A to Z of Charcot Foot Reconstruction

People suffering from neuropathy (considerable nerve damage) have weakened bones in the foot, which are prone to stress buildup, and may eventually suffer a crack or fracture. This condition is called Charcot foot. With continued walking, the injured foot or ankle is subjected to continuous pressure. As the disorder reaches an advanced stage, it can finally lead to a collapse of the joints, which would give an abnormal shape to the foot.

Charcot foot is an extremely serious disease that can cause disability and deformity. Some cases may even lead to amputation. That’s why it becomes important for those with diabetes, a disease connected to neuropathy, to take preventive measures and consult a doctor as soon as they spot symptoms of Charcot foot. 

Symptoms

Common symptoms of Charcot foot could include:

• Redness in the foot
• Feeling of warmth in the affected foot
• Soreness
• Swelling in the area
• Pain

Treating Charcot Foot

The optimal treatment for this condition, which could be either amputation or salvage, has been a subject of long-term debate among orthopedic surgeons. Though non-operative treatment options include limiting any walking, weight bearing and loading of the foot and ankle until the bone has healed, it may not give effective results in severe cases. During such instances, surgical intervention may become necessary. 

Depending on the extent of ulcerations, foot deformities and instability, the best surgical option is assessed. From simple exostectomy with ulcer excision, exostectomies with rotational flaps, free tissue transfers, to arthrodesis (major elective reconstruction) as well as internal and external fixation, there are various surgical treatment options available today. However, the key to successful reconstruction depends on proper selection of the procedure and patient compliance. Though patient compliance may seem like a foregone conclusion, it becomes important to educate patients about the need for a period of non-weight bearing post-operative phase where the foot heals slowly and eventually becomes free of pain.

For treating Charcot joints, the clear winner is arthrodesis. This procedure involves joint fusion between two bones via surgery that helps in realignment and correction of deformities, improves function, eliminates instability and helps in the maintenance of such corrective steps. 

Usually, the level of fusion (triple, mid-foot or ankle arthrodesis) is determined by the extent of the deformity. In these complex fusions, the use of screws, plates and intramedullary nails has become a standard practice these days as they offer improved outcomes with better solid fixation. In recent years, an increase in the usage of external fixation has been noticed. In reconstructive surgery of the Charcot foot and ankle, surgeons may use external, internal and combined fixation, after assessing what the situation demands.  

Past vs. Present

Earlier, standard methods of internal fixation were used for corrective surgery, which was performed as a staged procedure. The first stage involved resection of the infected bone while internal fixation was applied at the second operation. Today, fine-wire external fixation is used to conduct a single-stage resection along with correction. To maintain the correction, a fine-wire (multi-plane) external fixator is used.  

Charcot foot adversely affects the patient’s quality of life and creates a severe negative impact on his/her overall health. Therefore, it becomes important to consult an orthopedic or foot and angle surgeon on time to avoid amputation and get the limb salvaged.

Know All About Ankle Arthroscopy

Ankle arthroscopy refers to a surgical procedure used to treat ankle problems. This minimally invasive procedure employs an arthroscope (thin fiber-optic camera) that magnifies images of the ankle and transmits them to a video screen. The aim of this surgery is to decrease ankle pain and improve overall function.

Conditions and Causes that Require Ankle Arthroscopy

This procedure can be used to identify and treat several disorders of the ankle joint. Some conditions that can be treated with ankle arthroscopy include:-

• Ankle arthritis
• Ankle instability
• Severe fracture or sprain in the ankle
• Arthrofibrosis
• Athlete’s ankle
• Loose bodies (free floating bone, cartilage and scar tissue in the joint)
• Infection
• Synovitis (inflammation of the synovial tissue)
• Infection in the joint
• Osteochondral defect

At times, patients may develop symptoms in and around the ankle that other diagnostic techniques fail to explain. In such cases, ankle arthroscopy can help the surgeon look directly into the joint to identify the issue and decide on the treatment.
 

When Do You Require Ankle Arthroscopy?

Ankle arthroscopy is usually recommended for injuries caused by sports activities, accidents and age-related bone conditions. This surgical procedure is performed to diagnose a problem in the ankle or when an ankle injury fails to settle. Those suffering from inflammation and arthritis can get relief when ankle arthroscopy is used to repair damaged tissue and cartilage or remove loose bodies.

Why is ankle arthroscopy better than an open surgery?

Arthroscopy is an advanced option that minimizes post surgery effects and scars. Some of the key benefits due to which ankle arthroscopy is adopted by the patients as well as the doctors include:-

• Pain levels are significantly lower than open procedure
• Faster healing of the wound and hence, movement of ankle and physiotherapy can be conducted early on
• No obvious scars
• Probability of infections are low
• Quick return to normal activities
• Most often, it is a single day procedure including the admission and discharge procedures

Treatment Procedure of Ankle Arthroscopy

• Before Surgery: The option to undergo an ankle arthroscopy should always be the combined decision of the individual and the surgeon. You need to know about the procedure as much as possible. In case you have questions or concerns, make sure to talk to your surgeon. Once the decision to proceed with the surgery has been taken, your surgeon may recommend going to your regular doctor for a complete physical examination. This exam will help ensure that you are fit to undergo the operation. You may also be advised to talk to the physical therapist who will be managing your post-surgery rehabilitation in order to get a head start on your recuperation. The therapist will examine your present pain levels, capability to do your activities and the strength and movement of each ankle. She/he will also teach you how to walk safely using a walker or crutches as well as teach some exercises that you can do during your recovery.
• The Actual Procedure of Ankle Arthroscopy: Most often, local anesthesia is administered in the ankle region. However, in some cases, a general anesthesia might be required. Your ankle would be placed on a traction table with an arthroscope, TV screen, and other essential tools set up and connected through portals and tubes to your ankle joints. The actual procedure involves making minimal incisions in the area of injury. The surgeon performs the procedure on completion of which the openings would be closed with stitches. The leg would be elevated throughout and after the procedure to avoid swelling.
• Post Surgery: You would be given medications for healing and pain relief as the surgeon deems fit. The dressings will be removed within a few hours though the feet would be covered in minimum surgical plasters. Most often, the weight bearing is done on the same day with or without the help of crutches. You may even be allowed to drive or return to your sport within one week, depending on your recovery time.

Today, ankle arthroscopic procedures are adopted even for reconstructive surgeries. No two individuals have the same type of problem or heal the same way. Therefore, it is essential for you to go through all the stages of surgery according to the advice of your general doctor and the surgeon in charge of the procedure.

Treatment for Nail Fungus

Nail fungus, which mostly occurs in your feet, is a common problem troubling many. Your feet support your entire body weight and bear the constant wear and tear. However, neglecting the feet is a common trend among most people, which in turn paves way for a lot of pain and discomfort. One of the major foot problems is nail fungus, which usually occurs when fungus enters the nail through a break or cut in it.

The common symptoms of nail fungus are thick and discolored nails that are either distorted in shape or are brittle/ragged. However, pain at the fingertips or toes is quite uncommon. Nail fungus can lead to severe health issues, if not treated on time. Hence, it is important to treat nail fungus with the help of an expert podiatrist. 

Here are some of the tried and tested methods to cure nail fungus.

Medications

Keeping your nails properly trimmed and filed can help reduce the amount of fungus in the nails. Taking oral antifungal drugs, and applying medicated nail polish as well as nail creams are some of the most common methods that you can follow in order to cure nail fungus.

• Medicated nail polish – Podiatrists often prescribe antifungal nail polish to combat this disease. You should paint the affected nail and its surrounding skin with this nail polish. It is advisable to apply the nail polish once a day, consecutively for seven days. After that, you can wipe off the piled-on layers and begin fresh application. 
• Oral antifungal drugs – Doctors often prescribe oral antifungal drugs to treat nail fungus, as they encourage the growth of new nail that can replace the infected nail. Usually, it is advisable to take these drugs for six to twelve weeks. However, it may take as long as four months to eliminate the infected nail completely. People aged over sixty five years are reported to have lesser benefits from such drugs. If suffering from nail fungus, you may get better results by combining topical and oral antifungal therapies.
• Medicated nail cream – Just like medicated nail polish, nail creams too are often prescribed by podiatrists. You need to rub this cream into the infected nail once you have soaked it in water. It is advisable to make the nail thinner before applying such creams. This will ensure that the cream gets through the hard nail surface to reach the underlying fungus. You may request your foot doctor to thin the surface of the nail using a nail care tool.

In case the medications don’t help, your podiatrist may consider either of these two procedures to treat nail fungus.

• Surgery to remove the affected nail: Your foot doctor may recommend removing your affected nail in case the infection is very painful or at a severe stage. You shouldn’t worry though, as a new nail will grow in its place, though it may take up to a year. At times, doctors may decide to treat the nail bed by combining a surgery with Ciclopirox.
• Other therapies: Carbon-dioxide laser treatment and light-based therapy, coupled with medications such as antifungal nail cream, can offer speedy relief and help improve your nails.

If you or anyone you know is troubled by nail fungus, and over-the-counter medicines and products haven't helped much, you should consult your podiatrist right away to get the condition treated.

Treating Achilles Tendon Disorders

Achilles tendinitis, an injury of the Achilles due to overuse, is a common disorder which often occurs in people who usually participate in sports like gymnastics, running, football, baseball, softball, tennis, basketball and volleyball. If you are involved in any of these sports, you are at risk of suffering from this disorder. At times, even inactive people or recreational exercisers may suffer from this condition which triggers pain along the rear part of the leg, close to the heel.

Achilles tendinitis is caused when the tendon is subject to repetitive stress. Most people fall prey to this disorder by pushing their bodies to do too much in very little time. However, other factors such as increasing the intensity/amount of exercise all of a sudden, using an aggressive exercise schedule when you have tight calf muscles (that strain the Achilles tendon), or bone spur can also increase the chance of developing tendinitis.

Most cases of this Achilles tendon disorder can be treated with nonsurgical treatment. Though these treatment options offer pain relief, the symptoms may take a few months to subside completely. Popular nonsurgical treatment for Achilles tendinitis includes:

• Ample rest: The best way to heal yourself is to take adequate rest. Stay away from any activity that causes strain to your tendon. These include running or climbing the stairs as well as other high-impact exercises. Since you can't get involved in these activities, you can opt for easy, low-impact exercises that will put less stress on the Achilles tendon.
• Apply ice packs: You can reduce the pain by applying ice packs on the affected area at any time, during the day. You may use these packs for up to 20 minutes but if your skin becomes numb, it’s advisable to stop it. 
• Take NSAIDs: You can take some non-steroidal anti-inflammatory drugs (NSAIDs) that help reduce swelling and pain. However, you should remember that such medications won’t decrease the thickening of the degenerated tendon. You should also consult your podiatrist before continuing such medications beyond a month.
• Exercise to stretch the calf muscles: One of the best ways to treat Achilles tendinitis is to do some stretching exercises that decrease stress on the Achilles tendon and strengthen your calf muscles. You may also do eccentric strengthening exercises under the supervision of an experienced physical therapist. 
• Avoid having pain killers: Popping pain killers won’t be of much help in treating this Achilles tendon disorder. Since it is not an inflammation but a degenerative injury, the pain killing drugs will mask the problem temporarily, which will make the degeneration even worse.
• Using orthotics and supportive shoes: Your podiatrist may suggest supportive shoes like those with heel lifts or the ones with a softer section at the back that offer pain relief. A silicone Achilles sleeve or a walking boot (albeit for a shorter time period) may also be advised by your foot doctor.

In case the nonsurgical treatment options fail to offer pain relief after 6 months, your podiatrist may consider surgery. Depending on the extent of tendon damage and location of the tendinitis, the specific type of surgery is determined.

Gastrocnemius recession to elongate the calf (gastrocnemius) muscles can help patients having difficulty in flexing their feet. Débridement (amputation of the damaged tissue) and repair operation is performed in cases where damage to the tendon is less than 50%. Débridement with an Achilles tendon transfer is done where the tendon damage is over 50%. Physical therapy is a significant part of post-surgery recovery and most patients usually need a year of rehabilitation before they can become pain-free.

Maintaining Foot Health during Pregnancy

The extra weight and hormonal changes that women have to bear during pregnancy can be tough. Apart from a swollen belly, what will make it more difficult are swollen feet and legs that some women experience during this phase. With an increased stress on the feet due to the extra weight, pregnancy can often make it an uphill task to walk around. Unless steps are taken to maintain foot health, a phase that should be spent in a joyous mood can become a disappointing chore.

Don’ts

Most pregnant woman pay more attention to the aesthetic look of their shoes rather than considering how comfortable they are to wear and move around in. In their quest to keep up with recent fashion and celebrity trends, many even make choices that are risky for their foot health. Choosing unsupportive shoes such as ballet pumps, high heels, Ugg boots and flip flops is a total no-no for pregnant women, say experienced podiatrists.

During pregnancy, ligaments and muscles stretch and soften. This makes your feet increasingly prone to ligament and ankle strains. When you wear high heels, your posture is altered and your calf muscles are shortened, which will put increased pressure on your knees and back. Due to extra weight gain, your joints are already under strain and you shouldn’t make the situation worse by wearing high heels. Apart from causing several leg, foot and back problems, high heels can even increase chances of a fall.

When choosing your shoes for daily wear, you should avoid Ugg boots, flip flops and ballet pumps too as they don’t give your feet the necessary support.

Do’s

Wearing supportive, comfortable footwear is the primary step in pregnancy to ensure foot heath. Foot doctors suggest choosing shoes with laces, a strap or Velcro to ensure that they fit comfortably and stay firmly on your foot. However, you should not buy shoes with tricky straps that are difficult to fasten. This is especially applicable when you are in the final trimester of your pregnancy.

Footwear with small heel height (ideally of 3 cm) can shift your weight a bit to the front of your feet, which in turn can lessen discomfort. Supportive shoes that have a firm heel, supportive arch and extra shock absorption are good choices in pregnancy.

Rather than selecting tight, pointed shoes, you should invest in square shaped or rounded ones that have a spacious toe box to offer you a comfortable fit.

During the day, your feet tend to swell. They are at their largest in the late afternoon. This is the ideal time to buy shoes. You should make sure that a 1 cm gap exists between your shoe’s edge and your longest toe.

Whether you are sitting or lying, maintain the correct posture. For instance, refrain from crossing your ankles or legs when sitting.

Perform some simple exercises to reduce swelling and discomfort. To improve circulation and avoid cramps, you can rotate your ankles for 10 counts, first in the clockwise and then in an anticlockwise direction. While lying on your back, pedaling to imitate riding a bicycle can help strengthen leg muscles and reduce swelling in the feet. Daily calf and leg stretches can also help. It’s best to consult your podiatrist to find which exercises or poses are safe and beneficial to do before your start your pregnancy fitness routine.

Foot health in pregnancy is often neglected. Starting from simple foot and back pain to more serious diseases like over-pronation and plantar fasciitis may occur due to this negligence and lack of awareness. Foot doctors suggest consulting a podiatrist and adhere to the advice given, for maintaining foot health and enjoying pregnancy.

What You Should Know About Fungal Toenails

Unhygienic conditions often result in several foot conditions, fungal toenails being one of the most common problems.  If the fungus is left untreated for long, this results in a serious toe infection. Mostly due to lack of maintenance and ignorance, the fungal infection spreads thus doing major harm to your feet.

What exactly causes fungal toenail infections? Reasons are many and so are its treatments. Most of the causes are preventable but certain factors enhance the possibility of developing such infections.

Symptoms:

Onychomycosis, also called as Tineaunguium, is a common fungal infection that usually affects nails. This kind of infection may harm a part of the nail or an entire portion of it. The list of symptoms for early detection are given as follows:

• Scale formation under the nail
• A yellow strip formation on the nail
• Curving of the corners or tip of the nail
• White flake like areas appearing on the surface of the nail
• Yellow spots under the nail
• The final stage is loss of the nail

Factors that cause fungal toenail infections:

A person is most likely to develop this infection if he is prone to the following factors:

Diabetes: This is the most common symptom. People with diabetes often suffer from sweaty feet as compared to others. Since the feet area remains covered most of the time and not well maintained, the infection attacks this portion more often. Care should be taken to keep the feet clean. A very easy home remedy is to immerse the foot in warm water with rock salt added in it.

Swimming in public pools: This is another common factor that can cause toenail infections. Mostly water at public pools remains unclean thus spreading infection. The fine gap between nails becomes primary target for bacteria to settle. Preventive measures like applying water based lotions and having a hot water bath after the swim can help prevent this condition.

Moist toes: Moist toe areas are the breeding places for fungi. People wearing closed shoes or boots most of the time remain susceptible to fungal infections. This is because bacteria in the feet receive additional boost, when toes remain moist. Changing socks regularly and cleaning shoes can be very good hygienic habits which help prevent foot infections.

Weak immunity: A weak immune system decreases the body's ability to fight diseases thus making it vulnerable to infections. Since the immune system fails to produce necessary antibodies to fight germs and bacteria, this lets the infection escalate.

How to treat fungal toenails:

Home remedies and professional treatments can be sought to cure such infections. An antifungal cream can be applied on the affected area. Another alternate is to apply Vaseline on dry toenails. Antifungal powder rubbed on the feet before wearing shoes or slippers, proves to be effective too. One can soak feet with vinegar and warm water solution.

The wisest approach is to get in touch with an expert podiatrist if your toenail starts showing signs of a fungal infection.

How aging affects foot health

Taking care of your health is a serious process and should be done in a manner to ensure that you age hale and hearty. Many fail to include foot care within their routine health checkups. This is absolutely wrong! The fact is your feet mirror the aging process. Hence it can have profound consequences as you age. Severe foot disorders can come in the way of an elder’s mobility and independence.

The human body undergoes natural changes with aging, which in turn causes foot inflammation, pain and various other disorders. Careful assessment of an older person’s feet usually reveals gross changes in appearance, alterations in sensitivity and joint motion, which can eventually lead to limited mobility or even dysfunction. Continue reading to know how aging affects foot health and what you can do to take care of your feet from an early age.

Effects and Preventive Measures

• Skin problems that might affect feet
Your skin gradually changes with aging. This results in reduced skin cell growth and collagen production. Many might experience thinness of their foot skin. Dry foot skin can be avoided by applying moisturizers on a daily basis. This is the best remedy for cracked feet or skin rashes.
Bathing is very important to ensure sound foot health. Particular care should be given to cleaning between toes. Feet should be dried gently and thoroughly especially after returning from the workplace. Frequency of footbaths can be increased, which is definitely more convenient and safer.


• Disfiguration of toenails
Toenails tend to lose its normal shape with age, thereby getting thicker. Some might experience brittleness of toenails too. This is due to hormonal effects that slow down the toenail’s growth over time. Then the toenail might get thick because of hypothyroidism. Poor blood circulation might also cause brittle toenails.

Pedicure is troublesome for elders who have poor vision or whose dexterity is faulty. One can seek professional help to properly cut toenails across so that in-growths and skin punctures can be prevented.


• Foot conditions from Orthopedic disorders
It’s normally seen that shoe sizes or foot shapes changes with time. As a person starts aging, his body’s ligaments undergo several modifications which put extra stress on the foot. This is the reason why most elders develop joint, ankle and toe pain. The condition becomes severe for those suffering from Arthritis. Specially designed orthopedic shoes with custom insoles can bring relief to joint or foot pain.


• Reduction in blood circulation
Often elders complain of a very common foot problem, that of swelling. Inflammation results from poor blood circulation in the leg’s veins. The problem usually starts with one limb but may spread to the other one, if not cured in time. Elders suffering from cardiovascular conditions or those undergoing specific medications might experience blood circulation problems. Custom molded shoes can be used for the perfect fit. Superficial circulation maybe enhanced with a gentle massage using a good quality skin lotion.

Feet are particularly vulnerable to age-related changes. Walking is the best exercise for your feet. Inspect your feet every day, or let a foot specialist do this for you. The best way to prevent the effects of aging on your foot is by getting it examined by skilled foot care professionals at least once a year. Physical therapists can play a key role too, in guiding you towards having healthy feet.