brain.  While Emla is often associated with use on intact skin in preparation for painful medical procedures, it can also be used on broken skin, but must be done so with care because more of the medication is absorbed when the medication is used in this way.

      Emla is very easy to use and is available in many clinics or by prescription for the patient to use before coming to the doctor’s office.  Emla is available in a cream or patch form and is applied to the skin at least 30 minutes prior to the procedure or injection to allow it to take effect. Once Emla begins to work, it will last for 30 minutes to one hour.  When Emla is applied in its cream form, it is best to use an occlusive, or airtight, bandage or plastic wrap to help hold the cream against the skin, allowing it to work most effectively to lessen a patient’s discomfort.  While Emla does not completely numb the skin like an injectable anesthetic would do, it definitely deadens the skin allowing uncomfortable medical procedures or injections to be more tolerable for the patient.

If you have questions about Emla, we have much more information on our website www.nastfootandankle.com. For an appointment please call our office at 305.220.3636 or visit our website for an appointment request. You can also sign up for our newsletter and request my FREE podiatry book.

Jorge F. Nasr, DPM
11760 Bird Road, Suite 610
Miami, FL 33173
305.220.3636
www.nasrfootandankle.com