While the Cleveland Browns play the Texans this weekend in Houston, another Texas team will be hoping that their punter Mat McBriar has made a sufficient recovery to help them score some points.  Unlike the more commonly heard of sports injuries,  including ankle sprains, pulled muscles or broken bones, McBriar has injured the nerve in his left foot and leg.  Although he kicks the ball with his right foot, the planting foot also plays a critical role in a player’s ability to punt the ball. 

Mat has not only been experiencing pain severe enough to disrupt normal walking, but he has also lost the ability to “lift his foot up”.  This lack of “dorsiflexion” or lifting the top of the foot up towards the shin is of critical importance not only for playing football, but also is necessary in walking!  The nerve that controls this is called the deep fibular or deep peroneal nerve.  When the deep peroneal nerve is not functioning properly, the foot will not be able to clear the ground while walking, and the foot will slap to the ground instead of being slowly lowered as it normally would.  This can make walking a very difficult and tedious process.  Mat may have caused this injury by a sudden stretch of the nerve when planting his foot to punt the ball.  Other causes of this nerve injury can include frequently crossing the legs, which is the most common cause, knee dislocation, or knee surgery. 

Mat may also want to talk to his podiatrist about the possibility that he could have a mass in his foot that could be pressing on the nerve and causing his symptoms.  A neuroma or a ganglionic cyst are both small masses in the foot that can cause problems on their own even without impinging on a nerve in the foot as could be a possibility in Mat’s case.  A Morton’s neuroma is an abnormal nerve growth found between the third and fourth toes.  A ganglionic cyst is an out-pouching of fluid from a joint that can require surgery to treat. 

Symptoms of nerve damage can include, but are not limited to, pain that shoots up or down the foot or leg, loss of sensation and loss of function.  If you have signs of a nerve injury it is important to contact your podiatrist as soon as possible because damage can become more severe over time including permanent loss of nerve function. 

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

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

Tennis enthusiasts at the Wickertree Tennis Club and Raquet Club of Columbus, as well as fans around the world are currently enjoying one of the biggest tennis tournaments of the year, the Championships at Wimbledon.  It is always interesting to follow the previous year’s champions to see how they will do.  It is even more interesting when last year’s champion is Spain’s Rafael Nadal, who is widely recognized as one of the greatest tennis players of all time. 

This past Monday, June 27 in the 4^thround of Wimbledon, Nadal began having what appeared to be some very intense heel pain.    Nadal had trainers called onto the court twice to check where the pain was located around the back and sides of his heel.  Luckily, he was able to play through his pain to win and continue on to Friday’s match which he also won, beating out Andy Murray.  Although the injury has not yet been definitely diagnosed, Nadal is taking a risk to play out his last few games at Wimbledon before taking an already scheduled vacation. 

Heel pain can be debilitating to any athlete, especially for one playing at as a high level as Nadal.  The most common cause of heel pain on the bottom of the foot in athletes is called plantar fasciitis, or heel spur syndrome.  The plantar fascia is a thick connective tissue deep on the bottom, or plantar surface of the foot, that connects the heel bone, or calcaneus to the ball of the foot.  Plantar fasciitis occurs when the plantar fascia has too much tension put on it and begins to pull at its attachment point on the heel bone, causing pain.  Pain associated with plantar fasciitis is often worse in the morning, when the individual first steps out of bed.  Individuals who overpronate, or have flat feet are at a greater risk for plantar fasciitis because of the extra tension placed on the plantar fascia when the arch is flattened and elongated.  Ultrasound can be helpful in diagnosing plantar fasciitis versus other causes of plantar heel pain such as a loss of the fat pad under the heel or a nerve entrapment.  If the diagnosis is plantar fasciitis, it can often be treated non-surgically.  More conservative methods that may be used include icing, rest, custom orthotics to relieve plantar fascia tension cause by overpronation, night splints and stretching.  If pain persists, many cases have been successfully treated by similarly non-invasive extracorporeal shock wave therapy. 

Although Nadal will have to work through his pain at Wimbledon, at least his injury at this point is not severe enough to force him to drop out altogether.  The promise of long break to rest your feet and get the best treatment and relief from pain in the near future can be a great motivator for anyone to make it through a tough time!

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 Worthington, Ohio.

By Dr. Animesh (Andy) Bhatia