Nathan Lane Injures Foot

Last Wednesday 2013 Tony nominee Nathan Lane injured his foot during a performance of The Nance and had to be replaced by his understudy Stephen DeRosa. Despite the injury, Lane was back on the stage at the Lyceum Theatre last Thursday. 
According to a phone interview with the New York Times Arts Beat, the Birdcage actor injured his foot and leg during the play's first act when Lane stepped off the production's turntable, which spins around to allow the sets to transform from a burlesque house to the apartment of Lane's character, Chauncey Miles.
"The turntable was moving very quickly and I misjudged it, and had one foot on the stage while the other was still on the turntable, and it pulled my leg," Lane said. "It twisted badly. I'm seeing a physical therapist today, and we'll see. I hope to be back in the show tonight."
The Nance tells the story of a 1930's era homosexual burlesque performer named Chauncey Miles. A "nance" was a show business term for a stereotypically camp homosexual man, who struggles with his own identity and society's hypocrisy towards homosexuality. In The Nance Playwright Douglas Carter Beane tells the story of a homosexual man living and working in the secretive and dangerous gay world of the 1930's New York City. The play runs through Sunday August 11th. 
References: Broadway World 
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You Can't Rock With Rocker Bottom Feet

Congenital vertical talus, also known as rocker bottom foot, is a rare deformity of the foot which is diagnosed at birth. It is one of the causes of flatfoot in the newborn. One or both feet may be affected. It is not painful for the infant, but if left untreated, it can lead to serious disability and discomfort.

The talus is a small bone that sits between the heel bone and two bones of the lower leg. The tibia and fibula sit on top and around the sides of the talus to form the ankle joint. The talus is an important connector between the foot and leg, helping transfer weight across the ankle joint.
In congenital vertical talus, the talus has formed in the wrong position and the other foot bones to the front of the talus has shifted on top of it. Because of this, the front of the foot points up and may even rest against the front of the shin. The bottom of the foot is stiff and has no arch. Usually it curves out, hence the rocker bottom phrase.
Vertical talus is sometimes confused with newborn flatfoot, or even as clubfoot. The exact cause of this deformity is not known, but many cases of vertical talus are associated with a neuromuscular disease or other disorder, such as arthrogryposis, spina bifida, neurofibromatosis, and numerous syndromes. Your doctor may perform tests to see if your infant has any of these conditions.
Treatment for vertical talus centers on providing your child with a functional, stable, and pain-free foot. It is crucial to have this condition treated early, as your child will learn to walk on an abnormal foot and painful skin problems will develop.
Nonsurgical treatment includes a series of stretching and casting designed to increase the flexibility of the foot and even sometimes correct the deformity. Some doctors will also prescribe continued physical therapy exercises to improve flexibility.
Surgical treatment, however, is the most common treatment. When nonsurgical treatment has failed, your doctor will recommend surgery between the ages of nine and 12 months. Surgery is designed to correct the aspects that cause the deformity, like problems with the foot bones, ligaments, and tendons that support the bones. The surgeon will put the bones in the correct position and apply pins to keep them in place. Tendons and ligaments may have to be shortened. A cast will be placed on your child's foot, and they may have to spend the night in the hospital. After four to six weeks, the cast will be removed and a special brace or shoe may be worn to prevent the deformity from returning.
With treatment, your child's foot should make a full recovery, allowing them to run and play without pain and wear normal shoes. Your doctor may recommend repeat visits throughout the years to monitor the development of your child's foot.
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My Baby's Foot Turns Inward!

Metatarsus adductus, or metatarsus varus, is a common foot deformity present at birth that causes the front half of the foot to turn inward. This condition can be flexible, meaning the foot can be straightened by hand, or non-flexible, meaning the foot cannot be straightened by hand.

The cause of metatarsus adductus is not known and occurs in one out of every 1,000 or 2,000 live births, affecting boys and girls evenly. Causal factors include a family history of metatarsus adductus, the position of the baby in the uterus, especially with breech babies, and the sleeping position of the baby (babies sleeping on their stomach sometimes increase the tendency to turn their feet outward).
Babies born with metatarsus adductus may be at an increased risk of having a related hip condition called developmental dysplasia of the hip (DDH). DDH is when the hip joint slips in and out of its socket, because the socket is too shallow to keep the joint intact.
Diagnosis is through a physical examination, where the doctor will ask if any other family members have metatarsus adductus. X-rays are taken in cases of non-flexible metatarsus adductus.
Infants with metatarsus adductus have high arches and the big toe has a wide separation from the second toe and deviates inward. Flexible metatarsus adductus is diagnosed when the heel and forefoot can be aligned with each other with gentle pressure on the forefoot while holding the heel steady. If the heel is difficult to align with the heel, it is considered non-flexible, or stiff foot.
Treatment for metatarsus adductus is based on:

• Your child's age, overall health, and medical history
• Extent of the deformity
• Your child's tolerance for certain medications, procedures, or therapies
• Expectations of the course of treatment
• Your opinion or preference

The goal of treatment is to straighten the position of the forefoot and heel. There are various options, including:

• Observation for those with flexible forefoot
• Stretching or passive manipulation exercises
• Casts
• Surgery

Metatarsus adductus may suddenly resolve itself without any medical intervention.
Your doctor will instruct you in passive manipulation exercises on their feet while diaper changing and will recommend changing their sleeping position.
In rare cases where stretching and manipulation exercises do not work, long leg casts will be applied. Casts are used to stretch the soft tissues of the forefoot and are changed every one to two weeks. If the foot responds to casting, straight cast shoes will be prescribed to hold the forefoot in place. This cast is made without a curve in the bottom of the foot. Infants with very severe metatarsus adductus will require surgery to release the forefoot joints.
With treatment, this condition can be resolved and the child can live without pain in their foot.
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Braves' Tim Hudson Suffers Gruesome Ankle Fracture

It was not a happy scene last night in the Atlanta Braves dugout.

Pitcher Tim Hudson broke his right ankle last night while covering first base, ending one of his best starts this season and ruining the Braves' bounce back 8-2 win over the New York Mets.
Hudson had a shutout in the eighth inning when Eric Young Jr. accidentally stepped on the back his right leg while trying to beat out the grounder. The 38 year old pitcher was carried off the field, in obvious pain and had X-rays at Citi Field.
He was working on a four-hitter when Young hit a grounder that was taken down by first baseman Freddie Freeman. Hudson took Freeman's toss at first before Young arrived, but Young unintentionally drove the pitcher's right ankle into the ground.
"We won, but it's a tough night," said catcher Brian McCann.
"I flipped and spun," said Freeman. "I didn't see it and I don't want to see it."
Young ran over to help Hudson, along with Braves manager Fredi Gonzalez and a trainer. Hudson took off his hat and held his shaved head in his hands. The pain he was feeling was clear in his pained expression.
The crowd at Citi Field groaned in sympathy when the replay was shown on the video board- not something I'd necessarily like to see replayed.
Hudson, 8-7 this season, will have surgery in Atlanta when the swelling going down. The NL East leaders will be without their veteran pitcher, who was having a good season. It is unclear how long Hudson will be out or if he'll be able to pitch again this season. In my opinion, it's unlikely the Braves will get him back and in baseball ready shape by the end of the season, which has just three months left.
Without Hudson, the Braves stand to lose their eight game lead in the NL East, and their chances at a post-season run may be diminished.
"He was kind of in disbelief," said second baseman Dan Uggla of Hudson. "You could see the thoughts running through his head: 'This can't be happening. This is unbelievable.'"
Young stayed with Hudson during the ten minutes it took to take him off the field, expressing his apologies and disbelief. He shook Hudson's hand as he was taken off the field and Hudson nodded back at him.
"I knew I didn't get any of the base," said a somber Young. "I got all of his foot. I pretty much knew it was broke right when I did it. That's why I ran back to him and tried to console him as much as I could and to apologize."
Hudson won his fourth straight start, striking out nine in 7 2/3 innings, his most since striking out 10 Mets on June 17, 2011.
Reference: CBS Sports.
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My Toes Are Going For A Hike!

"Hit the road, Jack, and don't you come back no more no more..."
Hitchhikers are often seen on major state roads, giving the old thumbs up gesture, an indication that they're looking for a ride. But did you ever see a hitchhiker giving the old big toe up gesture???
Hitchhiker's toe resembles the thumb of a hitchhiker, due to the hyperextension of the extensor hallucis longus muscle. This involuntary position is also called striated toe.

A patient often develops the hyperextension of hitchhiker's toe from spasticity,  which is caused by brain injuries, like a stroke, neurological condition, or spinal cord injury. Some toes are painful because of an altered gait or shoe fitting issues. This issue is also commonly found with other neurological conditions; drop foot and equino varus deformity are also common with hitchhiker's toe.
Symptoms include the first toe pulling up instead of lying down as it should, pain due to pulling on the muscle, and pain or callusing on the toe where it hits the shoe. The patient should look out for when the foot moves into the varus position, the aftereffects of a stroke or other neurological condition, or recovery from spine surgery or injury.
Causes of this deformity include stroke, cerebral palsy, physical trauma, such as a spinal cord injury, and
other neurological disorders.
The goal of treatment is to restore balance and support in the foot, since the big toe bears a great deal of our body's weight. An lower and thinner orthotic may be created to support the longitudinal and metatarsal, and bracing may be necessary to relax the toe. The patient should avoid flip-flops, except those approved by the American Podiatric Medical Association, high heels, and going barefoot. Physical therapy may be prescribed to regain strength in the toe.
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What Is Adult Cavovarus Foot?

Adult cavovarus foot is the result of an imbalance of muscle forces, usually from motor sensory neuropathies. cerebral palsy, cerebral injury (stroke), anterior horn cell disease (spinal root injury), talar neck injury, and residual clubfoot.

It is seldom seen at birth, but the deformity becomes apparent as the child, or the deformity grows. Other causes include 
In this foot deformity, the strong peroneus longus and tibialis posterior muscles cause the hindfoot varus and forefoot varus (pronated) position. Hindfoot varus causes overload of the border of the foot, which results in ankle instability, stress fractures, and peroneal tendonitis. In overloaded joints, degenerative arthritis can develop. Claw toes may also be a symptom of this deformity.
Your podiatrist will do a gait examination, which allows for the planning of tendon transfers to correct the stance and swing-phrase deficits. They will also inspect the forefoot and hindfoot to determine the need for soft-tissue release and osteotomy. The Coleman block test assesses the cause of hindfoot varus.
Oddly enough, prolonged use of orthotics and supportive shoes can result in muscle imbalance, creating the deformity and causing irreversible damage to the tendons and joints. Your doctor will have to rebalance the tendons to avoid deterioration of the foot. Muscle imbalance can be rectified by tendon transfer, corrective osteotomy, and fusion.
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Kohler's Disease In the Foot

Kohler's Disease is a rare bone disorder of the foot found in children between the ages of 6 and 9, affecting boys more than girls. It was first described in 1908 by Alban Kohler a German radiologist.
It is caused when the navicular bone temporarily loses its blood supply and as a result, the tissue in the bone dies and the bone collapses.
Symptoms include pain and swelling in the middle of the foot and usually a limp. Patients who limp tend to put increased weight on the lateral side of their foot. They may also experience tenderness over the navicular and pain over the apex.
In February 2010 the Journal of the American Medical Association reported that Egyptian boy king Tutankhamun may have died from complications of the disease along with malaria.
Your podiatrist will take an X-ray of the affected foot to diagnose the disease. The affected foot will have a sclerotic and flattened navicular bone.
When treated, this disease has no long term affects, but rarely it can return in adults. Treatment includes resting the affected foot, taking pain relievers, and avoiding putting pressure on the foot. In severe cases, the patient wears a cast, worn between 6 and 8 weeks. After the cast is removed, arch supports are worn for about 6 months. Children may benefit from moderate exercise and physical therapy. Children who follow the prescribed treatment will heal quickly. Kohler's Disease may persist for some time, but most cases are resolved within two years.
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What Is Freiberg's Disease?

Freiberg's Disease is a painful condition that affects the second metatarsal head. This is the bony knuckle in the ball of the foot behind the second toe. It can also affect the third and fourth metatarsal bones, but they are less commonly affected.
More than 80% of cases are females, and most of those are women up to the age of 20 years. Children who are athletes are often most commonly affected, especially those who are on their toes a lot in sprinting or jumping. The primary complaint is often vague forefoot pain, worsened by activity and weight-bearing and relieved with rest.

Freiberg's Disease occurs in children when there is a disruption of blood flow to the tip of the bone because of excessive pressure. It happens at the site of the growth plate, which closes in adolescence and therefore does not affect adults. In some cases a mechanical cause is thought to be the reason for the condition. A traumatic event, such as a heavy blow, or several small incidents can also cause Freiberg's Disease.
Freiberg's Infarction is the term applied when it occurs to children. Infarct means tissue death because of lack of blood. It is likely the excessive pressure causes a small fracture to occur within the cartilage growth plate that is between the long shaft of the metatarsal bone and the head, cutting off the blood flow. On an x-ray the area will be transparent as calcium leaves the bone, which will collapse on itself. The process takes about a year and when it is complete, the bone will be denser and whiter. An x-ray will also show the flattening of the rounded tip of the metatarsal bone and thickening of the shaft.
Freigberg's Infraction is applied to adults where the x-rays are similar. Most people have two or three arteries supplying blood to the area, but some have only one artery, making possible bone death. In others, the first metatarsal does not function properly and shuns its share of the body weight over the second, third, and fourth bones.
Treatment includes examination of the foot, which should show the area to be swollen, stiff, and painful. To find the tender spot, the podiatrist will flex the toe back as far as possible to expose the end of the metatarsal as well as the bottom surface. Treatment will focus on reducing the pressure on the second metatarsal head, by deflecting the pressure away from the area, causing the first metatarsal to take its share of the weight.

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I Have An Extra Toe!

Polydactyl is a deformity present at birth, when the baby is born with extra fingers or toes. It usually occurs in single duplication, meaning just one extra digit.
Associated anomalies include duplications bilaterally (both feet) in 40-50% of patients, but often duplications are not symmetrical. Syndactyl (webbing) of the toes occurs in 1/5 of patients, and Down's Syndrome is present in a minority of patients. Only 30% of patients will have a positive family history of polydactyl.
It occurs in 1 to 2 of 1,000 births, in 0.3 to 1.3 of 1,000 caucasian births, and 4 of 1,000 black births, and males more than females.
Polydactyl occurs when the body follows a different set of directions when forming the feet during development. Researchers are still learning about the genes that cause polydactyl. It may be caused by an associated syndrome, like Greig Cephalopolysyndactyly Syndrome (GCPS) or Bardet-Biedl Syndrome (BBS).
Extra digits are often poorly developed and attached by a small stalk, generally on the little toe. Some are well-formed and may even function. Poorly formed digits are usually removed. If there are no bones in the toe, tying a string around it will cause the toe to fall off over time.
In older patients, the main complaint is difficulty with shoe gear.
Treatment of polydactyl is typically surgery, which excises the toe, providing the toe with the most normal contour, to facilitate shoe wear. Typically the most lateral toe is excised, depending on whether the deformity is pre or post axial. Pre-axial means the extra toe is adjacent to the big toe, while post-axial means they are adjacent to the pinky toe. Most surgeons will recommend surgery after 1 year, to reduce aesthetic risks, and prior to walking, allowing for the greatest potential for remodeling. Patients are often referred in at ages 4 or 5 because of difficulty with shoe wear.
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Emma Watson Injures Foot On Set

Actress Emma Watson injured her foot on the set of Sofia Coppola's new movie The Bling Ring after a

stiletto wearing extra put her heel through Watson's toe. Owie! Just another reason not to wear stilettos- not only do they hurt your feet, they are a lethal weapon!
The former Harry Potter star plays one of the "Bling-Ring" thieves, who stole more than $3 million worth of items from the Hollywood homes of celebrities like Lindsay Lohan, Paris Hilton, and Orlando Bloom. In one particular scene Watson heads to a nightclub to party. 
Watson told Teen Vogue, "We were doing this scene in a nightclub and this girl accidentally put her stiletto through my toe! And the crazy thing is, I had so much adrenaline going through my system that I just kept dancing until, finally, I looked down at my foot and saw the blood."
The actress has also made news recently after condemning extravagant celebrity lifestyles. Watson called this lifestyle "consumerism as a form of kleptomania."
Watson, who has a reported fortune of $26 million pounds,  revealed she only owns eight pairs of shoes and was flabbergasted walking into some of the celebrity homes they shot The Bling Ring in. 
The celebrity who had the most items stolen from her house, heiress Paris Hilton, gave permission for them to film in her home. Watson said walking into Hilton's expansive walk-in closets was like walking into a department store.
"She could never wear all of those clothes and half of them were brand new and she still had the price tag on. But I suppose she just bought them to have them. We've all bought things on impulse but that's an entirely different thing," Watson said.
Reference: Star Pulse and Daily Mail. 
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Ray Lewis Couldn't Climb Every Mountain

Former Baltimore Ravens star Ray Lewis was in Tanzania with former Chicago Bears defensive tackle

Tommie Harris and Douglas Pitt, Brad Pitt's brother, who also serves as the goodwill ambassador to the country to raise money for a mission called TackleKili, which was created to benefit WorldServe International and Pros for Africa's charitable efforts for clean water projects in Africa.
The group left on last Wednesday to trek the 19,340 summit of Africa's highest point, Mt. Kilimanjaro. It is expected they will reach the top of the summit by Sunday.
The group was missing one person, however. Lewis had to pull out of the venture because of an injured foot and fever.
According to a statement released by TackleKili, "In the end, Ray's decision was to let the team move on without him, rather than hold them back or put himself in a position where an injury which requires surgery could become even more complicated. As always, his team backed his play. So while Ray refocused his service to this cause at a lower altitude, his team began the ascent on behalf of those in desperate need for clean water."
Lewis instead helped to provide hearing aids to children.
Frank Gamble, who is doing a video of the trip, said of Lewis, "Last night he had a bad night, fevered and really rough. So, this morning when he woke up, the foot was killing him, years of injuries and all of that. So, we're going to miss him.
"I just say goodbye to him and told him we love him. He made a significant contribution financially to provide safe water to people. Even though we're not going to have Ray, we're going to have plenty of wonderful people."
This story has gathered a bit of controversy from commentors on NBC Sports, who believe Lewis bowed out at the right time, calling his trek to the top of Mt. Kilimanjaro a "scam" and his "way of hiding his white suit"- referring to the white suit that went missing in his murder investigation more than ten years ago. Whatever you chose to believe, Lewis was bringing attention to a situation that we need to be aware of.
Reference: NBC Sports and USA Today.
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Trevor's Disease In the Foot

Trevor's Disease is an extremely rare congenital bone developmental disorder that occurs in one case per million. It is three times more common in males than females.

This disease is characterized by an asymmetrical limb deformity due to localized overgrowth of cartilage, resembling osteochondroma. It usually affects the lower limbs and it is also known as dysplasia epiphysealis hemimelica (DEH) or Fairbanks Syndrome. It affects the epiphyseal plate, or growth plate, at the end of a long bone. The plate is found in children and adolescents, but not adults, whose epiphyseal plate is replaced by epiphyseal line. The disease was named after researcher David Trevor, who believed the disease to be a congenital error in epiphyseal development that affects limb buds during early fetal life.
Trevor's Disease is a benign disorder, and no cases of malignant transformation have been reported. The causes are not known and the disease does not appear to be genetically transmitted. Typically a lesion will grow in size until skeletal maturity with a progression toward pain and arthrosis.
Patients with Trevor's Disease will have painless swelling or a mass on one side of the joint, limitation of motion, angular deformity, concomitant regional muscle wasting, and recurrent locking of the joint. It may be commonly confused with chondroblastoma, osteochondroma, or enchondroma.
Trevor's Disease should be treated if the lesion is causing pain, deformity, or interference with function.
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My Baby Has A Curly Toe

Your child may have been born with curly toe, which describes a toe with a flexion contracture, which

causes the toe to flex and bend under the adjacent toe. The deformity is characterized by flexion and medial deviation of the proximal joint of the toe and lateral rotation of the distal joint. The cause is congenital tightness of the flexor tendons. The second and third toes are the most common toes that curl, with the pinky toe being the least common.
It is uncommon for curly toe to cause problems. 25% of toes resolve by the child's first birthday. Some toes will spontaneously resolve by the age of six. There is often a family history of curly toe, consistent with autosomal dominant transmission.
Some children will have pressure between the toes, which can cause pressure sores or blisters. The adjacent toe may develop corns because of pressure from the other toe. Shoes with extra padding or space will be required. If the child continues to have skin problems, a simple procedure is available to improve the toe position.
Diagnosis is made by physical examination. Curly toes are typically present bilaterally and x-rays will often be used to rule out other deformities and abnormalities.
Treatment sometimes involves taping of the toe, but the deformity usually recurs once the taping is taken off. Surgery is recommended for children over the age of 6 who have a persistent deformity. A simple open flexor tenotomy leads to relief of symptoms and does not lead to hyperextension.
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What Is Podoconiosis?

In this country, it's likely you've never heard of podoconiosis before. Podoconiosis is a disease of the lymph

vessels of the lower extremities that is caused by chronic exposure to irritant soils. It is the second most common cause of elephantiasis and is characterized by prominent swelling of the lower extremities, especially the feet and ankles, and leads to disability and deformity.
The history of the condition goes back to the 19th century, when parasitic filariae were discovered to be the cause of elephantiasis, also known as tropical lymphedema. It was believed, at the time, that filaria was the sole cause of the disease, but it became apparent that the distribution of the two conditions did not overlap and scientists recognized that some forms of elephantiasis were not associated with filariae. Ernest W. Price, a British surgeon living in Ethiopia in the 1970's and 1980's studied the lymph nodes and vessels of those afflicted with the disease. Using a light microscope, he discovered macrophage cells weighed down with micro-particles in the lymph nodes of the affected extremity. Then, using an electron microscope, he found the presence of silicon, aluminum, and other soil metals. Price demonstrated that the lymphatic vessels of these patients experienced edema, and eventually collagenization that leads to complete blockage.
The primary symptom of podoconiosis is swelling and deformity of the feet and ankles. The swelling can be either soft and fluid, or hard and fibrotic. Multiple firm nodules will develop over time, as well as hyperkeratotic papillomata that resembles moss. Because of this, podoconiosis is also known as Mossy Foot. Before lymphatic failure, the patient may exhibit itching, burning, hyperkeratosis, plantar edema, and rigid digits. Like with elephantiasis, fusion of the toes, ulceration, and bacterial infection may occur. The disease has an acute component where some patients have moments of foot and ankle warmth, firmness, and pain.
Podoconiosis is most commonly seen in highland areas of Africa, India, and Central America. The highest rates of occurrence are in Uganda, Tanzania, Kenya, Rwanda, Burundi, Sudan, and Ethopia, where the prevalence is as high as 9%. Nearly four million people worldwide suffer from this disease. The incidence of podoconiosis increases with age, due to the cumulative exposure to irritant soil. It is rare to see podoconiosis in children 0-5 years old, and the incidence rapidly rises in the 6-20 age group, with the highest percentage in the 45 plus age group.
Prevention and treatment are characterized by avoidance of the irritant soil . Wearing shoes is the most crucial thing in preventing this disease and further deformity. In Rwanda, where the incidence of the disease is high, the government has banned walking barefoot in public to curtain soil-born disease like podoconiosis.
Even once the disease has begun, vigorous daily washing with soap and water, application of an emollient, and the nightly elevation of the affected extremity has been shown to reduce swelling and disability. Compression wrapping has been shown to be effective in other forms of lymphedema, but this therapy has not been proven in podoconiosis.

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