Halle Berry may not only have been afraid for her foot after she fractured it while shooting the movie “Cloud Atlas”, but she also may have feared for her job in revealing what she was doing when the fracture occurred!   Initially Berry reported that she was taking a casual stroll on her day off around the property she was staying at.  However, more recently she admitted that she was actually chasing goats with her young daughter leading up the injury!  Although the idea of chasing goats does not seem to make much sense, it at least makes a lot more sense for how a foot fracture developed!

To better understand fractures and how they occur, it is important to know that fractures can generally be divided into two groups: stress fractures and general bone fractures.  Stress fractures typically occur in people doing a low-intensity repetitive motion, such as running, marching or walking long distances.  The bone is not able to remodel and heal itself fast enough to keep up with the repetitive stress being place on it.  Muscles that are fatigued may also play a role in the development of a stress fracture because they will not be able to contract and redistribute force over a larger area. 

In this acute instance however, it is more likely that Halle suffered from a general bone fracture than a stress fracture.  This means that the cortex or hard outer shell of the bone was damaged all the way through in the area of the injury.  It was reported that Halle heard a “crack” & felt pain immediately shooting up her foot.  Because she was running on uneven terrain, it possible that Halle also sprained her ankle by rolling her foot.  While it has not been reported which metatarsal Halle broke, the fifth (or little toe metatarsal) is the most commonly fractured of the metatarsals in people above the age of 5.  In the instance of a 5^thmetatarsal fracture, it would be imperative to know exactly what position Halle’s foot was in and to have x-rays and other images taken to determine the location and characteristics of the fracture.  If she did in fact roll her ankle, she may not only have ligament and tendon damage, but the forceful stretch of tendon’s connecting to the bone may have pulled off, or avulsed a piece of the metatarsal causing the fracture.  Another scenario would be if she were propelling herself off the side of her foot, to run after a goat, she may have incurred a “Jones fracture”.  A Jones fracture not only disrupts the cortex of the bone, but also disrupts the blood supply to the bone that is crucial to its proper healing.  This type of fracture can require more serious treatment including surgery and longer periods of being non-weight bearing on the foot. 

The most important step in adequate healing of a fracture foot is getting the correct diagnosis in a timely manner.  Each of the different types of fractures described may have a slightly different course of treatment and identifying that course is critical to prevent delayed or improper healing or a longer course of foot pain for the patient.  Any actress, athlete or other individual who believes they may have a fracture or other foot injury should contact their podiatrist as soon as possible to ensure that they will be able to get back to chasing goats and all other fun activities as quickly as possible!

Please visit www.columbusfoot.com for more information or call 614-885 FEET (3338) to schedule an appointment with a podiatrist in Columbus, Ohio. Columbus Podiatry & Surgery is located on the North side of Columbus, Ohio  in between Westerville, Worthington and Powell. To schedule an appointment with a podiatrist in Dublin, Ohio, near Tuttle Crossing Mall, please call 614-885-FEET (3338).

By Dr. Animesh (Andy) Bhatia

Many diabetic patients may have heard warnings to look out for “charcot foot” but they may not know exactly what this means.  Different from diabetic charcot foot is an inherited disease with another characteristic foot type called Charcot-Marie-Tooth disease.  As a part of September’s Charcot-Marie-Tooth (CMT) disease awareness month, it is critical for patients to understand the differences between these two neurological disorders. 

CMT

Charcot-Marie-Tooth disease is caused by a gene defect that is often inherited.  If CMT is seen in other family members, parents should be on the lookout for the development of slowly progressing muscle weakness in the lower extremities before age 20.  Individuals with CMT have nerves that lose their myelin covering, which normally allows signals to be sent to and from skin and muscles at a normal speed allowing sensation and muscle contraction.  Patients will not usually complain of any numbness because their sensation was likely never completely normal.  As a result of the weakness and loss of sensation, first in the legs then typically seen in the upper extremities, kids with CMT may seem clumsy and have difficulty walking without tripping or rolling their ankles. The feet will often have a high arch appearance and may be prone to ulcers from damage caused by lack of ability to sense pain. 

Diabetic Charcot Foot

Patients with diabetes need to be concerned about charcot arthropathy when they develop areas of the foot where they can no longer feel anything.  The combination of lack of sensation allowing damage to the foot that patient cannot feel and an increased blood flow supplying mediators of the inflammatory process allows a “charcot joint” to develop.  In the charcot joint, the repeated small injuries occurring cause bones to gradually fracture and dislocate.   This causes deformity (often an extreme flat foot) which typically places the diabetic patient’s foot at a greatly increased risk of developing ulcers and subsequent infection with severe consequences.  The most common signs of the development of charcot arthropathy are swelling and increased temperature of the affected area of the foot, redness, pain and the feeling of a “loose bag of bones” when the joint is moved. 

In both diabetes with loss of sensation, and Charcot-Marie-Tooth, foot self-exams are immeasurably important in preventing ulceration and further complications.  Protective shoe gear and custom made orthotics can provide additional protective measures for the foot.  As shown by these two disease processes, loss of sensation in the foot is a major problem that should always be evaluated by your podiatrist.  

Please visit www.columbusfoot.com for more information or call 614-885 FEET (3338) to schedule an appointment with a podiatrist in Columbus, Ohio. Columbus Podiatry & Surgery is located on the North side of Columbus, Ohio near Worthington. To schedule an appointment with a podiatrist in Dublin, Ohio, near Tuttle Crossing Mall, please call 614-885-FEET (3338).

By Dr. Animesh (Andy) Bhatia

This past Sunday, the city of Columbus began working with the Diabetes Prevention and Control Alliance’s program to say “NOT ME” to diabetes.  As diabetes has become an epidemic in, programs such as “Not Me” are an important way to increase awareness about diabetes prevention and control.  The program involves a lifestyle coaching program to counsel those who are at risk for diabetes on making healthier choices involving diet and exercise. 

While this program provides useful information on how to take small steps towards a healthier life, it does not directly address how to prevent one of the scariest complications of diabetes:  amputation.  Diabetic individuals need to regularly see a podiatrist in order to receive proper foot care, keep a close watch on any changes in foot health that may indicate underlying pathological conditions, and to learn how to properly care for their feet on a day-to-day basis.  Diabetic patients should select podiatrists who are known for their excellence in diabetic wound care, such as those at the Columbus Podiatry and Surgery wound clinics located in both Dublin, OH and Columbus, OH. 

All diabetic patients should be educated on how to properly perform a self foot exam as one of the most important preventative measures to take to preventing major problems with the foot and ankle.  Overall skin health, adequate blood supply, and appropriately functioning nerves allowing for touch and pain sensation in the foot are three of the most important areas of the self exam.  While it may seem like a good thing to not feel pain in your feet, it is actually a very dangerous consequence of nerve problems from diabetes. Without the ability to feel pain, you would not be able to tell when tissue is being injured or destroyed in the foot.  Catching a small lesion before it develops into a non-healing diabetic ulcer is when self-exams and regular check-ups at the podiatrist can be a real limb-saver.  When lack of sensation is detected in areas of the foot, accommodative orthotics can be helpful in areas that can easily become irritated.  An accommodative orthotic for a diabetic patient is used to take pressure off and protect an area of irritation that could, unbeknownst to the diabetic unable to sense pain, develop into a dangerous wound. 

A custom-made accommodative orthotic is just one aspect of diabetic wound care and healthy preventative measures that a skilled podiatrist may need to utilize to avoid amputation for their patient.  Hopefully, with programs such as “Not Me!” and the work of all of the best podiatrists in the Columbus & Dublin, OH the diabetes epidemic will be slowed as people become more aware of healthy choices for their bodies and their feet to avoid serious complications or even the initial diagnosis of diabetes!

Please visit www.columbusfoot.com for more information or call 614-885 FEET (3338) to schedule an appointment with a podiatrist in Columbus, Ohio. Columbus Podiatry & Surgery is located on the North side of Columbus, Ohio in between Westerville, Worthington and Powell.

By Dr. Animesh (Andy) Bhatia

Ohio’s Major League Baseball team, the Cleveland Indians, will not be facing the Yankees until July, but many fans staying updated on the future opponent may have heard about an interesting injury of Eric Chavez, the team’s backup third baseman.

On May 5^thwhile running the bases, Chavez began limping and was helped off the field to get x-rays.  The initial diagnosis by the Yankee’s team doctor was a small fracture of the 5^thmetatarsal of the left foot.  However, this week, it was discovered that Chavez’s bone was not broken, but he had suffered a less severe injury called a bone bruise. 

People may not be aware that you can bruise the outer lining of bone, the periosteum, resulting in a periosteal bruise.  A bone bruise can also be called a stone bruise, because patients will often describe it feeling as if they are stepping on a pebble or small stone every time they put pressure on the affected area of the foot.  A bone bruise, periosteal bruise & stone bruiseare all describing the same injury in which there is a trauma that damages this superficial bone layer and the blood vessels coursing through it that supply nutrients to the bone cells.  In many cases, including Chavez’s, the trauma is simply an excess of pressure hitting the bone while running.  Underlying causes of this excess pressure on the foot can be from overtraining, underlying bony deformities such as metatarsalgia, or flat foot, the wrong type of athletic shoes, or shoes that are worn out. 

Bone bruises should be treated to reduce the inflammation of the area which can often be swollen, tender, and painful.  Resting the affected area, icing it and possibly taking anti-inflammatory medication are all recommended as part of a successful treatment regimen.  Patients should consult with their podiatrist to ensure the most appropriate route of treatment depending on the severity of the bruise.  It is also important to eliminate the cause of the excess pressure before returning to activities.  This may be done by getting custom athletic orthotics, new shoes, or surgery in cases with severe underlying foot deformities. 

Luckily for Chavez, it seems as though the Yankees had him consult with a podiatrist and the team physician to obtain an accurate diagnosis.  It is always great news for any athlete to discover that an injury is less severe than initially believed, and that their shorter recovery period will allow them to get back in the game at an earlier date!

Please visit http://www.columbusfoot.com/ for more information or call 614-885 FEET (3338) to schedule an appointment with a podiatrist in Columbus, Ohio. Columbus Podiatry & Surgery is located on the North side of Columbus, Ohio in between Westerville, Worthington and Powell.

By Dr. Animesh (Andy) Bhatia

The local favorites, the Buckeyes have begun their spring training for the upcoming fall’s football season.  Many people would have expected the Buckeye’s to be spending a little more time sulking, worrying and dealing with the controversy surrounding some of the players that has resulted in their suspension.  However, it seems that the ordeal has motivated the team to work together and show everyone what they are made of this upcoming season.  To start preparations, players have been working to be at their peak level of health and fitness.  One example of this, has been with an offensive tackle for the Ohio State University Buckeyes.  After suffering from foot pain for a good part of last season, the unnamed, OSU offensive tackle is utilizing specialized foot orthotics to keep him pain-free and on his feet this year. 

While the Unnamed Ohio State Football player was not especially clear on exactly what was causing his pain, it is clear that the orthotics he was trying out last season to initially combat the pain were not as effective as he had hoped and continued to suffer for an extended number of games.  While it is possible that he simply needed time off to recover from his foot injury, it is also possible that he may not have been able to get a custom foot orthotic quickly enough and was forced to use an over the counter version.  While an over the counter foot orthotic may be adequate for a minor issue with mild symptoms, in many cases they do not adequately adjust the foot to fix the specific issue in the patient.  There are generally two basic types of custom orthotics called accommodative and functional.  An accommodative orthotic adjusts the patient’s body weight so that it is no longer distributed over a painful area and is usually made of a softer material.  Accommodative orthotics are commonly used in diabetic foot care to adjust the patient’s body weight away from an area of increased friction in order to prevent development of an ulcer.  Functional orthotics place the foot in a corrected position to prevent the development of pain and deformities that result from walking with an abnormal foot position.  These are typically made of rigid or semi-rigid materials, depending on whether they are intended for everyday walking use, or for athletic activities.  Functional orthotics are also known as “arch supports” because they frequently are used in people with flat feet who require an orthotic to create an arch and prevent their feet from pronating, or rolling inwards.  The unnamed Buckeye would have greatly benefitted from a custom orthotic that had properties of both accommodative and functional orthotics last season in order to avoid pain by adjusting his body weight away from his injury, while also correcting the abnormality in foot structure that may have caused the injury in the first place. 

Orthotics offer a non-invasive treatment option for many ailments including bunions, plantar fasciitis, and arthritis.  When specially casted or designed to treat a patient’s specific foot problem, they can have significant pain relief and prevent future injuries and pains.  Hopefully the unnamed, offensive tackle for the Ohio State Buckeyes has seen his podiatrist to get the custom foot orthotics that will allow him to help the Buckeyes football team to many victories in the Fall 2011 season!!

Please visit www.columbusfoot.com for more information or call 614-885 FEET (3338) to schedule an appointment with a podiatrist in Columbus, Ohio. Columbus Podiatry & Surgery is located on the North side of Columbus, Ohio in between Westerville, Worthington and Powell.

By Dr. Animesh (Andy) Bhatia