An article published in “USA Today” this past week discussed the scary reality that many elderly patients will leave a hospital much weaker than when they arrived.  Even though the patient’s original condition will be treated, the overall health of the patient may suffer from lack of physical activity.  A similar concept can be applied to many treatments of the foot and ankle, in that even though a treatment may remove the original pain or deformity, post-treatment actions must be taken by the patient to ensure that they maintain optimum health and their condition does not return. 

One condition that requires continued maintenance even after a pain-relieving treatment is plantar fasciitis.  Stretching and orthotics are often suggested as the first line of treatment because they address the root of the problem.  However, individuals with severe plantar fasciitis may find even stretching to be too painful and can receive steroid injections for more immediate relief.  In plantar fasciitis, the fibrous band of tissue called the plantar fascia that attaches from the heel to the ball of the foot becomes irritated from having too much tension placed on it.  Overpronation and equinus, or stiffness of the ankle, can add to the tension placed on the fascia causing its inflammation.  Even though a steroid injection removes the heel pain of plantar fasciitis, the underlying causes of tension will remain and eventually allow the pain to return if they are not addressed.  For a patient to get optimal results from their treatment, they should discuss a daily stretching regimen with their podiatrist that should be easier to adhere to after their pain has been alleviated by the injection.  Simple stretches and custom orthotics will often relieve tension and thus the irritation on the tissue, allowing the patient to avoid recurrences of the condition. 

This concept of stretching and physical therapy following treatment is often used following surgeries that actually have removed the underlying problem, including those performed to remove a bunion.  While the bunion deformity is gone, physical therapy to get the toe moving after surgery can prevent complications down the road that may result from the prolonged inactivity of the toe following the operation.  Bones and tissues that have been cut need time without bearing the weight of the body in order to fuse together properly.  Unfortunately this period of rest that is necessary for bone healing may cause joints and ligaments to become overly stiff from the inactivity.  Physical therapy can be used to remove or prevent any adhesions of tissues to one another that can lead to painful limitation of motion or even arthritis. 

While for some patients, following a post-treatment schedule involving stretching, foot exercises and physical therapy may be difficult, other patients will struggle with the idea of doing as little as possible with their affected foot.  Whether you are eager to return to sports practice, or someone who does not look forward to the idea of any sort of exercise, it is crucial to follow the treatment plan your podiatrist or other doctor has provided to you to completion for your best health 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

Whether you are running in the St. Patrick’s Day 5K at Flannagan’s this Saturday in Columbus or simply running to the pub, taking care of your feet can make or break your celebration of this lucky holiday.  Properly fitting shoes are imperative for good foot health, and also can help in avoiding knee, hip and back problems that develop from the problems originating in your feet! 

When you travel to a shoe store, most have what is called a “Brannock device” that is used to measure feet and estimate shoe size.  This device measures not only the length of your foot from heel to toe, but also measures width, and the distance from heel to the ball of your foot.  The heel to ball distance is most critical in determining whether a shoe fits correctly.  Located at the “ball” of your foot on the middle or inner aspect is the joint called the 1^stmetatarsophalangeal joint or 1^stMTP.  This is where a bunion develops, but the normal movement permitted by the joint is also critical to the overall function of the foot.  The base of the joint is the first metatarsal which slides downward in order for the big toe to flex upwards and help propel the foot when walking or running.   When this motion sequence occurs in a normal foot, the foot pushes off the ground and swings into the next step.   

Correctly fitting shoes allow the 1^stMTP to function as it should, while shoes that are too small can cause major problems.  Shoes are designed to allow the normal bend at the 1^stMTP joint and to inhibit abnormal bending of most other joints in the foot.  However if the shoe is too small, the 1^stMTP joint will not be allowed to bend normally and big toe will be forced to flex upwards when it should not be.  This leads to the condition called hallux limitus, where, as the name implies, the movement of the hallux, or big toe, is limited.  Overtime, hallux limitus can progress to hallux rigidus where the joint big toe joint is practically immovable.  This is a painful form of arthritis that has resulted from the abnormal wear and tear of the joint.  Not only is this painful, but the combination of hallux limitus or rigidus in an already too small shoe can lead to calluses, corns and even ulcers developing on the big toe. 

It is important to recognize that biomechanical problems, including excessive pronation, can also contribute to the development of hallux limitus so custom orthotics can often help with this condition.  Wearing one size larger shoe is only a difference of one third of an inch in the actual length of the shoe.  So this St. Patrick’s day even if you think that a smaller size shoe may look better, by getting the correct size for your foot you will definitely have the luck of the Irish and keep your feet looking great!!

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 apodiatrist in Dublin, Ohio near Tuttle Crossing, call 614-885-3338 for an appointment.

By Dr. Animesh (Andy) Bhatia

If you are a follower of football news, this year it almost seems as though turf toe is a contagious disease at both the professional and collegiate level, even though that is not actually the case.  Luckily, this injury has not made the news for sidelining any Ohio State football players recently!

While ankle sprains are the most common foot and ankle sports injury, metatarsophalangeal joint sprains in the big toe, or hallux, have also been very common since the injury was first given the name “turf toe” in 1976.  Football players including Eddie Lacy of the University of Alabama, Kevin Kolb of the St. Louis Cardinals, and Evan Mathis of the Philadelphia Eagles are just a few of the players this year who have gotten medical attention for their turf toe injuries in order to not only to return to practice and games, but also to prevent long term problems with the use of the joint at the base of their big toe, the metatarsophalangeal joint. 

Turf toe gain its name because the hard surfaces of turf, along with more flexible athletic shoes, cause the big toe to hyperflex up towards the top of the foot in a way that stretches ligaments and causes a sprain.  This hyperflexion typically occurs when an athlete is on his toes running quickly and the foot is pushed down, flexing the toe past its normal range of motion.  As with most sprains, this is a painful injury that will also swell and sometimes bruise.  If you see and feel these symptoms in your big toe, it is also important to see your podiatrist to be examined not only for ligament sprain, but also for sesamoiditis, fracture of the bones in your big toe, or a tear of the plantar plate which is a structure crucial for keeping bones in place during motion of the toes.   The metatarsophalangeal joint at the base of the big toe is crucial for normal walking and running, and can be very painful if it is not functioning normally.  Thus, proper diagnosis and treatment is imperative in the short term for athletes who want to miss as little of their season as possible.  In the long term proper podiatric care of a turf toe is essential for everyone as the injured joint’s articular cartilage can wear down causing arthritis and loss of function.  When the motion of the big toe, or hallux is reduced, the disorder is called hallux limitus, and eventually when motion is completely lost it is called hallux rigidus.  Both of these conditions can be very painful during walking and when severe enough may require surgical correction. 

Hopefully Ohio football players will continue to avoid the notorious turf toe and players on other teams currently suffering from this injury will continue to receive proper care and treatment of this condition!

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

While Katy Perry was in Columbus at the Schottenstein Arena on September 13, one of her original opening acts, up and coming pop star Jessie J was unable to perform that night and for most of the tour.  In June, Jessie had jumped off a stage while dancing during rehearsals and badly hurt her foot.  Now, in recent interviews, Jessie has been describing the story of her injury and how she now feels it will cause her painful arthritis for the rest of her life.  Jessie and anyone else who has suffered a traumatic ankle injury need to know their treatment options to avoid or cope with possible arthritis in the future. 

After her injury, Jessie was initially diagnosed with a ligament injury of the ankle.  Unfortunately it was not diagnosed until later that she had also fractured 4 bones in her foot and ankle.  While ankle sprains are one of the most common injuries that dancers can encounter, it is also important that the individual be evaluated by x-ray or other radiographic imaging for bony injury if have symptoms of tenderness when they press on bone or are unable to stand on only the injured foot.  Chronic lateral ankle pain, or pain on the outside of the ankle, can result from both ligament or bone damage to the ankle, but bone fractures can also lead to arthritis of the ankle.  While arthritis in the knee or hip common result from wear and tear over time, the most common cause of arthritis of the ankle is a previous traumatic injury. 

The missed diagnosis of broken bones has led to a more severe situation for Jessie’s ankle.  Because Jessie’s fractures were not diagnosed until later, the broken bone pieces were allowed to continue moving in an unstable manner in her foot as she continued to bear some weight on them in a brace for the ligament injury.  Without proper blood supply or biomechanical stability, bone pieces cannot realign and unite.  This is called a non-union and when it occurs as it likely did with Jessie a graft of bone material must be surgically placed in the foot to promote union and healing of the bones.  After this “bone transplant” as Jessie has been referring to it, she now complains of chronic pain in her ankle and a possible future of painful arthritis.  Because she cannot turn back time and get her foot promptly diagnosed correctly to have possibly avoided the non-healing of her bones, Jessie and all foot and ankle arthritis suffers should talk to their podiatrist about their options to reach a much less painful state.  Physical therapy may be an initial step to healing and regaining motion in the joint after surgery.  There are also other surgical options to help an arthritic joint function less painfully and thus with better motion, including a fusion of the bones that make up the joint or a total joint replacement.  For active individuals such as Jessie, studies have shown that in arthritic patients who received a total ankle replacement were able to greatly increase their sports activity from their previous arthritic state. 

Luckily for Jessie J her diagnosis was eventually caught and she will hopefully look into future treatments to alleviate some of the pain of her current condition and possible arthritis!  

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 Westerville. 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 Friday, the Columbus Dispatch published a story in support of “Falls Prevention Awareness Day” in Ohio.  The article discussed ways for the senior citizen population of Columbus to prevent falls and the serious injuries and hospitalizations that can accompany them.  One crucial aspect of fall prevention not directly stated in the article is the importance of foot health in the elderly in maintaining good balance and stability. 

Feet provide the base of support for the body and in an older individual changes have often occurred that weaken that base.  Arthritis of the foot joints, foot deformities, muscle weakness and improper footwear can all play a role in changing the way that the foot keeps the body balanced.   Bunions, calluses, hammertoes, and ingrown toenails can all cause pain in the foot.  The body’s natural response is to avoid causing pain by changing the weight distribution on the foot so less pressure is placed on the deformity.  This change can alter the gait to be more unsteady and increase the chance that a fall may occur.  With a visit to your podiatrist there are many options to relieve these types of pain, and thus increase stability.  Calluses and ingrown toenails can often be removed at an office visit, while hammertoes and bunions can be treated with surgery or their pain can be lessened using nonsurgical methods.  Arthritis or other problems that may not allow the normal range of joint motion also can be treated with surgical methods, or with nonsurgical methods such as custom orthotics that can allow for better functioning of the entire foot while decreasing the pain of the afflicted joint.  Simple foot exercises can be used to maintain muscle strength against the loss of muscle mass that accompanies normal aging.  In the article in the Columbus Dispatch, this concept was being put to practice by the woman “tracing alphabet letters” with her toes.  One last tip is to ensure that shoes fit properly and that the shoe bottom is not slippery.  Shoes that do not fit properly can cause pain if they are too small or can cause tripping from the abnormally increased foot motion in the shoe if they are too large. 

By taking small measures to “fall-proof” your feet with the help of your podiatrist you can avoid the big health problems and expenses that come with a serious fall!

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. To visit our podiatrist in Dublin, Ohio call 614-885-FEET (3338)

By Dr. Animesh (Andy) Bhatia