A new treatment option that may one day be of great help to all those suffering from heel pain in Columbus has been making news for its success in a clinical trial.  The study focuses on an injection that shows potential for being used to treat individuals with plantar fasciitis who have not had significant pain relief with other treatments.

Luckily for the time being, patients suffering from plantar fasciitis can visit their podiatrist for a variety of treatment options that, for the majority of individuals, will provide great pain relief.  The first step in treating your plantar fasciitis is to determine if you in fact have plantar fasciitis.  While plantar fasciitis is one of the more common causes of heel pain, there are many other problems that occur relatively frequently that can also cause heel pain.  Some of the cardinal signs of this condition include the most intense pain of the day occurring when you take your first step out of bed in the morning and pain localized primarily to the bottom of the heel, at the front edge of the heel fat pad, on the side closer to the opposite foot.  A nerve entrapment can also cause similar pain on the bottom surface of the heel.  A nerve entrapment in this area typically involves what is known as “Baxter’s nerve” which supplies sensation and power to a muscle that allows movement to the smallest toe.  When the nerve is compressed, it is similar to a bruise and is called neuropraxia.  This bruise of the nerve then causes pain and decreases its ability to transfer information.  If the entrapped nerve is caught and treated, recovery occurs in around three to four months.  In areas around the heel that could cause heel pain in a location very near to the pain of plantar fasciitis also include fractures, and tendonitis.  

Once your plantar fasciitis has been correctly diagnosed, there are a variety of treatment paths to begin with.  While treatment varies for each individual, most people begin treatment with a conservative approach using the least invasive options available to start.  Some of the conservative treatment options include:  stretching, taping, icing, and wearing orthotics.   All of these treatment options can have great success in many patients if performed correctly.  The next step in treatment for plantar fasciitis that has not responded to the previously mentioned treatments can be an injection of a steroid with numbing agents.  This is done in addition to continuing conservative treatments.  The steroid is injected for its anti-inflammatory properties which serve to “soothe” the aggravated plantar fascia and relieve pain.  While surgery would typically be the last treatment resort as a plantar fascia that is still painful, the aforementioned research study provides a potential new option.  It has suggested that injecting plasma rich protein actually provides greater pain relief and healing potential than injecting steroids.  Hopefully this new research will continue, and the information gained can allow patients to receive the highest quality treatment options from their 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 Westerville. 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

With the unusual warm weather we have been seeing in Columbus, Ohio it is great to see so many people outside walking and exercising their feet lately.  Any extra exposure to sunlight is always appreciated during the short and often dreary months this time of year.  While excess sun exposure can be dangerous for skin, sunlight does provide the beneficial vitamin D, or calciferol that is crucial to bone health. 

Osteoporosis is the most common skeletal disorder.  It is characterized by an absolute reduction in bone density and mass.  Bones become weak and are at increased risk of breaking.  Because 28 of the bones in the body are located in the foot and they are under the pressure of the entire body weight, fractures commonly manifest here.  Sunlight does not directly provide vitamin D; it stimulates the body to make vitamin D from a precursor found in the skin.  The active form of vitamin D promotes the uptake of calcium from the intestines so it can be used to calcify bone as well as stimulating the parathyroid hormone to reabsorb calcium before it is filtered out by the kidneys as waste.  Without enough vitamin D, not only are individuals at risk for osteoporosis, but they can also develop a similar condition called osteomalacia.  In osteomalacia, bone cannot be mineralized and symptoms include muscle weakness, bone pain and bone deformities.    The childhood form of osteomalacia that is more commonly known is called rickets.  In rickets, children affected will typically be six to 12 months of age and will have symptoms of muscle tetany or extreme muscle contraction, delayed development, smaller overall stature and soft tissue swelling, or edema around the growth plates located at the ends of bones.  Bowing of the tibia bone inward in the legs is a common consequence of vitamin D deficiency in rickets. 

The one upside of these diseases is that there are some preventative measures that can be taken to avoid their occurrence.  To keep your foot bones and the rest of the bones in your body healthy, be sure you have enough vitamin D as a part of your healthy diet.  Bone mass peaks at age 35, so it is especially important to maintain an adequate amount of vitamin D and calcium in your diet and through exposure to sunlight later in life.  Females are prone to developing osteoporosis following menopause and therefore should also take extra care to keep their bones strong.  By contacting your podiatrist at the first signs of foot injury or bony pain in your feet and ankles, both any fractures that have occurred as well as loss of bone density can often be identified in one set of x-rays.    The sooner that loss of bone density is identified, the sooner steps can be taken to supplement vitamins and minerals necessary to keep you healthy and on your feet!

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. 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

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

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