Toe injury sidelines Ryan against Eagles

Matt Ryan, quarterback for the Atlanta Falcons, injured his right great toe early in the game against the Tampa Bay Buccaneers last week. It has been reported by several media outlets that he will miss the upcoming game against the Philadelphia Eagles as a result of this injury.

Ryan is reportedly suffering from turf toe. This is a condition that causes pain at the base of the big toe near the ball of the foot. The injury can occur by jamming the big toe or when cleats stick in artificial turf while coming to a sudden stop. The toe is hyperextended and damages the ligaments and capsule of the first metatarsophalangeal joint (MTP). Damage can range from a stretch injury or minor tear to a complete tear of the capsule and ligaments with injury to bone and cartilage. Symptoms include pain at the MTP joint and base of the great toe as well as swelling and joint stiffness.

Athletes typically do not participate in sporting events while being treated for turf toe because they cannot use the toe to push-off, jump or accelerate. Turf toe is treated with rest, ice, anti-inflammatory medication and immobilization of the joint, especially when the injury is acute. Immobilization may be accomplished with a cast or walking boot. Eventually, range of motion exercises are performed to gradually increase joint motion. Taping techniques and shoe modifications can also be used to help an athlete return to play. Most patients will respond to conservative care, but surgery may be necessary in severe cases.

Unfortunately, many athletes go on to experience long term complications from turf toe including arthritis, pain, development of bone spurs and joint stiffness.

What makes a runner fast?

Most people would answer training and practice are the keys to being a fast runner. However, research published by Stephen Piazza and Sabrina Lee of Penn State University has shown the musculoskeletal anatomy plays a role in allowing sprinters to rapidly accelerate. Their study showed longer toes and shorter heels in sprinters compared to those of non-sprinters.

Why are these traits beneficial to sprinters? Longer toes have more time in contact with the ground and allow for an increase in acceleration. The increased ground contact allows better push off at the start of a race. After measuring the ankle joints and Achilles tendons, sprinters were also found to have heels 25% shorter than non-sprinters. This allows the sprinter to produce a greater force with a shorter lever arm.

The characteristics of a sprinter defined in this study can provide better grip and power at the start of a race and could mean the difference between winning and losing. A question that remains unanswered is whether sprinters are born with these traits or do they develop from years of training?

All About Gout

Do you find your great toe is red and very painful, especially after eating a rich meal? If it does, then you may be suffering from gout. Gout is caused by an increase in uric acid levels. This develops because of increased production of uric acid by the liver or decreased excretion by the kidneys. Eating a diet of rich foods such as red meats, some types of seafood and heavy cream sauces as well as consuming alcoholic beverages can also contribute to a gouty flare.

Gout is characterized by a sudden onset, knife-like pain, swelling and warmth to the affected joint. These symptoms occur as the uric acid crystallizes in a joint space. This is commonly seen in the big toe joint of the foot. Men between the ages of 40-50 are frequently affected.

You should seek medical attention at the first sign of symptoms. It is important to rule out other causes of the pain, such as infection, so proper treatment can be offered. Gout is diagnosed through blood work to measure uric acid levels. A sample of joint fluid may be drawn to check for the presence of uric acid crystals. If left untreated, large deposits known as gouty tophi can develop and cause damage to the joint. X-rays are performed to check for changes to the joint and bone surfaces.

Gout is treated by anti-inflammatory medications prescribed by your doctor for an acute flare. Other medications are available for long term management of gout. An injection to the affected joint is another treatment option. Discussion of your symptoms with your doctor will determine the treatment best for you.

Holiday parties will be here soon with platters of rich foods that could lead to a gout attack. By eating a balanced diet, drinking plenty of water, exercising regularly and following the advice of your doctor this holiday season can be happy and pain-free.

NY Giants Bradshaw playing with fractured foot

It's been reported this week that Ahmad Bradshaw, running back for the NY Giants, has been playing with a stress fracture of the 5th metatarsal in his right foot. This is a problem he has had for several months. Earlier this week he was cleared to continue playing on Sundays, but during the week he wears a boot to immobilize the area and limits his activity.

The 5th metatarsal is the long bone on the outside of the foot. A stress fracture, or hairline break in the bone, develops from repeated stress to the area. Athletes that run or repeatedly pivot are susceptible to this type of injury. Pain, bruising and swelling to the outside of the foot are all signs of a possible fracture. When these symptoms are present a thorough podiatric exam is key to a correct diagnosis. Sometimes a stress fracture is not visible on x-ray and other imaging studies, such as a CT scan or MRI, are necessary.

Treatment options for the fracture include rest to decrease the chance of further damage, as well as ice, compression and elevation to decrease swelling. Often the fractured foot will be placed in a cast or boot to immobilize it with the use of crutches. When the fracture occurs in an area of the bone with decreased blood supply it is more difficult to heal. These fractures may result in surgery to place a screw across the fracture and aide in healing. Hopefully the fracture Ahmad Bradshaw has been battling remains stable and surgery can wait until the end of the football season.

...but my heel hurts!

Children have been playing fall sports for several weeks now and you may have heard an increasing number of complaints regarding pain in their heels. These complaints are likely to be more prevalent after a game or activity involving running or jumping. Some of the more common symptoms include pain at the back, side or bottom of the heel that increases in severity after activity. The pain may cause the child to limp. It is important to have a thorough podiatric exam to determine the cause of the pain. The most common diagnosis of pediatric heel pain is calcaneal apophysitis or severs disease, but it is necessary to rule out other causes such as a fracture or bursitis.

Calcaneal apophysitis is an inflammation of the growth plate in the heel. Children between the ages of 8 and 14 are most frequently affected because their growth plates remain open. As the bone finishes growing the prevalence of severs disease decreases. Treatment options vary depending upon the severity of the pain. Some children respond to a decrease in activity level and increased cushioning to the heel while other require immobilization with a cast and crutches. Medication, stretching exercises and custom orthotics are also used to decrease inflammation and help support the foot. Maintaining flexibility and wearing supportive shoes with good shock absorption can help prevent a recurrence of this condition. Your podiatrist will help determine the best treatment plan to help your child feel better and return to their favorite sports.

Warts...not just for witches

Halloween will be here soon, and children will be trick-or-treating dressed as witches and wearing masks with ugly warts. Unfortunately, warts are a problem for more than just witches and are frequently seen on the soles of our feet. They can be quite painful as well as unsightly. A wart is caused by the human papilloma virus (HPV). This virus is found on common surfaces such as locker room floors and the tiles of public showers and pool areas. Warts are often seen in children and young adults because of repeated exposure to these locations. They can appear as rough bumps, sometimes with dark spots throughout. There may be a solitary lesion or several in a cluster.

There are several options available to treat warts. One popular method is the application of a mild acid directly to the lesion. It is often necessary to undergo multiple applications before the wart has resolved. Other options include freezing the wart or surgically removing it. Your podiatrist can help diagnosis a wart and chose the best treatment option for you. Caution should be used with over-the-counter remedies because of the risk of damaging the surrounding healthy skin. To decrease the chance of recurrence avoid walking barefoot, especially in public places... and stay away from witches! Happy Halloween!

Morning Foot Pain

Are your feet in pain when you get out of bed in the morning? Does your heel ache or throb as you take the first steps of the day? These are just a few of the symptoms that may indicate a diagnosis of plantar fasciitis. The plantar fascia is a band of tissue extending from the heel towards the ball of the foot. When this band is inflamed it causes pain. Symptoms may increase over time, especially when standing for long hours on hard surfaces.

It's not necessary to suffer with this type of pain. There are several options to help treat this ailment. First, a podiatrist will do a thorough exam to identify the cause of the pain. Stretching exercises are key to help ease the pain associated with plantar fasciitis. It is also important to wear supportive, comfortable shoes and avoid flip flops and bare feet. Persistent pain may require oral anti-inflammatory medication or a corticosteroid injection. Custom orthotics are often necessary to address the underlying cause of plantar fasciitis. These are devices that are made for your feet and fit in shoes to help support the arches and increase shock absorption to the heel. Long term use is recommended to help prevent a recurrence of symptoms. A podiatrist will help determine the best course of treatment for you.

Sexy foot pain

Too many of us deal with painful feet. We walk everywhere but we do not consider our shoe gear. It's very important to wear proper fitting shoe gear. We need to have a shoe that not only fit correctly but also has a strong heel counter, a good toe box , rubber soles and proper support. Custom made orthotics can help with proper support. It's best to be fitted by a podiatrist and be casted in neutral position. If any questions go to www.sjfootdoctors.com.