With the record setting high temperatures the past few weeks in Columbus, kids have been soaking up the sun and playing outside as much as possible.  While the exercise is excellent for foot health, some new pains may develop from the sudden increase in activity level.  Parents need to pay careful attention to new pains as they can sometimes indicate issues more serious than just normal muscle soreness.  One of these conditions often identified during childhood years is called a pedal coalition. 

Pedal congenital coalitions are caused when the tissues destined to become two separate bones in the foot during development fail to separate and remain united as one bone.  These two bones may be united together by bone, fibrous or cartilage tissue.  The type and amount of tissue connecting what should be two separate bones will determine how much motion will be allowed where the joint would normally be.

While some coalitions may never cause any problems and go unnoticed, others can cause severe foot pain, stiffness, muscle spasm and foot deformity.  Some of the symptoms of a foot bone coalition can resemble the normal pains of post-playtime soreness with aching, and fatigue.  These symptoms are brought about by activity, and thus kids with lower activity levels may remain asymptomatic and undiagnosed.   The bones involved in a coalition can be identified by matching up the normal time the bones are ossifying with the onset of symptoms.  For example, a child who develops the foot pain and joint stiffness around three to five years of age would have a coalition between the talus and navicular bones as a possible diagnosis. 

Luckily, the most common congenital coalition in a child’s foot is typically not painful and is a fusion of the two bones that make up the fifth or “pinky” toe.  However, common coalitions that occur in the tarsal bones will cause symptoms in an active child.  Fusion of the talus and calcaneus, or heel bone, is the most common of the tarsal coalitions.  The subtalar joint, which is located between these two bones, requires mobility in each phase of walking or running and a coalition of the talus and calcaneus will limit that mobility.  When movement necessary for normal ambulation becomes limited, the body will try to force through the motion, causing pain, or will make changes to work around the need for that movement, causing deformity.  Commonly, with the talus-calcaneus coalition, overpronation will be part of the deformity and the child may appear flat footed. 

Early identification of these symptoms can result in earlier treatment and improved quality of life for the affected child.  Whether the coalition is congenital or has been acquired later in life as a result of osteoarthritis wear and tear or a fracture within the joint, a visit to your podiatrist can help relieve pain and work towards allowing your feet to function in the best way 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 near Worthington. If you would like to see apodiatrist in Dublin, Ohio near Tuttle Crossing, call 614-885-3338 for an appointment.

By Dr. Animesh (Andy) Bhatia

Holiday parties filled with colorful drinks and rich meals are an integral part of this time of year for many people.  However, all of this drinking and feasting can increase your risk of a painful attack of the arthritic condition that tends to strike in the foot known as gout. 

Gout is a disease of the metabolism or breakdown of purines.  Purines are nucleotides that are essential to the survival of all the cells in our bodies because they are vital building blocks of DNA.  While we naturally make proteins, they are also found in many foods.  When purines are broken down by the body, uric acid is created.  Abnormally high levels of uric acid in the body, or hyperuricemia, precede the development of gout. 

When the excess uric acid causes crystals to form in the joint, the joint will become inflamed and often extremely painful.  Gout more commonly affects men, but its prevalence increases in women after menopause.  The most commonly affected joint is at the base of the big toe, or hallux called the metatarsophalangeal joint (MPJ).  Other than the MPJ of the hallux, gout also occurs in the ankle, wrist and knee.  The affected joint will most often become red, hot and so painful that even the weight of a bed sheet will feel unbearable.  A bump, or mass filled with the urate crystals is also often seen at the joint affected. 

It is important to rule out a paronychia which is an infection of an ingrown toenail, a painful fracture, and other types of arthritis of the foot before being able to offer relief from gout.   With proper diagnosis, gout can be managed and the pain eliminated with various medications.  Lifestyle changes can also be helpful in gout management and prevention.  Excessive alcohol consumption and a diet rich in meat and seafood are associated with a greater risk of gout.  So while it may be difficult to resist this holiday season, you will certainly regret not limiting your intake of these items if you are unfortunate enough to develop painful gout later on! 

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 Powell. If you would like to see a podiatrist in Dublin, Ohio near Tuttle Crossing, call 614-885-3338 for an appointment.

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

In July, we posted a blog on international tennis champion Rafael Nadal’s troublesome heel pain he was forced to play through at this year’s Wimbledon games.  In Nadal’s new memoir titled “Rafa” he discussed another foot problem that has worried him throughout his career and in 2005.  The pain caused by the problem was so severe that it almost caused him to give up on the game of tennis entirely and try his luck at professional golf instead! 

While plantar fasciitis, the likely culprit begind Nadal’s previous heel pain, is very common here in Columbus, OH and around the world, his 2005 foot problem was likely due to a much more rare condition called Kohler’s disease.  Nadal refers to his problem as a congenital condition in which the navicular bone of the foot did not harden completely and has caused him problems ever since.  Kohler’s disease is not truly thought of as a congenital disease, but develops in a child’s foot typically around ages 5-10 when a traumatic event has caused loss of blood supply to the bone before it finished ossifying.  While this type of blood loss causes similar diseases in other bones in kids, the navicular plays an important role in the support of the long and transverse arches of the foot and is the last foot bone to ossify.  A child with Kohler’s disease will normally limp on the affected foot; have pain over the middle side of the arch; avoid putting pressure on the middle side of the foot and redness and swelling will often be present.  Foot pain in a child should always be treated carefully to ensure that any problems with the growing and ossifying areas of bone are handled appropriately to ensure proper development.   As kids go back to school, it is important to keep this in mind that not only are the right shoes important to prevent injuries, but so is proper care when an injury or pain does develop!  While Kohler’s disease typically heals normally with no adverse effects later on, it seems that Rafael Nadal unfortunately did not find the best podiatrist for him until later on in his tennis career!

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 near Lewis Center.

Looking for a podiatrist in Dublin, OH? Columbus Podiatry & Surgery's foot doctors are now in Dublin!

By Dr. Animesh (Andy) Bhatia

Although it seems far away, the November 2012 presidential election has candidates beginning to campaign near Columbus and across the country.  One interesting story related to feet about a candidate over the past few weeks were reports that Michelle Bachman supposedly noticed a link between wearing high heeled shoes and having migraines.   

While this may seem like a farfetched idea to those who are unfamiliar with severe headaches, it is actually very likely that not taking proper care of your feet can literally be a pain in the neck.  Migraines can be severely debilitating and caused by a variety of triggers.  Stress is one of the common triggers and it has been postulated that perhaps the reason Bachman linked her heels to her headaches was that she wore high heeled shoes to stressful events.

While the link to migraines is indirect, the most common type of headache called a tension headache can be directly linked to inappropriate shoe gear.  A tension headache is associated with a dull, aching head pain, a feeling of tightness across your skull, and tender scalp, neck and shoulder muscles.  These headaches can be so intense that they may resemble a migraine.  Poor posture is a trigger of a tension headache and can be caused by wearing shoes that create or amplify an unnatural curvature of the spine.  Along with high heels, other foot and ankle issues including limb length discrepancy, and lack of appropriate joint range of motion due to arthritis or limited flexibility can also cause back and neck pain. 

One relatively simple fix for many of these issues that can lead to a range of upper body problems are custom made orthotics.  Foot pain from arthritis can be lessened with an orthosis that limits the amount of painful motion and holds the foot in a more stable position.  Most people have a small difference in length between their two legs and may unknowingly compensate by pronating, or causing the longer limb to be flat-footed to equal out the length difference.  An orthotic can relieve this problematic compensation and prevent the limb length from causing pain further up the body.  Intense headaches should always be discussed with your doctor.  You just may end up finding that although the pain is at the top, relief can be found at the bottom – with proper foot care!

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.

By Dr. Animesh (Andy) Bhatia