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

Back in June, the Columbus Dispatch published an article on the scary reality of sepsis or septicemia, an infection of the blood that can be deadly.  This past week a follow up article was run on the positive outlook of the Columbus man who survived his sepsis and subsequent below the knee amputation.  With the help of a new prosthetic leg, the man is learning to walk again. 

While sepsis is a terrifying infection of the blood, an often related infection that frequently occurs in the foot and leg is called “osteomyelitis”.  Osteomyelitis occurs when bacteria reaches and infects the bone.  As bone tries to fight off the infection, it often walls off the dead piece of bone, called a sequestrum, and attempts to envelop the piece away from healthy tissue by quickly synthesizing a weaker woven bone around it called an involucrum.  Pain that feels as though it is coming from the bone, and edema, or swelling are the most common initial complaints of a patient with osteomyelitis.  In order to diagnose a bone infection, taking x-rays are the first step.  A timely diagnosis is imperative to prevent the spread of infection through larger areas of the bone and into the joint.  If not caught early enough, like sepsis, osteomyelitis may require lower extremity amputation to prevent further damage. 

But how can bacteria get to your bones through the surrounding layers of skin, fat and muscle unless you have had a bad fracturewhere the bone penetrated the skin?  In children, an elevated amount of bacteria in the bloodstream can not only lead to sepsis, but also has a tendency to dwell in and infect the slow moving capillaries of still growing bones.  This is called hematogenous osteomyelitis in which the blood has carried the igniting agent for the bone infection.  In adults, “direct extension” osteomyelitis is the most common cause of bone infections, with the foot bones of diabetic patientsbeing at a very high risk.  Direct extension means that bacteria has infected a wound in the more superficial tissues, such as the skin or fat and then “extended” its way down to attack the bone.  Because many diabetic patients often have lost some or all of their sensation in their feet, a small cut or irritation can quickly develop into a major ulcerby the individual unknowingly continuing to irritate the sensationless area.  This injury then allows an easy route for bacteria to travel to and attack the bones of the foot.  Amputation is a serious risk in diabetic patients through this process. 

Amputation is a grave condition on its own for diabetic patients.  Within five years of one below the knee amputation, research has shown that risk of below the knee amputation of the other leg greatly increased.  The second amputation has an almost deadly effect, with increased mortality seen within the next five years.    It is for these reasons that even the smallest wound or ulcer of the foot or ankle must be taken very seriously by diabetic patients.  Regular self-examsand visits to your podiatrist at the first sign of injury, infection or bone painin any patient are critical to preventing and treating these deadly conditions. 

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

By Dr. Animesh (Andy) Bhatia

Halloween can be a rough time of year for children with diabetes as well as for parents trying to keep their kids healthy.  Several Columbus area dentists and doctors have made efforts to give more options to keep Halloween healthy and fun for diabetic kids.  A local dentist’s office has offered to buy candy from kids after Halloween for $1 per pound to then be donated to Operation Gratitude which then gives the candy to troops overseas.  

Type 2 diabetes typically develops later in life than type I diabetes, but is becoming more common in children.  This increase in diabetes in kids has been linked to the increase in childhood obesity.  While type 2 diabetes has a genetic component, individuals who are overweight or do not exercise are at a greatly increased risk of developing the disease.  In this sense, while walking house to house may provide good exercise for kids, the excessive consumption of candy should be avoided. 

People with both types of diabetes often develop nervous system disease with loss of sensation in their foot.   When sensation is lost in the foot, people may develop injuries without being able to feel any pain and continue to cause further damage to their tissues.  This is why it is critical for diabetic patients perform regular self-foot exams and have complete checkups with their podiatrist.  These areas where sensation is lost are typically where ulcers develop and can lead to amputation. 

While diabetic ulcers are not often seen in children’s feet, it is important to take preventative measures to avoid serious diabetic disease changes that increase the risk of ulcers later in life.   One good preventative measure to start with during the Halloween season is to avoid excessive sugar consumption.  The more extremely elevated, or uncontrolled a diabetic individual’s blood sugar is, the higher their “HbA1C” values are.  The HbA1C indicates an excess amount of sugar that gets “stuck” to hemoglobin, the molecule that transports oxygen to tissues.  When the HbA1C is elevated, there is a much higher risk of developing problems with blood vessels, leading to diseases including high blood pressure and problems with the retina of the eye.   By not eating too much sugar and getting a lot of exerciseat Halloween and all year, kids with and without diabetes will be sure to have a scary good time keeping their feet healthy!

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