Chronic Ankle Instability

Chronic ankle instability is a condition characterized by a recurring giving way of the outer (lateral) side of the ankle. This condition often develops after repeated ankle sprains. Usually the giving way occurs while walking or doing other activities, but it can also happen when you're just standing. Many athletes, as well as others, suffer from chronic ankle instability.
People with chronic instability often complain of:

• A repeated turning of the ankle, especially on uneven surfaces or when participating in sports.
• Persistent (chronic) discomfort and swelling.
• Pain or tenderness.
• The ankle feeling wobbly or unstable.

Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not fully rehabilitated completely. When you sprain your ankle, the connective tissues (ligaments) are stretched or torn. The ability to balance is often affected. Proper rehabilitation is needed to strengthen the muscles around the ankle and retrain the tissues within the ankle that affect balance. Failure to do so may result in repeated ankle sprains.

Repeated ankle sprains often cause- and perpetuate- chronic ankle instability. Each subsequent sprain leads to further weakening (or stretching) of the ligaments, resulting ni greater instability and the likelihood of developing additional problems in the ankle. 

In evaluating and diagnosing your condition, the podiatrist will ask you about any previous ankle injuries and instability. Then he or she will examine your ankle to check for tender areas, signs of swelling, and instability of your ankle. X-rays or other imaging studies may be helpful in further evaluating the ankle. 

Treatment for chronic ankle instability is based on the results of the examination and tests, as well as the patient's level of activity. Non-surgical treatment may include:

• Physical therapy. Physical therapy involves various treatments and exercises to strengthen the ankle, improve balance and range of motion, and retrain your muscles. As you progress through rehabilitation, you may also receive training that relates specifically to your activities or sport. 
• Bracing. Some patients wear an ankle brace to gain support for the ankle and keep ankle from turning. Bracing also helps prevent additional ankle sprains. 
• Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to reduce pain and inflammation.

In some cases, the foot and ankle surgeon will recommend surgery based on the degree of instability or lack of response to non-surgical approaches. Surgery usually involves repair or reconstruction of the damaged ligament(s). The surgeon will select the surgical procedure best suited for your case based on the severity of the instability and your activity level. The length of the recovery period will vary, depending on the procedure or procedures performed.
If you believe you have chronic ankle instability and have not seen a podiatrist yet, call one of our six locations to make an appointment.
Connecticut Foot Care Centers
Podiatrists in CT
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I Think I Broke My Toe- What Can A Podiatrist Do?

The structure of the foot is complex, consisting of bones, muscles, tendons, and other soft tissues. Of the 26 metatarsal bones (the long bones in the midfoot). Fractures of the toe and metatarsal bones are common and require evaluation by a specialist. A foot and ankle surgeon should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room.

bones in the foot, 19 are toe bones (phalanges) and
A fracture is a break in the bone. Fractures can be divided into two categories: traumatic fractures and stress fractures.
Traumatic fractures (also called acute fractures) are caused by a direct blow or impact, such as seriously stubbing your toe. Traumatic fractures can be displaced or non-displaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated).
Signs and symptoms of a traumatic fracture include:

• You may hear a sound at the time of the break.
• Pinpoint pain (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours.
• Crooked or abnormal appearance of the toe.
• Bruising and swelling the next day.
• It is not true that if you can walk on it, it's not broken.

Evaluation by a podiatrist is always recommended.
Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. They can also be caused by an abnormal foot structure, foot deformities, or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored. They require proper medical attention to heal correctly.
Symptoms of stress fractures include:

• Pain with or after normal activity.
• Pain that goes away when resting and then returns when standing or during activity.
• Pinpoint pain (pain at the site of the fracture) when touched.
• Swelling, but no bruising.

Some people say that the doctor can't do anything for a broken bone in the foot. This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example:

• A deformity in the bony structure which may limit the ability to move the foot or cause difficulty in fitting shoes.
• Arthritis, which may be caused by a fracture in a joint (the juncture where two bones meet), or may be a result of angular deformities that develop when a displaced fracture is severe or hasn't been properly corrected.
• Chronic pain and deformity.
• Non-union, or failure to heal, can lead to subsequent surgery or chronic pain.

Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself and may include these options:

• Rest. Sometimes rest is all that is needed to treat a traumatic fracture of the toe.
• Splinting. The toe may be fitted with a splint to keep it in a fixed position.
• Rigid or stiff-soled shoe. Wearing a stiff-soled shoe protects the toe and helps keep it properly positioned.
• Buddy taping the fractured toe to another toe is sometimes appropriate, but in other cases it may be harmful. 
• Surgery. If the break is badly displaced or if the joint is affected, surgery may be necessary. Surgery often involves the use of fixation devices, such as pins.

Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges.
For example, sometimes a fracture of the first metatarsal bone (behind the big toe) can lead to arthritis. Since the big toe is used so frequently and bears more weight than other toes, arthritis in that area can make it painful to walk, bend, or even stand.
Another type of break, called a Jones fracture, occurs at the base of the fifth metatarsal bone (behind the little toe). It is often misdiagnosed as an ankle sprain, and misdiagnosis can have serious consequences since sprains and fractures require different treatments. Your podiatrist is an expert in correctly identifying these conditions as well as other problems of the foot.
Treatment of metatarsal fractures depend on the type and extent of the fracture, and may include:

• Rest. Sometimes rest is the only treatment needed to promote healing of a stress or traumatic fracture of a metatarsal bone.
• Avoid the offending activity. Because stress fractures result from repetitive stress, it is important to avoid the activity that led to the fracture. Crutches or a wheelchair are sometimes required to offload weight from the foot to give it time to heal. 
• Immobilization, casting, or rigid shoe. A stiff-soled shoe or other form of immobilization may be used to protect the fractured bone while it is healing.
• Surgery. Some traumatic fractures of the metatarsal bones require surgery, especially if the break is badly displaced.
• Follow-up care. Your podiatrist will provide instructions for care following surgical or non-surgical treatment. Physical therapy, exercises and rehabilitation may be included in a schedule for return to normal activity. 

If you believe you have a toe or metatarsal fracture and have not seen a podiatrist yet, call one of our six locations to make an appointment.Connecticut Foot Care Centers
Podiatrists in CT
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Risk Factors of Deep Vein Thrombosis

These are potential risk factors for deep vein thrombosis:
Blood or vein conditions:

• Previous DVT
• Varicose veins
• Blood clotting disorders
• Family history of DVT or blood-clotting disorders

Other medical conditions

• Heart disease
• Chronic swelling of the legs
• Obesity
• Inflammatory bowel disease
• Cancer
• Dehydration
• Sepsis

Women's health issues:

• Hormone replacement therapy
• Birth control pills containing estrogen
• Pregnancy or recent childbirth

Other:

• Age over 40 years old
• Immobility (through inactivity or from wearing a cast)
• Recent surgery
• Trauma (an injury)
• Smoking

If you have any of these risk factors please seek guidance from a physician who can tell you if you do in deed have deep vein thrombosis. If you believe you have deep vein thrombosis and have not seen a podiatrist yet, call one of our six locations to make an appointment.
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Podiatrists in CT
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Annie Lennox Cancels Performance Due To Foot Injury

Singer Annie Lennox cancelled her performance at the United Nation's Nansen Refugee Award Ceremony in Geneva on Monday night because of a foot injury that left her unable to travel.
The former Eurythmics star pulled out of the commitment due to an "ongoing issue" with her left foot that has left her in terrible pain. Lennox wrote on her Facebook page on Monday: "Sometimes I get searing electrical shocks flashing through the nerve endings. It's the kind of pain that makes you stop in your tracks. I'm sure that some of you know what that's like. It rendered me unfit to travel, so I'm not able to fulfill my performance at the Nansen Refugee Awards tonight, which is hugely disappointing. I'm therefore sending out a rather fragile pink flower as a means of apologies to everyone, once again... Unfortunately it was just one of those bad strokes of luck that you can't do anything about. Thanks to doses of ibuprofen and paracetamol, the situation is a lot better, and the 'flashing' has stopped for now. Normal service will be resumed as soon as possible!"
Lennox is suffering from foot drop, a painful neurological condition. Foot drop refers to the inability to lift the front part of one's foot off the ground when walking, resulting in a scuffing or dragging of the foot or lifting the thigh, known as steppage gait. It is most often caused by nerve or muscle disorders or damage, or by a central nervous system disorder.
Foot drop is usually diagnosed by physical examination, although additional testing may be required in some cases. Treatment may include braces, physical therapy, and electrical nerve stimulation, and in severe cases, surgery.
Lennox first discovered the symptoms in 2008 and immediately sought professional help, fearing she would never be able to walk again unaided. She writes, "(Four) years ago I found myself in the most extreme pain I've ever experienced. It turned out that I had a dropped foot, caused by my spinal column being impinged by a bulged disc. For the first time in my life, I was facing a real physical handicap, and had no idea whether I'd be able to walk normally again. It took months of physiotherapy to get movement back in my left foot, but gradually... painstakingly... my toes began to move again, to the point where I don't even have a perceivable limp.
"Now the only drawback is that I have a permanently numb left foot, which feels as if it's stuck in a bucket of ice, with constant pins and needles. It's very strange, but somehow I've managed to adapt, and I'm finding that I'm less aware of it than I was before."
Lennox admits that it prompted her to take better care of her feet, after realizing how lucky she was to receive help from doctors and nurses who helped her overcome the ailment.
"The reason I'm blogging about my feet is that I'm grateful for the 57 years of great service they've given me. And if this hadn't happened, I would be coasting along, not realizing what a gift it  is to have something I'd taken for granted all my life. Thanks to my neurosurgeon, the nurses and the physiotherapists, I can walk quite decently," concludes Lennox.
If you are experiencing a foot problem, call one of our six locations to make an appointment.
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What Is Deep Vein Thrombosis?

The blood supply of the leg is transported by arteries and veins. The arteries carry blood from the heart to the limbs; veins carry blood back to the heart. The leg contains superficial veins, which are close to the surface, and deep veins, which lie much deeper in the leg. Deep vein thrombosis (DVT) is a condition in which a blood clot (a blockage) forms in a deep vein. While these clots most commonly occur in the veins of the leg (the calf or thigh), they can also develop in other parts of the body.
DVT can be very dangerous and is considered a medical emergency. If the clot (also known as a thrombus) breaks loose and travels through the bloodstream, it can lodge in the lung. This blockage in the lung, called a pulmonary embolism, can make it difficult to breathe and may even cause death. Blood clots in the thigh are more likely to cause a pulmonary embolism than those in the calf.
Many factors can contribute to the formation of a DVT. The more risk factors a person has, the greater their risk of having a DVT. However, even people without these risk factors can form a DVT.
Some people with DVT in the leg have either no warning signs at all or very vague symptoms. If any of the following warning signs or symptoms are present, it is important to see a doctor for evaluation:

• Swelling in the leg.
• Pain in the calf or thigh.
• Warmth and redness of the leg.

DVT can be difficult to diagnose, especially if the patient has no symptoms. Diagnosis is also challenging because of the similarities between symptoms of DVT and those of other conditions such as a pulled muscle, an infection, a clot in a superficial vein (thrombophlebitis), a fracture, and arthritis.
If DVT is suspected, the doctor will immediately send the patient to a vascular laboratory or a hospital for testing, which may include a blood test, Doppler ultrasound, venogram, MRI, or angiogram.
If tests indicate a clot is present, the doctor will make a recommendation regarding treatment. Depending on the location of the clot, the patient may need hospitalization. Medical or surgical care will be managed by a team of physicians which may include a primary care physician, internist, vascular (blood vessel) surgeon, or hematologist (blood disease specialist).
Treatment may include:

• Medication. A blood-thinning medication is usually prescribed to help prevent additional clots from forming.
• Compression. Wearing fitted hosiery decreases pain and swelling. 
• Surgery. A surgical procedure performed by a vascular specialist may be required.

An early and extremely serious complication of DVT is a pulmonary embolism. A pulmonary embolism develops if the clot breaks loose and travels to the lung. Symptoms of a pulmonary embolism include:

• Shortness of breath.
• Chest pain.
• Coughing up blood.
• A feeling of impending doom.

A long-term consequence of DVT is damage to the vein from the clot. This damage often results in persistent swelling, pain, and discoloration of the leg.
For those who have risk factors for DVT, these strategies may reduce the likelihood of developing a blood clot:

• Take blood-thinning medication, if prescribed.
• Reduce risk factors that can be changed. For example, stop smoking and lose excess weight.
• During periods of prolonged immobility, such as on long trips: 

1. Exercise legs every 2 to 3 hours to get the blood flowing back to the heart. Walk up and down the aisle of a plane or train, rotate ankles while sitting, and take regular breaks on road trips.
2. Stay hydrated by drinking plenty of fluids; avoid alcohol and caffeine.
3. Consider wearing compression socks. 

If you believe you have deep vein thrombosis and have not seen a podiatrist yet, call one of our six locations to make an appointment.
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Laker's Steven Blake Out With Puncture Wound

The Lakers announced last Monday that Steven Blake will be restricted from impact exercises for three weeks after suffering from a puncture wound on his left foot. He sustained this injury after stepping on a spike strip in a parking lot.
We've demonstrated on this blog many times before that injuries for athletes don't have to occur on the court, field, track, etc. They can happen at any time, any where. Treating an injury for an athlete is a little different however, as their recovery times often need to be quicker than the average person.
This is Blake's third season with the Lakers and fans aren't convinced of his ability to actually spend time on the court and avoid strange mishaps. He was promised to be a consistent third point shooter. In his first season with the Lakers Blake had a bout of the chicken pox, and last year he missed 13 games because of a rib injury.
Reporters across the country are speculating as to how Blake got this bizarre injury. It was probably after a night on the town, and you know, sometimes you end up walking around barefoot. That's all we'll say.
Here are 5 reasons why this injury is a bummer for the Lakers:
1. He had a promising playoff finish, and loses his opportunity to build off that. Coach Mike Brown and General Manager Mitch Kupchak expressed their desire at the end of the playoffs for Blake to be more aggressive. Blake showed signs of improvement in the offseason, in that area, along with his shooting stroke, dribbling, and conditioning.
2. Lakers lose a dependable player. Even though Blake has not fulfilled his promise of three-pointers yet, he has been great in running offense, keeping it organized, and finding open teammates.
3. Steve Nash may have to play more minutes. Blake's absence lowers the team's hope they could diminish Nash's playing time- Nash, at 38 years, is still running the show, but he is getting older.
4. Who will be the backup point guard? There are two options in Chris Duhon and Darius Morris. It will likely come down to who makes the fewest mistakes
5. How will rehab affect Blake's game? A lot of athletes when they return from an injury are often cautious. It took Blake four games last season to get his shooting back to 50% after his rib injury. Even after that, Blake went on a six game stretch where he only made three field goals.
If you are experiencing a foot problem, call one of our six locations to make an appointment.
Connecticut Foot Care Centers
Podiatrists in CT
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October Shoe of the Month: Loafers

Reliable and dependable, loafers are just right for pounding the pavement or relaxing with friends. The perfect loafer should not be too flexible nor too stiff. The shoe should bend at the ball of the foot, but shouldn't fold in half. Leather shoes should be soft and supple. Also, look for a shoe with a toe box that is both round and deep with a firm heel counter. Featured is Rockport's Men's Park Drive Penny, $149.99. All of Rockport's men's loafers are barefoot friendly, lightweight, flexible, and feature adiPRENE by Adidas, to absorb shock in the heel, cushioning every step.
If you are experiencing a foot problem, call one of our six locations to make an appointment.
Connecticut Foot Care Centers
Podiatrists in CT
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