Clicking and Clacking in the Ankle: Talar Dome Lesion

The ankle joint is composed of the bottom of the tibia (shin) bone and the top of the talus (ankle) bone. The top of the talus is dome-shaped and is completely covered with cartilage- a tough, rubbery tissue that enables the ankle to move smoothly. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint. It is also called an osteochondral defect (OCD) or osteochondral lesion of the talus (OLT). Osteo means bone and chondral refers to cartilage.
Talar dome lesions are usually caused by an injury, such as an ankle sprain. If the cartilage doesn't heal properly following the injury, it softens and begins to break off. Sometimes a broken piece of the damaged cartilage and the bone will float in the ankle.
Unless the injury is extensive, it may take months, a year, or even longer for symptoms to develop. The signs and symptoms of a talar dome lesion may include:

• Chronic pain deep in the ankle- typically worse when bearing weight on the foot (especially during sports) and less when resting.
• An occasional clicking or clacking feeling in the ankle when walking.
• A sensation of the ankle locking or giving out.
• Episodes of swelling of the ankle- occurring when bearing weight and subsiding when at rest.

A talar dome lesion can be difficult to diagnose, because the precise site of the pain can be hard to pinpoint. To diagnose this injury, the foot and ankle surgeon will question the patient about recent or previous injury and will examine the foot and ankle, moving the ankle joint to help determine if there is pain, clicking, or limitation of motion within that joint.
Sometimes the podiatrist will inject the joint with an anesthetic (pain-relieving medication) to see if the pain goes away for a while, indicating that the pain is coming from inside the joint.
X-rays are taken, and often an MRI or other advanced imaging tests are ordered to further evaluate the lesion and extent of the injury.
Treatment depends on the severity of the talar dome lesion. If the lesion is stable (without loose pieces of cartilage or bone), one or more of the following non-surgical treatment options may be considered:

• Immobilization. Depending on the type of injury, the leg may be placed in a cast or cast boot to protect the talus. During this period of immobilization, nonweightbearing range-of-motion exercises may be recommended.
• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.
• Physical therapy. Range-of-motion and strengthening exercises are beneficial once the lesion is adequately healed. Physical therapy may also include techniques to reduce pain and swelling.
• Ankle brace. Wearing an ankle brace may be help protect the patient from re-injury if the ankle is unstable. 

If non-surgical treatment fails to relieve the symptoms of talar dome lesions, surgery may be necessary. Surgery may involve removal of the loose bone and cartilage fragments within joint and establishing an environment for healing. A variety of surgical techniques in available to accomplish this. The surgeon will select the best procedure based on the specific case.
Depending on the amount of damage to the cartilage in the ankle joint, arthritis may develop in the joint, resulting in chronic pain, swelling and limited joint motion. Treatment for these complications is best directed by a foot and ankle surgeon, and may include one or more of the following:

• Non-steroidal or steroidal anti-inflammatory medications.
• Physical therapy.
• Bracing.
• Surgical intervention.

If you believe you have a talar dome lesion and do not currently see a podiatrist, call one of our six locations to make an appointment.
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DWTS Gilles Marini Has A Weird Foot Injury

Dancing With the Stars Gilles Marini has been seen wearing a bandage around his right ankle while leaving the studio.
In the spring Marini had stepped on a sewing needle in his bedroom and broken his toe. Part of the needle was lodged in his toe, and Marini visited a specialist in Las Vegas in June to have the needle surgically removed. He filmed and posted the footage of his surgery to his Twitter page. While we're not going to post the gory footage here, the doctor is seen slowly extracting the needle from his toe and Marini declares "I did not feel a thing. The anaesthetic shots are painful, but let me tell you, I did not feel a thing."
The needle accident does not seem to have anything to do with the bandage that is around Marini's right ankle. Marini is also having some knee pain, saying he "hurt something already," and speculated it might be his MCL. The medial collateral ligament (MCL) is one of the four ligaments that stabilizes the knee joint.
We'll have to watch and see how Marini's foot injury plays out this season on DWTS, and who else injures their foot- seems like someone always goes down with a foot problem! The season premiere is Monday September 24th on ABC.
If you believe you have a dancing injury and do not currently see a podiatrist, call one of our six locations to make an appointment.
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Podiatrists in CT
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Peroneal Tendon Injuries

A tendon is a band of tissue that connects a muscle to a bone. The two peroneal tendons in the foot run side-by-side behind the outer ankle bone. One peroneal tendon attaches to the outer part of the midfoot, while the other tendon runs under the foot and attaches near the inside of the arch. The main function of the peroneal tendons is to stabilize the foot and ankle and protect them from sprains.
Peroneal tendon injuries may be acute (occurring suddenly) or chronic (developing over a period of time). They most commonly occur in individuals who participate in sports that involve repetitive ankle motion. In addition, people with higher arches are at risk for developing peroneal tendon injuries. Basic types of peroneal tendon injuries are tendonitis, tears, and subluxation.

Tendonitis is an inflammation of one or both tendons. The inflammation is caused by activities involving repetitive use of the tendon, overuse of the tendon, or trauma (such as an ankle sprain). Symptoms of tendonitis include: pain, swelling, and warmth to the touch.
Acute tears are caused by repetitive activity or trauma. Immediate symptoms of acute tears include: pain, swelling, and weakness or instability of the foot and ankle.
As time goes on, these tears may lead to a charge in the shape of the foot, in which the arch may become higher.
Degenerative tears (tendonosis) are usually due to overuse and occur over long periods of time- often years. In degenerative tears, the tendon is like taffy that has been overstretched until it becomes thin and eventually frays. Having high arches also puts you at risk for developing a degenerative tear. The symptoms of degenerative tears may include:

• Sporadic pain (occurring from time to time) on the outside of the ankle.
• Weakness or instability in the ankle.
• An increase in the height of the arch.

Subluxation- one or both tendons have slipped out of their normal position. In some cases, subluxation is due to a condition in which a person is born with a variation in the shape of the bone or muscle. In other cases, subluxation occurs following trauma, such as an ankle sprain. Damage or injury to the tissues that stabilize the tendons (retinaculum) can lead to chronic tendon subluxation. The symptoms of subluxation may include:

• A snapping feeling of the tendon around the ankle bone.
• Sporadic pain behind the outside ankle bone.
• Ankle instability or weakness.

Early treatment of subluxation is critical, since a tendon that continues to sublux (move out of position) is more likely to tear or rupture. Therefore, if you feel the characteristic snapping, see a foot and ankle surgeon immediately.
Because peroneal tendon injuries are sometimes misdiagnosed and may worsen without proper treatment, prompt evaluation by a foot and ankle surgeon is advised. To diagnose a peroneal tendon injury, the podiatrist will examine the foot and look for pain, instability, swelling, warmth, and weakness on the outer side of the ankle. In addition, an x-ray or other advanced imaging studies may be needed to fully evaluate the injury. The podiatrist will also look for signs of an ankle sprain and other related injuries that sometimes accompany a peroneal tendon injury. Proper diagnosis is important because prolonged discomfort after a simple sprain may be a sign of additional problems.
Treatment depends on the type of peroneal tendon injury. Option include:

• Immobilization. A cast or splint may be used to keep the foot and ankle from moving and allow the injury to heal.
• Medications. Oral or injected anti-inflammatory drugs may help relieve the pain and inflammation.
• Physical therapy. Ice, heat, or ultrasound therapy may be used to reduce swelling and pain. As symptoms improve, exercises can be added to strengthen the muscles and improve range of motion and balance.
• Bracing. The surgeon may provide a brace to use for a short while or during activities requiring repetitive ankle motion. Bracing may also be an option when a patient is not a candidate for surgery.

In some cases, surgery may be needed to repair the tendon or tendons and perhaps the supporting structures of the foot. The podiatrist will determine the most appropriate procedure for the patient's condition and lifestyle. After surgery, physical therapy is an important part of rehabilitation.
If you believe you have a peroneal tendon injury and do not currently see a podiatrist, call one of our six locations to make an appointment.
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Podiatrists in CT
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Pain in My Big Toe Joint

A sesamoid is a bone embedded in a tendon. Sesamoids are found in several joints in the body. In the normal foot, the sesamoids are two pea-shaped bones located in the ball of the foot, beneath the big toe joint.
Acting as a pulley for tendons, the sesamoids help the big toe move normally and provide leverage when the big toe pushes off during walking or running. The sesamoids also serve as a weight-bearing surface for the first metatarsal bone (the long bone connected to the big toe), absorbing the weight placed on the ball of the foot when walking, running, and jumping.

Sesamoid injuries can involve the bones, tendons, and/or surrounding tissue in the joint. They are often associated with activities requiring increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet. In addition, people with high arches are at risk for developing sesamoid problems. Frequent wearing of high-heeled shoes can also be a contributing factor.
There are three types of sesamoid injuries in the foot:

• Turf toe. This is an injury of the soft tissue surrounding the big toe joint. It usually occurs when the big toe joint is extended beyond its normal range. Turf toe causes immediate, sharp pain, and swelling. It usually affects the entire big toe joint and limits the motion of the toe. Turf toe may result in an injury to the soft tissue attach to the sesamoid or a fracture of the sesamoid. Sometimes a pop is felt at the moment of injury. 
• Fracture. A fracture in a sesamoid bone can be either acute or chronic. An acute fracture is caused by trauma- a direct blow or impact to the bone. An acute sesamoid fracture produces immediate pain and swelling at the site of the break, but usually does not affect the entire big toe joint. A chronic fracture is a stress fracture (a hairline break usually caused by repetitive stress or overuse). A chronic sesamoid fracture produces longstanding pain in the ball of the foot beneath the big toe joint. The pain, which tends to come and go, is generally aggravated with activity and relieved with rest.
• Sesamoiditis. This is an overuse injury involving chronic inflammation of the sesamoid bones and the tendons involved with those bones. Sesamoiditis is caused by increased pressure to the sesamoids. Often, sesamoiditis is associated with a dull, longstanding pain beneath the big toe joint. The pain comes and goes, usually occurring with certain shoes or certain activities.

In diagnosing a sesamoid injury, the foot and ankle surgeon will examine the foot, focusing on the big toe joint. The surgeon will press on the big toe, move it up and down, and may assess the patient's walking and evaluate the wear pattern on the patient's shoes. X-rays are ordered, and in some cases, advanced imaging studies may be ordered.
Non-surgical treatment for sesamoid injuries of the foot may include one or more of the following options, depending on the type of injury and degree of severity:

• Padding, strapping, or taping. A pad may be placed in the shoe to cushion the inflamed sesamoid area, or the toe may be taped or strapped to relieve that area of tension. 
• Immobilization. The foot may be placed in a cast or removable walking cast. Crutches may be used to prevent placing weight on the foot.
• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the pain and inflammation.
• Physical therapy. The rehabilitation period following immobilization sometimes includes physical therapy, such as exercises (range-of-motion, strengthening, and conditioning), and ultrasound therapy. 
• Steroid injections. In some cases, cortisone is injected in the joint to reduce pain and inflammation. 
• Orthotic devices. Custom orthotic devices that fit into the shoe may be prescribed for long-term treatment of sesamoiditis to balance the pressure placed on the ball of the foot.

When sesamoid injuries fail to respond to non-surgical treatment, surgery may be required. The podiatrist will determine the type of procedure that is best suited to the individual patient.
If you believe you have a sesamoid injury and do not currently see a podiatrist, call one of our six locations to make an appointment.
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I Have a Knot in My Arch! Plantar Fibroma

A plantar fibroma is a fibrous knot (nodule) in the arch of the foot. It is embedded within the plantar fascia, a band of tissue that extends from the heel to the toes on the bottom of the foot. A plantar fibroma can develop in one or both feet, is benign (non-malignant), and usually will not go away or get smaller without treatment. Definitive causes for this condition have not been clearly identified.
The characteristic sign of a plantar fibroma is a noticeable lump in the arch that feels firm to the touch. This mass can remain the same size or get larger over time, or additional fibromas may develop.

People who have a plantar fibroma may or may not have pain. When pain does occur, it is often caused by shoes pushing against the lump in the arch, although it can also arise when walking or standing barefoot.
To diagnose a plantar fibroma, the foot and ankle surgeon will examine the foot and press on the affected area. Sometimes this can produce the pain that extends down to the toes. An MRI or biopsy may be performed to further evaluate the lump and aid in diagnosis.
Non-surgical treatment may help relieve the pain of a plantar fibroma, although it will not make the mass disappear. The podiatrist may select one or more of the following non-surgical options:

• Steroid injections. Injecting corticosteroid medication into the mass may help shrink and thereby relieve the pain that occurs when walking. This reduction may be temporary and the fibroma could slowly return to its original size. 
• Orthotic devices. If the fibroma is stable, meaning it is not changing in size, custom orthotics (shoe inserts) may relieve the pain by distributing the patient's weight away from the fibroma. 
• Physical therapy. The pain is sometimes treated through physical therapy methods that deliver anti-inflammatory medication into the fibroma without the need for injection. 

If the mass increases in size or pain, the patient should be further evaluated. Surgical treatment to remove the fibroma is considered if the patient continues to experience pain following non-surgical approaches.
Surgical removal of a plantar fibroma may result in a flattening of the arch or development of hammertoes. Orthotic devices may be prescribed to provide support to the foot. Due to the high incidence of recurrence with this condition, continued follow-up with the foot and ankle surgeon is recommended.
If you have a plantar fibroma and do not currently see a podiatrist, call one of our six locations to make an appointment.
Connecticut Foot Care Centers
Podiatrists in CT
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Gout Attacking Big Toe!

Gout is a disorder that results from the build-up of uric acid in the tissue or a joint. It most often affects the joint of the big toe.
Gout attacks are caused by deposits of crystallized uric acid in the joint. Uric acid is present in the blood and eliminated in the urine, but in people who have gout, uric acid accumulates and crystallizes in the joints. Uric acid is the result of the breakdown of purines, chemicals that are found naturally in our bodies and in food. Some people develop gout because their kidneys have difficulty eliminating normal amounts of uric acid, while others produce too much uric acid.
Gout occurs most commonly in the big toe because uric acid is sensitive to temperature changes. At cooler temperatures, uric acid turns into crystals. Since the toe is part of the body that is farthest from the heart, it's also the coolest part of the body- and, thus, the most likely target of gout. However, gout can affect any joint in the body.

The tendency to accumulate uric acid is often inherited. Other factors that put a person at risk for developing gout include: high blood pressure, diabetes, obesity, surgery, chemotherapy, stress, and certain medications and vitamins. For example, the body's ability to remove uric acid can be negatively affected by taking aspirin, some diuretic medication (water pills), and the vitamin niacin (also called nicotinic acid). While gout is more common in men aged 40 to 60 years, it can occur in younger men as well as women.
Consuming foods and beverages that contain high levels of purines can trigger an attack of gout. Some foods contain more purines than other and have been associated with an increase of uric acid, which leads to gout. You may be able to reduce your chance of getting a gout attack by limiting or avoiding shellfish, organ meat (kidney, liver, etc), red wine, beer, and red meat.
An attack of gout can be miserable, marked by the following symptoms:

• Intense pain that comes on suddenly- often in the middle of the night or upon arising.
• Signs of inflammation such as redness, swelling, and warmth over the joint.

To diagnose gout, the podiatrist will ask questions about your personal and family medical history, followed by an examination of the affected joint. Laboratory tests and x-rays are sometimes ordered to determine if the inflammation is caused by something other than gout.
Initial treatment of a gout attack typically includes the following:

• Medications. Prescription medications or injections are used to treat the pain, swelling, and inflammation.
• Dietary restrictions. Foods and beverages that are high in purines should be avoided, since purines are converted in the body to uric acid.
• Fluids. Drink plenty of water and other fluids each day, while also avoiding alcoholic beverages, which cause dehydration.
• Immobilize and elevate the foot. Avoid standing and walking to give your foot a rest. Also, elevate your foot (level with or slightly above the heart) to help reduce swelling.

The symptoms of gout and the inflammatory process usually resolve in three to ten days with treatment. If gout symptoms continue despite the initial treatment, or if repeated attacks occur, see your primary care physician for maintenance treatment that may involve daily medication. In cases of repeated episodes, the underlying problem must be addressed, as the build-up of uric acid over time can cause arthritic damage to the joint.
If you have gout and do not currently see a podiatrist, call one of our six locations to make an appointment.
Connecticut Foot Care Centers
Podiatrists in CT
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September Shoe of the Month: Clogs

Look past the tough exterior to find the softer side of clogs. Choose a pair with ultra-soft soles that provide cushioning, such as APMA-accepted Crocs, which are ideal for sufferers of plantar fasciitis, neuromas, bunions, hammertoes, or achy feet. The wide toe box also affords the front of the foot lots of room to move around, making it a very comfortable shoe inside and out. They are also a lot more fashionable than they used to be, melding their shoe construction with style and comfort.
If you have a foot problem and do not currently see a podiatrist, call one of our six locations to make an appointment.
Connecticut Foot Care Centers
Podiatrists in CT
Visit our website, friend and like our page on Facebook, and follow our tweets on Twitter.

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