Foot Care For Diabetics

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Image Credits: Times of India

“The really important thing is not to live, but to live well… and to live well means the same thing as to live honourably or rightly.” - Socrates

Diabetes is just a word, not a sentence to a miserable life. While the treatment can be potentially dangerous, as a patient, you can actually look at it as a means to improve your ability to take care of yourself. Studies have shown that stress induces illness, so if you put yourself in a situation where you reverse the root causes of your conditions, you will heal. 

Diabetes and Peripheral Artery Disease (PAD) 

Diabetes and Peripheral Artery Disease (PAD) often go hand in hand. As a cardiovascular condition, with induced restriction of the blood vessels, many diabetics often develop a condition known as peripheral neuropathy. Patients that have peripheral neuropathy often lose sensations in their extremities, and in the instances of any cuts or bruises on the body, patients may not be aware of them, and ulcers can ultimately develop. With time, the ulcer can become infected. PAD is the ultimate breeding ground for amputation. 

Foot Care for Diabetics 

There are a few key activities, which will lead to great foot health. As with all things, prevention is better than cure. The following should be part of your pamper routine if you’re a diabetic: 

  1. Daily Foot Inspection: Take good care, and take the time to inspect your feet at one specified time each day. This could be in the evening once you are getting ready for bed. After your shower, you can take the time to check your feet for any bruises, swelling or ingrown toenails that can affect the health of your feet. A great tool to have is a hand held mirror, so that you can see the base of your feet, and the back of your heels. If you still can’t manage, you can use this as an opportunity to have your partner or your children check for you. 

  2. Lukewarm Baths: The more you nurture yourself, the better you’ll feel and the more that you’ll heal. Warmth improves your blood’s circulation. With a daily wash of your feet, with warm water you facilitate the dilation of your blood vessels, and improved circulation of your blood. This facilitates healing. If you so desire, you can add essential oils to your bath and raise the healing properties of the water. Wash your feet with a soft washcloth, and carefully dry them after your bath. Allow them to air dry. 

  3. Moisturize Your Feet: Your feet have skin as their primary cover. Skin loves and needs moisture in order to heal itself. Use a moisturizer such as Eucerin or Vaseline to keep your skin moisturized and minimize the occurrence of dryness or cracking. Air dry your feet to minimize fungal infections. 

  4. Adequate Foot Care: This is the time of your life, where pedicures should be a standard. When you’re cutting your nails, ensure that they are cut straight and filed. Do what you can to minimize the occurrence of ingrown toenails, because the induced cuts can lead to ulcers. If you see a cut or wound, see your doctor. 

  5. Wear Diabetic Socks: With added cushions, these are special socks that will help you to keep the socks clean and dry. When it comes to your footcare, check your shoes carefully to ensure that there is nothing inside them before you wear them. Since such objects can cut the feet, it is critical to ensure that the feet are protected in their shoes. 

  6. Keep Your Feet Clean and Dry: As strange as it may seem, an antiperspirant on your feet will keep them dry. 

This list is by no means exhaustive, but it is a great start to your diabetic foot care. As with all medical conditions, do consult with your orthopaedic surgeon, in order to ensure that you are getting the appropriate care. Your health is your wealth! 

 

References: 

  1. Diabetes Footcare Guidelines: https://www.foothealthfacts.org/conditions/diabetic-foot-care-guidelines

Lower Extremity Amputations and Diabetes

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Image Credit: Medical News Today

“What is called genius is the abundance of life and health.” - Henry David Thoreau

Diabetes, as a medical condition is a global concern for a variety of reasons. As a potentially debilitating condition that impacts the blood sugar level of an individual, there is an innate tendency for the body to not be able to manage its insulin generation. The two types of diabetes are Type 1 and Type 2 diabetes. This article will focus on the impact of Type 1 diabetes on amputation cases. 

Type 1 diabetes occurs when the body, in an autoimmune response, attacks its own pancreas, and inhibits the ability of the organ to generate insulin. Insulin management is key to health, and requires consistent monitoring. Treatment of Type 1 diabetes includes insulin intake via injections or more recently, the use of insulin pumps to regulate the hormone. 

Australia, as a nation houses approximately 1 million diabetics. Of this total, approximately 10% are diagnosed with Type 1 diabetes. Diabetes Australia studies have indicated that the annual cost of medical treatment for Type 1 diabetes is on the order of magnitude of $570 million. Individual patient cost averages $4669.00. With a range of costs depending on the severity of the condition, those patients who are ailing from a combination of both diabetes and cardiovascular conditions can expect their individual health costs to be as high as $16,698.00. 

The root cause of the increased medical costs for diabetics with cardiovascular diseases is influenced by the downstream conditions that are induced by the fusion of ailments. One downstream condition that has had statistical impact for individuals with Type 1 diabetes is the onset of lower extremity amputations. Medical research was able to identify that of a group of control vs patients with Type 1 diabetes, the absolute risk of amputation was up to 40 times higher.  

The research team focused on medical parameters such as diabetes duration, glycemic control, and renal complications. With each parameter monitored, the lowest risk for amputations, was with patients that adequately managed their glycemic levels, as well as maintained good renal health. Diabetes and amputations have always been directly correlated. If you are diagnosed with diabetes, a good prevention plan will ensure that you prevent a condition that has both economic and social impact. Amputation is preventable. 

Diabetes and Peripheral Artery Disease (PAD) 

Diabetes and Peripheral Artery Disease (PAD) often go hand in hand. As a cardiovascular condition, with induced restriction of the blood vessels, many diabetics often develop a condition known as peripheral neuropathy. Patients that have peripheral neuropathy often lose sensations in their extremities, and in the instances of any cuts or bruises on the body, patients may not be aware of them, and ulcers can ultimately develop. With time, the ulcer can become infected.  

PAD is the ultimate breeding ground for amputation. Where there is reduced blood flow, the healing properties of the body are significantly reduced. The wound therefore, either will heal very slowly, or not at all. With the onset of gangrene, the ulcer can affect the bone. Gangrene is a condition that medical personnel will then have to manage either via harvesting the existing limb and attempting to restore life to the area, or in the extreme case, the limb will have to be amputated. Many diabetics have lost a toe, their feet, or even the lower leg as indicated in the image above. 

How to Manage Amputation

The good news, is that amputation is preventable. If you are diabetic, constantly seek medical attention and ensure that you are inspecting your limbs on a daily basis. If you can’t reach your extremities, have your spouse or children help you to ensure that you are healthy. Good medical practices for diabetes management include: 

  1. A healthy, balanced diet that helps to regulate your insulin. Consult with a nutritionist to determine what foods are best for your body. 

  2. Minimize your sugar intake

  3. Relax 

  4. Exercise constantly. This activity does not have to be strenuous. At least 30 minutes of activity per day will help your body to stay in tune, and your cardiovascular system to stay at its peak. 

  5. Ensuring that all doctor’s recommendations are adhered to. 

  6. Daily Foot checks

To reiterate, you don’t have to become an amputee if you’re a diabetic. With appropriate health management, you can live a long and healthy life.

References: 

  1. Open Access Research: Excess risk of lower extremity amputations in people with type 1 diabetes compared with the general population: amputations and type 1 diabetes

  2. Healthline: https://www.healthline.com/health/diabetes/diabetes-amputation

  3. Diabetes Australia: https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/e7282521-472b-4313-b18e-be84c3d5d907.pdf

Ankle Fusion

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Image Credits: Orthobullets 

What is Ankle Fusion? 

There is a point in every arthritis sufferer’s life where a choice has to be made. That choice is often whether or not to have an ankle fusion therapy treatment, or to opt for ankle replacement therapy. Thankfully, your orthopaedic surgeon will take you through the decision matrix that will determine what path will be ideal for your lifestyle. 

Symptoms of Ankle Arthritis

If you are experiencing the following sensations in your ankle, you are a prime candidate for arthritis.

*Loss of smooth cartilage on the surface of the tibiotalar joint bones

*Pain 

*Inflammation 

*Swelling in the Ankle Joint

Consult with your orthopaedic surgeon to determine how acute or severe your condition is. Your consultation will often involve a detailed assessment of your medical history. Via a deeper insight of the joint via scans like MRI’s or X-Rays, the internal condition of your ankle joint can be determined. If your condition is acute and you are below the age of sixty, your orthopaedic surgeon will recommend that you be treated via ankle fusion surgery. 

What is Ankle Fusion? 

The ankle is a joint composed of a series of bones. As the joint degenerates, it will often be imperative for the surgeon to restore the joint via a fusion treatment. As the integrity of the ankle joint is lost, the surgeon will restore it via a series of internal scaffolds, that enable the joint’s strength and flexibility to be restored. As indicated in the image above, your orthopaedic surgeon will affix to your joints a series of plates and screws that will support the joint. 

During the surgery, there will be an incision made, that will expose the ankle joint. The surgeon will then create the scaffolding on the bones, and reinforce the joint. In some instances, there will be the addition of a bone graft, in addition to the metallic hardware that is added to the joints. Enquire with your surgeon if your treatment can be facilitated via a minimally invasive surgery. 

Post Surgery Treatment 

Once an ankle surgery is completed by the orthopaedic surgeon, the patient usually spends the night, and then is released the next day once all the patient checks are completed. The treated leg is often placed in a cast and the patient is allowed to be mobile via crutches or a walker. 

During post operative treatment, it is advised that the patient minimize weight placement on the restoring ankle joint. The fusion process takes up to twelve weeks to facilitate the initial healing phase. The time frame for complete healing is up to six months. 

While no treatment is one hundred percent effective, your treatment will facilitate the restoration of normal physical activity. Your health is your wealth. With careful research and discussion with your doctor, you’ll feel confident that your therapy is the best path forward for you. 

Reference: 

Ankle Fusion: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/ankle-fusion

Ankle Replacement for Arthritis

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Image Credits: Wall Street Journal 

“I have chosen to be happy because it is good for my health.”- Voltaire

What is Ankle Replacement Surgery for Arthritis? 

All arthritis treatments are not the same! Depending on the extent of ankle joint degeneration,  minimally invasive intervention or even orthopaedic surgery may be warranted. If you are experiencing variable sensations on a daily basis - it may be time for a stabilizing treatment. Ankle replacement surgery may be the solution to your ankle pain. As a surgical option for the treatment of arthritis, consult with your orthopaedic surgeon in order to determine if this is the path for your healing. Ankle replacement surgery is an alternative therapy to ankle fusion. 

As a complex therapy, ankle replacement is often the last resort therapy if alternatives haven’t worked for a patient. During your consultation, your doctor will assess your medical history and determine if you’ll be a prime candidate for ankle replacement surgery. Distraction arthroplasty is also possible option in certain arthritic ankles. Since recovery can take up to twelve months after surgery, various factors will have to be decided on, before the decision is made and the acute treatments have proven ineffective.

Arthritis of the Ankle 

Also known as the tibiotalar joint, the ankle joint incurs cartilage loss through a variety of various root causes leading to arthritis. Ankle fusion therapies include fusing damaged ankle bones with a series of metal plates and screws. The intention is for the bones to actually heal into one. With the benefit of improved joint integrity, with a downside of limited mobility. Arthritis isn’t completely healed by ankle fusion, however, it is a therapy that is prevalent due to its effectiveness. No therapy is one hundred percent effective. Research and consultation will determine the best path forward. Orthopaedic surgeons favor ankle fusion in younger patients. With ankle fusion, physical activity can be resumed once the joint has healed. 

Ankle replacement, involves joint restoration via the removal of the joint internals, and replacing them with prosthetics. These are synthetic joints which are made of plastic and metal, as indicated in the image. The original joint was damaged, and replacement joint aims to restore the damaged portion of the joint. With joint replacement, there is increased mobility, but still has the ability to regenerate arthritic conditions. Ankle replacement surgery is often prescribed for patients over the age of sixty, who restrict their physical activity. 

What are the Post Surgery Treatments? 

If a replacement surgery is performed on a patient, the patient will be required to release weight from the treated leg. There will often be a protective splint on the leg. The patient will also be mobile via the use of crutches. During the healing process, there will be the incorporation of physical therapy exercises to ensure that joint mobility is properly restored. The joint has to fuse into the surrounding healing ankle joint. The body can either accept or reject the joint, so it will be important for the careful monitoring of the site to be facilitated via the various specialists who monitor the site. 

Your orthopaedic surgeon will ensure that your surgery and your treatment path go as planned. Have a detailed consultation with your specialist, if you feel that this will be the ideal path for you going forward. Your health is your wealth. 

Reference Articles: 

  1. Total Ankle Replacement Surgery for Arthritis: http://www.orthop.washington.edu/patient-care/articles/ankle/total-ankle-replacement-surgery-for-arthritis.html

  2. Considering Ankle Replacement Surgery: https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-considering-ankle-replacement-surgery/

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Approved Stem Cell Usage In The United States

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Image Credits: Docwire News

“Health is a large word. It embraces not the body only, but the mind and spirit as well;…and not today’s pain or pleasure alone, but the whole being and outlook of a man.”-  James H. West

The medical field is coming full circle. Early in our existence, there was a reliance on natural therapies to heal the body’s ailments. Food was our medicine, and medicine was our food. With the advent of technology, there was an emergence of medical procedures, and synthetic drugs that were able to heal the body. While synthetic drugs have their use, they do often have adverse side effects that can cause the patient to often opt not to take the medicine. As an alternative, researchers delved into a world where they could simply allow the body to heal itself. This revolution, led to the discovery of the healing properties of stem cells. 

What Type of Stem Cell Therapies Are Approved By The FDA? 

The FDA is the regulating authority for the approval of stem cell products in the United States. The types of stem cells used for treatments include stem cells from embryonic sources, as well as adult stem cells derived from bone marrow or fat. Although there are a variety of stem cell clinics globally, the majority of them operate with a disclaimer. They are not actually FDA approved. The FDA has approved products from only one source of stem cell - that from blood-forming stem cells (hematopoietic progenitor cells) derived from cord blood. 

The field of stem cell biology is a very complex one. Some of the factors that influence the lack of regulation of the majority of stem cell products is due to the following factors: 

  1. The intricate nature of the genetics of cell development 

  2. The approval phases go through various scales from pilot to full scale trials in humans. Not all results observed in testing lab animals such as mice, scale up to the equivalent in humans. 

  3. The transplanted stem cells may not develop into the desired cells. A deeper understanding of cell biology will be needed to correctly engineer the types of cells needed for the desired therapy. 

  4. The body’s immune response to any injected substances may not be favorable. The body can attack the stem cells in an effort to protect itself as an immune response. It may take a while for the cells to be accepted by the body. 

As the field evolves, and deeper knowledge is gained, there will be an improvement in the available therapies. At best, the existing facilities that are non-FDA approved, are helping to increase the pool of knowledge that exists in the field via clinical trials. 

As a fact, there are stem cell clinics all over the United States, that patients have access to for the treatments of conditions such as cancer, multiple sclerosis, Alzheimer’s and arthritis. Using therapies such as fat derived stem cells, the cells are re-injected into the body to facilitate healing. With minimal evidence, be careful of stem cell clinics that are not FDA approved. There are action steps being taken over the next three years, in order to facilitate their regulation. The primary concern is due to the fact that there are potential adverse side effects which could be detrimental to the patient. With unregulated therapies, there is limited protection if a patient reacts to the treatment.

The benefits of stem cell treatments outweigh their risks, or else there won’t be 570 stem cell clinics in the United States. FDA regulation has been known to take several years, and many doctors are able to access therapies via disruptive technologies that are able to treat patients for conditions that were once considered to be debilitating. Patients are now recovering from conditions such as multiple sclerosis and arthritis thanks to the advent of stem cell therapies. 

Speak to your orthopaedic surgeon, about stem cell therapies. It is an emerging technology that could heal your body with its own natural mechanisms. 

References: 

  1. Rising Tide Biology: https://www.risingtidebio.com/history-stem-cell-therapy-benefits/

  2. Vox Publication: https://www.vox.com/2019/1/9/18173772/stem-cell-therapy-fda

FDA: https://www.fda.gov/consumers/consumer-updates/fda-warns-about-stem-cell-therapies

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Augments For Bone Grafts

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Image Credits: BroadcastMed 

“What is called genius is the abundance of life and health.” - Henry David Thoreau

Why Am I Feeling Pain In My Ankle? 

If you’re prone to ankle pain, rest assured that not all ankle pain is the same! With a myriad of reasons why you can feel ankle pain, and have limited mobility, the best way to find the root cause of your pain is to speak to your orthopaedic surgeon. Statistics have shown that the majority of ankle injuries are due to fractures or to root causes that cause changes in the gait. 

During your consultation, your medical history will be assessed by your doctor. Via screening methods such as a CT scan, an X-ray or an MRI image of your foot and ankles, a thorough analysis of the bone integrity will be assessed. The diagnosis of your ankle pain will then be determined. With a diagnosis, the next step is to actually create a treatment plan. Where possible, you’ll be directed to a minimally invasive procedure. If acute therapies aren’t effective, you will then be directed to a surgical procedure such as fusion surgery. 

How Does Fusion Surgery Heal My Ankle Pain? 

When healing ankle pain, surgical procedures such as arthrodesis are the protocol followed by orthopaedic surgeons. Where fractures have occurred, your surgeon will create a scaffolding that will facilitate the healing of the ankle or the hindfoot. Grafting is added to the fracture to hold the bones in place, and facilitate healing. The bones are secured to the site via a series of wires, screws and plates. With the joint secure, the surgery is completed and the site allowed to heal. 

As the procedure works to relieve your pain, there is a high probability of improvement of mobility. In successful surgeries, the bones will heal together nicely, and the joint integrity and flexibility will be restored. In some instances, the bones will not fuse, and the condition is defined as a nonunion. In this instance, there will have to be some additional interventions taking place to facilitate the healing of the fracture. Historically, surgeons would correct the issue with an autograft - a harvested bone. To do this, a follow-up interventional surgery will be required. Currently, there is a trend towards the use of Augment - a technology that promotes self healing of the body. 

How does the Augment Therapy Work? 

The body naturally heals itself if the right conditions for healing are facilitated. The Augment system will utilize proteins that naturally occur in the body, in order to heal the joint. The beauty about Augment is that it has proven to be just as effective as an autograft, and saves the time and inconvenience that is added to surgical harvesting for an additional interventional procedure. 

The mechanism of action of Augment is twofold - containing both a carrier and a growth factor. The treatment is injected into the site as indicated in the image above. Containing a reagent known as β-TCP, the reagent is capable of healing bones, having been tested at alternative orthopaedic sites, apart from the ankle joints. As a scaffold for healing, bone cells will accumulate on it. Also in the therapy, is a synthesized protein known as (rhPDGF-BB), which facilitates the natural healing of the body. In the treatment, the protein is mixed with a bone-like substance and then the mixture is added to the bone fracture to promote healing. With all the elements necessary for healing in place, the injected protein cells absorb nutrients from the bone site’s blood circulation, regenerate and then restore the joint in time. 

Natural healing therapies, which help the body to autoheal, are ideal paths to investigate if you feel that you would like to try an alternative after your initial fusion surgery. Talk to your orthopaedic surgeon about this minimally invasive procedure. 

References: 

  1. FDA: https://www.accessdata.fda.gov/cdrh_docs/pdf10/P100006d.pdf

  2. Why Does My Ankle Hurt? : http://www.augmentbonegraft.com/patients/why-does-my-ankle-hurt/

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Stem Cell Therapy and Arthritis

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Image Credits: Eickmeier Foot and Ankle Clinic 

“A fit body, a calm mind, a house full of love. These things cannot be bought – they must be earned.”- Naval Ravikant

So you have arthritis. As a patient, you probably have realized that not all arthritis treatments are the same. Once you start your treatments, you realize that how you feel varies per day. You have your highs, and then you have your lows. With even the advanced treatments, you realize that not all cutting edge arthritis treatments are the same. You may opt for surgery in some instances, or even attempt something new and daring like...stem cell therapy or even growth factors. If your pain point is high enough, you’ll be better able, with the help of your orthopaedic surgeon to find a path that will result in the best restorative treatment. 

The beauty about science and technology, is that knowledge is continuously evolving. While researchers have attempted to identify the root causes of various arthritis symptoms, so that the treatment path can be identified there still remains some variation in the results of the treatments. That being the case, the results are favourable enough, that it will be worth an attempt at improving your health, in a manner that allows it to actually self-heal. 

How does Stem Cell Therapy Heal My Arthritis?

With the advent of ortho-biologics, arthritis treatments with the facilitation of cartilage restoration is now a modern-day possibility. With options ranging from total joint replacement, to distraction arthroplasty, stem cell therapy and growth factors there are a myriad of evolving technologies and minimally invasive methods that can heal the arthritic site.

As a word of caution, many new therapies are not covered by insurance due to their recency, and the fact that the methods are still being approved by various medical bodies globally. In Australia, growth factors are rebated, whereas stem cell therapy is not. Talk to your orthopedic surgeon about this procedure, and find out how the treatments can be financed. Your doctor may have their own payment options so investigate with them how your therapy can be financed. 

How do Stem Cells or Growth Factors Regenerate the Body? 

The stem cell has long been identified as the regenerative life force in our bodies. With their ability to divide and duplicate, as well as generate new and different stem cells that are relevant to a healing site, it is possible to regenerate cartilage cells and even bone cells. This is great news for the arthritic foot. Over time, the joint can wear away, and with the ability to rebuild it naturally, it will save the individual time from having to go through processes like harvesting. 

How are Stem Cells Administered? 

Stem cells are administered either surgically, or via injection into the arthritic joint. Much like the image above, your orthopaedic surgeon will utilize medical imaging in order to identify where on the body, the stem cells are to be administered. Depending on the severity of the injury, either of the two options will be applied. When the stem cells are being administered, your orthopaedic surgeon will more than likely utilize mesenchymal stem cells that have been harvested from the individual's body. 

When To Approach Your Doctor for Stem Cell Therapy

As a patient, it is very useful to be proactive. Many times, doctors will offer you therapies that are standard practice. If you feel that you want to try something new, you can personally push the envelope and ask them about these next generation therapies. As a transition from external treatments, to natural self healing methods, you may save yourself many months and years of pain. As the field embraces this evolving technology, it will be a joint decision between yourself and your doctor that determines how the therapy is progressed. 

Reference Articles: 

Cartilage Restoration: http://www.cartilagerestoration.org/stem-cell-ortho-biologics-and-regenerative-medicine-program

Stem Cell Therapy for Arthritis: https://www.arthritis-health.com/treatment/injections/stem-cell-therapy-arthritis

Regenerative Stem Cell Therapy for Foot and Ankle Pain: https://www.stemcellctr.com/procedures/foot-ankle/


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Cartilage Restoration

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Image Credit: Ontario Stem Cell Research Centre

What is Cartilage Regeneration?

Modern living brings with it, added mobility. Aging is much less of a factor today, than it was in previous generations. Regardless of stage in life, individuals want the ability to do more than just the day to day living, they want to do things like go sporting and even go on vacations. With age and even sporting activities comes joint degeneration, and with the ability to improve joint health via science and technology, patients are able to have their joint functions restored, and have the ability to resume their lives as normal.

Orthopedic surgery has evolved to a point where there are a series of surgical techniques which have facilitated the restoration of cartilage. Cartilage regeneration is one such procedure, which facilitates the joint restoration and improved mobility. Consult with your orthopaedic surgeon today, to determine if this treatment will be right for your joint pain. Cartilage regeneration is ideal for the treatment of various root causes of joint pain, and may just be what you need to restore your life activity.

How does Cartilage Regeneration work?

Cartilage regeneration functions by restoration of the articular or joint cartilage. The cartilage in the joint is a fusion of various components such as collagens, proteoglycans and sustaining proteins. Cartilage is alive, and averaging about 85% of water, and the balance the binding elements, it is the joint’s natural cushion. Since joints are hinge joints, motion can induce wear and tear in the cartilage, and decrease the thickness of the film. As we age, the water content, and chrondrocyte cells reduce in number. These cells are hold the cartilage matrix together and give it its strength and ability to line the surrounding bones. Additionally, illnesses such as Osteoarthritis have been heavily linked to cartilage damage. Patients often complain of joint stiffness, with restricted mobility.

How does Cartilage Regeneration Work?

Cartilage, is not a self healing material. From the medical innovation perspective, many efforts have been undertaken to understand why this is so, and what can be done to improve joint health, knowing this condition. The articular cartilage therefore has to be externally generated, and a transplant into the site of injury be facilitated as the treatment method. Essentially, if the body won’t create it, the aim is to synthesize it and restore what was lost in the natural processes of life.

Your orthopaedic surgeon will identify the best path forward for your treatments. With an assortment of restoration options from abrasion, distraction arthroplasty, microfracture, mosaicplasty, autologous chrondrocyte implantation, osteochrondral allografts and matrix assisted chrondrocyte implantation there are a variety of paths for treatments. Everyone’s case will be different, and with thorough analysis via detailed scans, your diagnosis and treatments will determined. Some treatments are acute, and other require more advanced preparatory methods for healing. Research methods are still being studied, to determine which methods are ideal for healing. As an emerging technology, there are limited guarantees, but over time the procedures are finding favor in the eyes of the orthopaedic specialists.


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Orthobiologics - A Healing Alternative

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What is Orthobiologics?

When it comes to the human bone structures, healing is a process that can often take a long time to facilitate if there is a serious injury or fracture to the bone. With a new understanding of the healing mechanisms of the body, there are natural and artificial substances which orthopaedic surgeons can use to accelerate the rate of healing. These substances, are known as Orthobiologics. With their abilities to heal bones, muscles, tendons and ligaments, orthobiologics is the path forward to a life of accelerated healing. Consult with your orthopaedic surgeon, to identify if you’ll be a suitable candidate for this cutting edge medical innovation.

How do our bodies heal?

The key to all healing is the facilitation of healing agents to attend to an injury site. The blood is the agent that facilitates this change. Additionally, there are three orthobiologic substance which research has identified is key to aid the healing process. These include the cell matrix which helps to heal bone gaps, proteins for regulation of the healing process, and stem cells for regeneration of the relevant cells that will heal the injury. While all three elements are critical, stem cells are the very versatile agents that are finding their relevance in global healing of the body. They have the ability to generate a multitude of cells, and facilitate healing. The integration of all these elements will ensure that injuries are able to restore to normalcy.

Types of Orthobiologic Materials:

There are various natural and synthetically derived materials that are used in the orthobiologic process. When there is an injury, often the site must be protected by a special scaffolding that provides support and mobility. There are various materials that facilitate the scaffolding. Injected into the site will be the healing agent such as the stem cells. Materials such as Bone Grafts (autograft/allograft), involve the use of bone fragments to support the injured bones. Bone fragment sources vary, and in some instances are harvested from cadavers. Alternately, with the advent of materials science, there are compounds such as calcium phosphate which can be used to fill gaps in bone fragments.  

How do the growth elements help to heal?

Via processes such as genetic engineering, the body’s healing processes can be accelerated. On its own, the body takes a very long time to heal structures such as bones. Via science and technology, mechanisms of healing are now much more easily understood, and the levers that facilitate healing are now being manipulated. While not one hundred percent effective, research has shown favorable adaptation of the body to the injection of healing agents such as stem cells and growth factor proteins. With good blood circulation in the area, the two agents work in tandem with each other to repair the injured site. Via innate intelligence, the cells will regenerate the relevant cells needed to heal bones, muscles and ligaments.

The future of orthobiologics is still unfolding, and from the current vantage point, the possibilities look endless. Consult with your orthopaedic surgeon to identify if you are a suitable candidate for this new wave of medical treatment. Your health is your wealth, if there are new and better methods, take advantage of them.

Reference Article: https://orthoinfo.aaos.org/en/treatment/helping-fractures-heal-orthobiologics/


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Achilles Tendon Rupture

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Image Credit: Mayo Clinic

“Your health is what you make of it. Everything you do and think either adds to the vitality, energy and spirit you possess or takes away from it.”- Ann Wigmore

What is Achilles Tendon Rupture?

Achilles Tendon Rupture is a condition  that occurs when the Achilles tendon separates into two separate parts after the introduction to a stress, that causes the tendon to shear then break! It is usually associated with hearing a loud “pop” in the feet once there’s a vigorous blow to the heel area. The variation in ankle conditions is expansive from minor conditions to debilitating conditions where patients cannot walk. Not all ankle pain sufferers are the same!

The symptoms list can be numerous! The symptoms of Achilles tendon rupture can be mistaken for additional ailments, so consult with your foot and ankle surgeon in order to determine what the root cause of your ankle pain is!

What are the symptoms of Achilles Tendon Rupture?

As an injury of the lower leg, the statistics have proven that the condition occurs when a blow is received to the back of the lower leg. As a ligament, the Achilles tendon facilitates the flexibility of the ankle joint. Athletes are the number one suffers from Achilles tendon rupture. Additionally, risk factors such as age, gender, antibiotic usage, obesity, and steroid usage have proven to increase the odds of Achilles Tendon Rupture.

As a strong fibrous cord, via the laws of physics, if stretched to the limit...the Achilles Heel will definitely break. Orthopaedics has identified two different types of rupture of the Achilles Tendon:

  1. Complete Rupture: This results in the tearing of the tendon into two segments, as outlined in the image above.

  2. Partial Rupture: This results in the partial tearing of the tendon. There will still be a joining of the tendon at one phase of the defect, but a separation at one stage.

What are the treatment options for Achilles Tendon Rupture?

With an excruciating pain that affects your ability to walk, the most common treatment for Achilles Tendon rupture is a minimally invasive surgical procedure. Surgery is the ideal way to engineer the tendon back to its former glory. As with all surgery, your orthopaedic surgeon will assess the area, usually with a scan like an X-ray in order to determine where the problem is. Post surgery, you will be prescribed a recovery plan, to facilitate your healing.

While there are non-surgical treatments for Achilles tendon rupture, minimally invasive procedures have proven effective for healing the root cause, particularly for a internal tear. For maintenance of the ankle, stretching exercises have proven effective in facilitating the healing of the ankle regions. An appropriate physiotherapy will aid in the restoration.

Reference:

https://www.mayoclinic.org/diseases-conditions/achilles-tendon-rupture/symptoms-causes/syc-20353234


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Heel Pain Syndrome

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Image Credits: WebMD

“Three things in life – your health, your mission, and the people you love. That’s it. “ - Naval Ravikant

Heel pain syndrome (formerly known as heel spurs) is an initially painless foot condition that occurs in the feet. Whenever you feel pain in your feet, be careful. Not all pain in your heels is the same!

With a list of symptoms list that can be numerous, it is best to consult with your orthopaedic specialist in order to discuss minimally invasive treatments.  The nature of foot conditions that it is very prevalent so one symptom can have a myriad of root causes. With the right consult, you can easily determine what the root cause of your ankle pain is!

When you develop calcium deposits in your heels, which eventually accumulate to create bony protrusions right under the heel bone, a heel spur is said to have developed. Detection is best identified via scans such as an X-ray. Athletes are particularly susceptible to this condition due to their stretching of the ligaments in the region of the heel. On the other extreme, if you are overweight or obese, you will be prone to heel spurs due to the excessive pressures that are placed on the feet.

What are the symptoms of heel spurs?

As often painless accumulations in the feet, if left unattended to, heel spurs can become painful when coupled with plantar fasciitis or inflammation of the soft tissue that cushions the heel. Once there is a change in the feet, the spurs will become problematic. For this reason, prevention is often better than cure. There are a myriad of treatments for heel spurs, but at best, the ideal is to eliminate them completely via minimally invasive methods. In the orthopaedic field, the following are recommended for treating heel spurs:

  1. Custom Made Orthotics: With these specialized insoles, the heels can be protected as they are healing.

  2. Anti-inflammatory medications. These can either be over the counter or prescribed. These medications will help to heal the feet, particularly if you have plantar fasciitis, which will be aggravated by the presence of the spurs. Cortisone injections have also been found to be quite effective in reducing inflammation.

  3. Physical therapy exercises such as stretches to ensure that maximum circulation is taking place in the heel region to facilitate healing.

As suitable treatments for acute conditions, minimally invasive surgeries will be ideal for those more serious conditions which can’t be treated by orthotics, anti-inflammatories or cortisone injections.  

Minimally Invasive Surgery for Heel Spurs

While the majority of persons get better with non-surgical treatments, it is often the case that the remaining ten percent will need surgery. In the instance that surgery is needed, your orthopaedic surgeon will inform you of the plan to correct the condition. The surgical treatment is known as plantar fascia release.

The treatments will center on healing the plantar fascia and removing the bone spurs. There will be a pre-surgery period where you will be prepped, and you will also be prescribed the appropriate healing plan after the treatment has taken place.

Reference Article: https://www.webmd.com/pain-management/heel-spurs-pain-causes-symptoms-treatments#1


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How to Choose the Right Sandals for Your Feet

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Image Credits: Betabrand

Our feet are one of the most important parts of our body, yet they tend to be the parts that are least paid attention to. For the majority of the world, it is now currently the summer season, which is when we like to wear those open toe shoes we love so much - our sandals.

Before you head out to your favorite stores to purchase, be reminded that not all sandals are the same!

Strappy sandals, thin soled sandals, gladiator sandals...the list goes on! The nature of sandals is that they are easy to wear, but careful care must be taken because with sandals, you need to seek not only the cosmetic appeal, but the ankle and foot support that will prevent downstream injuries. The ankle is a hinge, and is susceptible to shears if the appropriate rotations and shears are applied to the area. If you are unsure as to how to choose your sandals, consultants at your local foot store will me more than happy to assist.

How to choose the perfect Sandals

With the myriad of sandals on the market today, the process of choosing the right sandals can be confusing. Questions to think about include:

  1. Will this sandal suit my lifestyle?

  2. Will I have have appropriate ankle and arch support?

  3. How long do I intend to wear them for and will they be comfortable?

  4. Are they for cosmetic use - just for running errands, or will I need them for uses that are more rigorous such as hiking?

As you embark on your journey, with a more conscious approach to the need to take care of your feet, it will be import to ensure that the critical factors that will ensure both comfort and support are being met. Focus on the mission. Keep in mind what will be the primary use of your sandals. Are you planning to hike in a nearby or distant mountain range or are you simply planning to go to the beach with sandals that won’t dissolve after water touches them? The answer to these key questions will determine what will be next for you on your shoe journey. Once you have decided the choices will be narrowed to a few options that you can choose from.

What is the right sandal?

The right sandal will support your feet, and provide the cushion, support and comfort that you need. The anatomy of the foot is such that it supports the body on a hinge joint. The appropriate alignment of the feet is critical to so much, inclusive of the health of the spine. The right fit of the shoe should be such that it fits snugly, and there is at least 1-1.5 cm of space at the end of shoe. A few key characteristics of shoes that should be factored in include:

  1. A stiff back for appropriate heel support

  2. Flexibility to facilitate the motion of your feet

  3. Appropriate arch support - The arch of the foot is part of its engineering design that facilitates its ability to support the body appropriately. Shoes will not all be perfectly designed, so with the appropriate inserts, shoes can be customized to facilitate that additional comfort.

  4. Heel height - Heel height is very important for the support of the feet and the body. The body was designed for an optimum height. The higher an individual is off the ground, the higher will be the center of gravity of that individual. Any object with a high center of gravity will have the tendency to fall, compared to an object with a lower center of gravity. Women are aware of the fact that with higher heels, they do feel the instability that comes with being elevated. It will be important for an individual to ensure that they match their heel height with their personal height.


    Reference Article: https://www.outdoorgearlab.com/topics/shoes-and-boots/best-sandals-womens/buying-advice

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Distraction Arthroplasty

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Image Credits: BMS Musculoskeletal Disorders - BioMed Central


What is Ankle Distraction Arthroplasty?

Ankle Distraction Arthroplasty is a procedure that is utilized to treat arthritis in the ankle in a way that allows the joint to heal naturally. The variation in ankle arthritis is expansive from minor conditions to debilitating conditions where patients cannot walk. Not all arthritis sufferers are the same!

The symptoms list can be numerous ! The nature of arthritis is that it is very prevalent. The ankle is a hinge, and is susceptible to wear and tear if the appropriate rotations and shears are applied to the area via activities such as sports, or via internal conditions such as diabetes which induce neuropathy. The symptoms of arthritis are similar to other ankle conditions, so consult with your foot and ankle surgeon in order to determine what the root cause of your ankle pain is!

What does Ankle Distraction Arthroplasty focus on?

Ankle Distraction Arthroplasty focuses on restoring the joint. Usually during arthritis, there is a degradation of the cartilage in the joint, which affects the ability of the patient to use the joint properly. With distraction arthroplasty, the patient is provided with a mechanical scaffold, that cradles the leg. It also facilitates the transfer of weight from the feet to the scaffold, relieves the joint, and allows natural healing of the cartilage to take place. In terms of the outcomes...the results are positive, with ankle motion preserved, and increased mobility being facilitated after the 10 to 12 weeks of wearing the frame, and then facilitating final healing.

Your foot and ankle surgeon, will assess you and determine if distraction arthroplasty or other minimally invasive procedures will be ideal for your arthritis. At the time of writing, distraction arthroplasty is gaining widespread acceptance across the orthopaedic field, so feel free to enquire about it if you feel that your arthritis is severe enough. There are several athletes who have used the procedure to heal themselves, and have returned to activities after the treatment.

How does the Distraction Arthroplasty Procedure Work?

Arthritis as a condition, involves the degradation of the articular cartilage that facilitates smooth joint operation. When your orthopaedic surgeon assesses your X-rays there will be cartilage loss that can easily be seen. As the joint stiffens, the patient will feel pain which affects their mobility. Since the joints are constantly in motion, healing is always slower than anticipated. By utilizing distraction arthroplasty, the body will be allowed to naturally heal itself. The procedure serves to release the joint contact, and the interbone spaces where the cartilage occupies is allowed to regenerate as there is renewed blood circulation to the area. What circulation does is facilitate healing.

How does the procedure work?

The distraction arthroplasty procedure is categorized as minimally invasive. A frame is erected around the joint to be treated. Via a configuration of rings, plates, hinges and screws as you’ll be able to see outlined in the image above, the ankle and leg are gently cradled. The application is executed surgically, and the removal is accomplished in a similar way. During surgery, if there are any additional joint adjustments to be made, they will be facilitated by your surgeon. If there are any bone spurs due to the joints rubbing together, they will be removed. Additionally, techniques to facilitate cartilage repair will be facilitated by your orthopaedic surgeon.

Post Operative Care

The Distraction Arthroplasty process takes about two days. The first day is to facilitate the surgery, and the second day is to ensure that the patient can confidently manage to operate with the frame. A physical therapy session is usually prescribed, after which, the patient is discharged and allowed to return to their home life to heal. The frame is worn by the patient for ten weeks. They will be allowed to participate in regular hygiene activities such as showers, and also swim in pools. Careful treatment of the area where the skin is penetrated by the frame is also prescribed by the orthopaedic surgeon.

Consult with your orthopaedic surgeon, if you believe that distraction arthroplasty will help to heal your arthritis.

Reference Article: https://www.hss.edu/conditions_ankle-distraction-arthroplasty.asp


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Ankle Fractures

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What is an Ankle Fracture?

When bones break, either partially or fully they as classified as fractures. The variation in fractures is expansive from minor injuries to complete shatters. Not all ankle fractures are the same! If you were to assess all the fractures that existed, you’d find that there’d be a bell curved distribution of the fractures with a few being the most popular classifications.

Lateral malleolus fracture, Medial malleolus fracture, Posterior malleolus fracture...the list goes on! The nature of ankle fractures is that they are very prevalent. The ankle is a hinge, and is susceptible to shears if the appropriate rotations and shears are applied to the area. The symptoms of ankle fractures and ankle sprains are similar, so consult with your foot and ankle surgeon in order to determine what the root cause of your ankle pain is!

What are the symptoms of an Ankle Fracture?

There are multitude of symptoms that contribute to the condition of an ankle fracture:

  1. Pain is the initial sign, usually after an incident such as a twisting of the foot during activities such as sporting activities. The pain may be localized at the ankle joint, or be felt all the way up to the knees.The patient also finds it hard to walk due to the pain, and the instability of the joint.

  2. Swelling. Similar to the pain, the swelling can either be localized at the ankle or spread to the rest of the leg up to the knee.

  3. Blisters at the fracture site as well as a discoloration of the leg.

  4. Bone protrusion due to the shifting in the alignment of the leg.

The following is the anatomy of the ankle joint.

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How are Ankle Fractures Diagnosed?

A detailed evaluation by a foot and ankle surgeon is a sure way for the ankle fracture to be diagnosed and treated. Attempt to have the foot addressed as soon as possible after the fracture. If possible, begin at an emergency room for an initial assessment, and they will subsequently refer you to an orthopaedic surgeon. Via internal checks via imaging technology such as X-rays, the appropriate diagnoses can be determined.

How are Ankle Fractures Treated?

When an ankle is fractured, there is the possibility for the fracture of one or more bones. Depending on the severity, there are various treatment solutions that you will be prescribed in order to ensure that the weight pressure is removed from the leg, and the healing process is allowed to take place. The ankle stability will be influenced by the extent of the fractures to the bones, and the surrounding ligament damage.

Based on the anatomy of the ankle, shown in the image above, one can see that there are a group of bones that make up the ankle joint. These include the tibia and the fibula, which are the main bones. The tibia and fibula can be further dissected into the:

Medial malleolus - inside part of the tibia

Posterior malleolus - back part of the tibia

Lateral malleolus - end of the fibula

Fractures can take place in each of these regions. When the ankle region is aggravated due to rotation, rolling of the ankle, or any traumatic impact. The types of treatments that can be applied to the area are:

  1. Nonsurgical Treatments: If the bone alignment is minor, the fracture can be protected and allowed to heal. These methods include casting the leg, so that it it held in place and allowed to refuse.

  2. Surgical Treatments: For bones where the alignment displacement is significant, and the fracture pattern is unstable, the fracture has to be surgically treated. During surgery, the bone fragments must be re-aligned with internal scaffolding - plates and screws. Additionally, if the fracture is not too severe, the injury can be treated with minimally invasive techniques.

References:

  1. Ankle Fractures: https://www.foothealthfacts.org/conditions/ankle-fractures

  2. Ankle Fractures: https://orthoinfo.aaos.org/en/diseases--conditions/ankle-fractures-broken-ankle/

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Prevention of Diabetes-Related Amputations

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Diabetes, as a health condition, has associated side effects that cause it to impact the mortality of the patients it affects if the patient is not carefully monitored. Not all diabetic patients are the same! Assessing the patient categories will identify various downstream conditions!

Type 1 Diabetes, Type 2 Diabetes...the side effects are numerous!!

One side effect of the diabetes is the condition known as diabetes-related foot diseases, also known as DFD. DFD is one of those health conditions that is so subtle, that it doesn’t get noticed until it’s in an advanced state.

The final stages of the condition results in amputation of limbs, particularly feet. With amputations come an increase in mortality rates, and for both the patients longevity and ease of life, there is now an increased paradigm shift in how DFD is approached by the health industry. DFD statistically is the leading cause of amputations in Australia. The downstream effects are also propagated as the condition progresses. With a total expenditure of up to $1.6 billion each year, the financial benefits of reducing the adverse effects of DFD will not only be economical, but will facilitate the improvement of the quality of life of the patients who are saved. More research is still left to be carried out on the DFD condition. Mainly linked to peripheral neuropathy or peripheral artery disease the resulting neuropathy that causes the patients to lose the sensations in their feet and ultimately develop ulcers that lead to amputations.

The root cause of DFD is the loss in the sensation of the feet, so it is imperative for the feet to be carefully monitored as the patient progresses through their diabetic care. For this reason, more attention at the early stages of diabetes, must be paid to the feet.

What are the next steps?

Once DFD is diagnosed, the medical industry has identified that an integrated approach to DFD management is needed. The team needed will consist of the following professionals:

  1. Medical

  2. Surgical

  3. Nursing

  4. Allied Health Disciplines

The process must be integrated across all the tiers of the medical sector - primary, secondary and tertiary phases of the system. With appropriate treatment at each stage, the achievement of the prevention of amputation will be facilitated. The state of the Australian statistics is the nation is in the leading OECD nations for its amputation rates linked to diabetes. Compared to the EU nations, the gap is significant. Fortunately, the root cause of the difference has been attributed to the integrated systems which facilitate increased patient care.

How will DFD related amputations be reduced?

Policy changes are the key to changing the status quo of the Australian Health Care System. The business case for the reduction of the expenditure on DFD has peaked the attention of national bodies in Australia. The statistics for DFD have been collated over the past few years, and from the root cause analysis of the numbers recommendations for healing the system have been proposed. The interdisciplinary integrated systems have been added to the health care system. The resulting outcome is a halving in the amputation rates.

Additionally, dedicated entities such as the Diabetic Foot Australia, is leading the cause for facilitating further amputation reductions via the improvement of system monitoring. With an integrated team of experts from various disciplines, their efforts will in time achieve their target objectives. They aim to eliminate amputations within a generation.

How can you help?

If you’re a diabetic, or a relative of a diabetic, enquire about their level of care. If there is a gap in the attention being paid to the patient, seek entities that will provide the services offered by entities such as Diabetic Foot Australia. You may save their lives via this action.

Reference Article:

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/327941465

Pathway to ending avoidable diabetes-related amputations in Australia

Article in The Medical journal of Australia · September 2018


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Gout and Your Feet

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Image Credits: WebMD

“Three things in life – your health, your mission, and the people you love. That’s it.”  Naval Ravikant

There are many root causes for joint pain. Arthritis is an autoimmune response that causes inflammation and stiffness in the joint. Under the subset of arthritis, is gout. Gout is a painful condition that causes pain, stiffness and also has an associated swelling of the joints during an attack. The onset pain is attributed to a build-up of uric acid in the bloodstream. In time, the uric acid crystals crystallize, and the body reacts to their presents via an autoimmune response, in order to remove them from the the joint. One of the regions that are most affected by gout are the feet, particularly the big toe.

Gout must be carefully treated in order to prevent flare ups, because it does have a re-current nature. If not carefully monitored, tissue damage can result. Gout prevalence varies globally, with between 0.1% and 10% of the total population being impacted by the condition. There are a few factors which influence the onset of gout. These are:

Diet: Rich, and highly sweetened foods have the propensity to increase the risk of gout. Meats, seafood and sweet drinks create the ultimate pathway for the synthesis of uric acid via metabolism, and can increase the risk of gout. Carefully managing the diet, and ensuring that the weight is properly managed is key.

Pre-existing condition: The body is one interconnected unit. If you suffer from conditions that affect your cardiovascular systems (eg high blood pressure or diabetes), you will have the propensity to induce the onset of gout if the condition is not managed. Treatment of these conditions can also create the environment within the body that can facilitate gout. Check your family history for any traces of these conditions, in order to ensure that you are not at hereditary risk.

Gender: Men are more prone to develop gout than women due to their higher levels of uric acid. With age however, there can be an eventual match in the levels and the playing field can be levelled.

How is gout treated?

Your foot and ankle specialist will be able to facilitate the treatment of gout. The condition will initially be diagnosed via diagnostic tests such as a joint fluid test. Additionally, the condition can be determined via blood test to determine the uric acid content in the body. Additionally, deeper assessments are determined via ultrasounds or CT scans, in order to ensure that there are no other underlying root causes.

Via a series of prescribed medications, appropriate management of your gout will result. Since the entire process of gout management is the management of internal chemistry, the following processes are facilitated by gout treatment:

  1. Treatment of a current flare up

  2. Prevention of a future attack via controlling the internal management.

In the treatment of gout, the medication most prescribed include nonsteroidal anti-inflammatory drugs (NSAIDS), colchicine, or corticosteroids. Your doctor will determine what is best for your condition. Additionally, injections of treatments are administered.  Expect about two weeks for a full recovery.

As with all conditions, prevention is better than cure, so take good care in ensuring that your diet is rich in foods that enable your body to function well, and prevent the onset of gout. A diet rich in fluids, particularly water will facilitate the function of your kidneys, and flush uric acid from your system.

References:

  1. Gout Slideshow: https://www.webmd.com/arthritis/ss/slideshow-gout

  2. Everything you need to know about gout: https://www.medicalnewstoday.com/articles/144827.php

  3. Gout-symptoms and causes: https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897

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Ankylosing Spondylitis and the Feet

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Image Credit: Arthritis Support Board

“Cheerfulness is the best promoter of health and is as friendly to the mind as to the body.”- Joseph Addison

What is Ankylosing Spondylitis?

The human body, is a system of interconnected systems. There are many root cause conditions which have the ability to develop downstream complications in the body and affect the feet as they progress. Ankylosing Spondylitis (AS) is one such ailment. As an inflammatory condition that first begins in the spinal cord, calcium deposits in the ligament-bone condition can cause a fusion of the spinal cord. There are treatments that can control this condition and slow its propagation to the rest of the body.

In the peripheral regions of the body, there can be complications due to AS. The feet can be affected by more than one condition as a result of AS. The entire skeleton is one interconnected unit, and the spine is connected to the pelvis, and the bones and joints connect all the way to the feet. Since the flow is linear. If there’s a problem in the spine, the propagation to the feet is more than likely imminent.

The body, as a system adjusts its alignment if certain areas become painful. The gait pattern will shift if the muscle and joint connections are shifting. Foot complications developing as a result of this shift are as follows:

Plantar Fasciitis:


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Image Credit: Upstep.com

This condition develops as a result of the inflammation of the plantar fascia fusion to the heel bone. The plantar fascia is one of the tissues in the feet and provides the cushioning under the heel. With the aggravation of this joint due to shifts in the gait and weight distribution, patients often experience painful sensations under the heels at differing points during the day.

Your orthopaedic surgeon will facilitate your treatment. Usually physiotherapy is prescribed, along with treatments that aid to cradle the area (via orthotics) in a means to protect the inflammed segments of the feet. Where necessary, your foot and ankle specialist will inject the area with cortisone (steroid) injections. Carefully wrapping the feet can also provide the appropriate therapies needed.

Insertional Achilles Tendinitis

In some instances, the point at which the Achilles tendon attaches to the heel bone can also become inflamed. This condition is known as Achilles Tendinitis. Painful sensations are experienced at the back of the heels, along with a swollen heel region and painful walking. If not monitored, a Haglund’s bump or bony protrusion is noticed.

Treatments include raising the heels to relieve pressure during healing. Additionally, orthotic use to cradle the area are key to ensuring that mobility is facilitated.

Toe Ailments

Due to posture changes, the gait will change. As the muscles also shift to accommodate the change, then the propensity for muscle spasms and cramping to occur in the toes is a possibility. With AS, if the spine shifts to create a forward curve, the toes will adjust (clawing motion), in order to provide the support to keep the body stable. The knees also adjust themselves to flex, and facilitate the skeletal stability. With the shifts, the knee joints can be affected as well as the toes. Orthotics will enable appropriate support.

Additionally, if there are additional treatments needed, your foot and ankle surgeon will determine what these are.

References:

  1. What is AS: https://www.versusarthritis.org/about-arthritis/conditions/ankylosing-spondylitis/

  2. NASS Article: https://nass.co.uk/about-as/what-is-as/your-feet/

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Morton's Neuroma

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“Health is a large word. It embraces not the body only, but the mind and spirit as well; …and not today’s pain or pleasure alone, but the whole being and outlook of a man.” - James H. West

Morton’s neuroma, develops when there is a non-cancerous growth between the third and fourth toes. The nerve tissue expands and becomes swollen, as outlined in the image above, and the resultant sensation is a painful sensation, often experienced by patients as “feeling as if there’s a marble” in the sole of the feet. Consult with your orthopaedic specialist if you experience any prolonged pain in the feet. With the appropriate diagnostic tools, your specialist will be able to diagnose your condition.

Women are more prone to Morton’s neuroma, and the primary root cause is tied to the wearing of high heeled shoes. Take caution with your shoe design. Wearing high heels induces the conditions that develop the condition - the ability to induce stress to the nerves since the feet are not in positions that they are comfortable in, but remain elevated and stretched for prolonged periods of time. The nerves respond by thickening, causing neuroma. Additionally, some sporting activities which stress the feet, are also capable of inducing the condition.

What happens in your consultation?

During your consultation, your orthopaedic surgeon will usually ask detailed questions about the symptoms that you are experiencing. Your medical history and lifestyle will be assessed. A thorough medical examination will follow, with an X-ray, Ultrasound scan or MRI used to get a closer look at the internals of the feet. What these tools will do, is eliminate other possibilities such as stress fractures and other orthopaedic conditions, and facilitate a clear view of the internals of the feet.

Treatment

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Image Credit: YouTube

After your consultation, your orthopaedic surgeon will determine the path that you will take to recovery. For acute conditions, treatments such as corticosteroid injections, and alcohol sclerosing injections are used. These treatments are done in series, and eventually facilitate the healing of the area. If the instance of severe Morton’s neuroma, your orthopaedic surgeon will recommend a surgical option. Minimally invasive treatments are used to remove the painful growth. The adverse effect of surgery is numbness, so attempt the acute treatments for up to 6 months, before deciding with your surgeon’s help, that surgery is the path for you.

Recommended with your treatment are the following lifestyle changes:

  1. Footwear changes

  2. Pain treatment - painkillers or injection

As with all conditions, early treatments will ensure that drastic medical action will not have to be taken. Along with your treatments, there are series of physical therapy exercises that you can do, to ensure that you are improving the flexibility of the area. Additionally, insoles and orthotic devices can be applied to the area, in order to protect the area and facilitate healing.

Reference Articles:

  1. Morton’s Neuroma: https://www.mayoclinic.org/diseases-conditions/mortons-neuroma/symptoms-causes/syc-20351935

  2. Medical News Today: https://www.medicalnewstoday.com/articles/179773.php

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Sesamoiditis

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Image Credit: The Foot Group

“Our greatest happiness does not depend on the condition of life in which chance has placed us, but is always the result of a good conscience, good health, occupation, and freedom in all just pursuits.”- Thomas Jefferson

What is sesamoiditis?

In the human body, there is a special family of bones called sesamoids, that are unique in their connection to the rest of our skeleton. Sesamoid bones, are connected to muscles via a tendon connection. The two areas of the body where sesamoid bones are found are in the knees, and in the feet. The majority of the bones in the body, are connected via joints.

In the feet, are two small sesamoid bones, which are in the soft padded area, close to your big toe. These bones can become inflamed, once aggravated. When this takes place, the condition that develops is known as sesamoiditis. Based on the location of the injury, statistically athletes and dancers are prone to develop this condition.

This is due to the fact that athleticism requires use of the feet, causing vigorous vertical stress during jumping. With the excessive activity, the area of the feet are overworked, and the sesamoids ultimately become aggravated.

Diagnosis of sesamoiditis

Consult with your foot and ankle specialist if you feel that you may have sesamoiditis. Any prolonged pain in the feet, should be examined by your orthopaedic specialist, just to ensure that you are treated for the right condition. The examination will be very thorough, and your orthopaedic surgeon will look for the signs of tenderness in the region around the sesamoid bones as an indicator of the condition.

Many foot and ankle ailments have similar symptoms, so ensure that the right diagnosis is determined. Via X-rays and other scanning mechanisms, you will be able to determine the root cause of your pain, and then ultimately treat it.

Treatment of sesamoiditis

As an inflammation of the sesamoid bones, what you’ll need to heal is to simply reverse the conditions that induced the condition. Your doctor will prescribe for you rest. In terms of treatments, you can take pain-killers and anti-inflammatories (Aspirin or Ibuprofen work well ) to ensure that the inflammation is reduced.

The sesamoids are very critical to the function of your feet, and they provide pulley mechanisms that permit your tendons to smoothly glide over as you are walking. Take good care, if you feel pain in the area. If you’re an athlete, if you aggravate the area, you ultimately lead to a fracture, so ensure that you attend to the pain early. Additionally ice treatments help to soothe the area and reduce inflammation. When wearing shoes, ensure that they are comfortable, and have the appropriate cushioning.

Sesamoiditis, is easily treatable so ensure that you facilitate your healing. Dancers and baseball players are particularly prone, so if you find yourself in this category, wear protective insoles to ensure that you protect your soles.

Reference Articles:

  1. Sesamoiditis: https://orthoinfo.aaos.org/en/diseases--conditions/sesamoiditis

  2. Sesamoiditis on Healthline: https://www.healthline.com/health/sesamoiditis

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Hammertoe

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Image Credits: Medicinenet

“Keep your vitality. A life without health is like a river without water.”- Maxime Lagacé

The types of shoes that you wear can either help your feet or affect them adversely. The hammertoe is the result of wearing incorrectly sized shoes for the feet. If the shoes are too narrow, over time, there will be stresses induced on the second, third or fourth toes. Over time, the toes will have a bend at the middle joint. The angular shape created by the toe, creates a shape much like a hammer.

Hammertoes are actually painful, and over time the muscles, tendons and ligaments will be distorted as the toes are bent out of shape. In the beginning, the hammertoes are actually flexible, but with the conditions sustained, the toes eventually remain in their position. At this point, surgical intervention will be required in order to restore them to their original state. Symptoms include:

  1. Pain in the toes. As the soft tissue distorts, movement will induce pain.

  2. Corns and callouses due to the fact that the toes are rubbing against the shoes due to the projections.

  3. Open sores on the toes

Some root causes of hammertoes are:

Shoes: Tight shoes or high heels are constricting to the toes.

Gender: Women are more prone to hammertoes due to the fact that they are more prone to tight shoes or high heels.

Injuries: During regular activities such as walking, a toe can be stubbed. Additionally, during sporting activities the feet are prone to impacts which can induce hammertoes.

A visit to your orthopaedic surgeon will determine the severity of your hammertoe condition, and determine the next phase of your treatment. Your orthopaedic surgeon will prescribe either minimally invasive surgery, or other simpler treatments.

Hammer toe Treatments Include:

  1. Toe exercises to flex the joint. Stretch the toes to ensure that the joint is being exposed to both stretches and contractions.

  2. Changing your shoes from those that are tight and constricted to those that are roomier.

  3. Shoe inserts to facilitate the re-alignment of the toes.

If these methods don’t work, then minimally invasive surgical procedures can be utilized in order to treat the area. Surgical treatments including methods such as arthroplasty, arthrodesis, tendon transfer, will help to realign the muscles and tendons, and realign any bones that may be in the incorrect position.

In the case of human induced hammer toes, prevention is always better than cure. Take good care of your feet, ensure that you have the correctly fitting shoes, and you’ll be well on your way to having feet that you can be proud of. Since women are the most affected, it is best to seek comfort rather than cosmetic appearances. On occasion, you can wear heels if you have special events, but for the every day, you can wear flatter shoes or wedges if you’re seeking height. Your health...is your wealth.

Reference Article:

  1. Medical News Today: https://www.medicalnewstoday.com/articles/315600.php

  2. Hammertoe: https://www.foothealthfacts.org/conditions/hammertoe

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