Physician Journal : Midwest Foot & Ankle Clinics

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2011-11-30T01:53:59Z

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Stress Fractures

2008-08-21T02:23:09Z

A stress fracture is a tiny or incomplete crack in a bone that is often caused by overuse. Stress fractures occur most frequently in the foot and ankle, so your podiatric physician is well trained to

diagnose and treat this problem.

Stress fractures may be caused by a number of factors. Overuse or strain in the foot (fatigue fracture) is one of the most common causes, while weak bones (insufficiency fracture), caused by medical conditions such as osteoporosis, can also be a factor. Medications such as steroids can lead to stress fractures, as can a sudden increase in activity levels. All of these causes can and should be evaluated by your podiatrist when you have the signs and symptoms of a stress fracture.

Those signs may include pain that increases with activity and decreases with rest, pain that increases over time, or pain that persists even at rest. Often a stress fracture will result in swelling and a spot that feels tender to the touch.

If you experience any pain during physical activity or any of the symptoms described, you should see your podiatric physician. Prompt diagnosis and treatment of a stress fracture can often prevent further injury. The doctor will ask you to describe the signs and symptoms and then physically evaluate your foot or ankle. While x-rays will most likely be used for diagnosis, often stress fractures do not appear on regular x-rays for several weeks after the symptoms begin. In some cases, the fracture may never appear on an x-ray. In those cases, the doctor may recommend other diagnostic testing such as MRIs, ultrasounds, or bone scans.

Many stress fractures can be treated with rest, ice and over-thecounter pain relievers. For most people, an appropriate period of rest will be sufficient for the bone to heal. In other cases, your podiatrist may need to immobilize the affected bone with a cast, cast boot, fracture shoe, or a splint. In the most severe cases, a pin may be surgically inserted into the bone to hold it together and promote proper healing. However, surgical intervention is the treatment of last resort.

Here are a few simple steps to prevent stress fractures:

Start new exercise programs slowly and progress gradually. Work with your doctor to design a routine that fits your fitness level.
Avoid sudden intensity changes in your exercise routine.
Always use the proper equipment for your sport. This includes finding the best shoe for your foot type.
Cross-train to avoid repetitively stressing your feet and ankles.
Visit your podiatrist to have custom shoe inserts (orthotics) made to improve foot function.
Eat right and make sure that you include plenty of calcium and nutrients in your diet.

Reprinted with permission from the APMA Footprints Newsletter.

Is There a Fungus Among Us?

2008-08-13T00:53:23Z

A very common problem evaluated in our office is that of fungal toenails. Women and men alike will relate toenails, which are "funny" or "ugly" looking. The nails are abnormal in appearance, but can also be painful with shoes and during activities. But, not all abnormal nails are due to fungus. So, let's dive into this common problem and get to the bottom of it!

Fungal Nails...What do they look like? Nails infected by fungus can be white and/or yellow to brown in color. The nails can get thick, develop ridges, crumble and spilt easily. They can have debris underneath the nail and separate from the skin below.

What causes it? Yeast, mold and several types of fungi can cause fungal toenails, A.K.A Onychomycosis and Tinea Ungium. The most common culprit is a fungus called Tricophyton Rubrum. This is the same organism that causes athlete's foot.

Where did I get it? Fungus is everywhere! But it really likes warm, moist places such as, pools, showers, locker rooms, beaches and your shoes! Nail polish and acrylic nails do not let the nail "breath" and can increase your risk for fungus. It can be spread from person to person and from skin (athlete's foot) to nail.

Is it always fungus? Nope! There are many other causes for abnormal nails. Trauma to the nails can cause bruising, thickening and lifting. Certain diseases such as Psoriasis can lead to abnormal pitted nails. Nails also tend to become thicker and more brittle as we age.

How can we tell for sure it is fungus? Your physician can obtain a sample of the affected nail and tissue and submit it for testing. A KOH and fungal culture would be ordered to evaluate for yeast, fungi or mold. Many insurance companies will require a positive fungal test prior to authorizing medications.

How is it treated? Depending on the severity of the nail infection topical and oral medications exist. Many times fungal nail infections can be very difficult to treat. In mild cases the topical medicine Penlac can be applied daily for up to 12 months.The oral medications (Lamisil, Sporanox and Diflucan) are given, usually, on a daily basis for several months. With these medications, the patient's liver function should be assesses prior to starting treatment and retested during the course of the medication. Numerous home remedies have been attempted such as, Vicks VapoRub, Tea Tree Oil and vinegar but with little success.

Can I prevent it from happening again? Allow your shoes to air out, not wearing the same pair daily. You can also apply antifungal powder to the shoes. Keep your feet clean and dry, drying well in-between the toes after bathing. Protect yourself at pools, showers, and locker rooms. Most importantly, treat athlete's foot in a timely fashion!