• GARETH BALE, PFA (PROFESSIONAL FOOTBALLERS ASSOCIATION) PLAYER OF THE YEAR... ENDS HIS SEASON WITH RUPTURED ANKLE LIGAMENT.

Wales National Team soccer(football) player, and Club Tottenham Hotspur player rolled his ankle last weekend during a slide tackle on the field.  Not a career-ending injury, but definitely a season-ending one.

Ankle injuries are too common a problem, especially in athletes changing speeds and directions.  The basic mechanism of an ankle injury is a forced twisting/rolling in, or a forced twisting/rolling out of the ankle. 

Before we go on, let's briefly discuss the ankle joint bones and ligaments.  There are 2 bones that make up the ankle joint, the talus bone and the tibia bone.  The talus and the tibia bones come together and are supported by soft tissue structures, AKA joint capsule, on all sides.  This joint capsule holds the ankle joint together and supports the ankle joint movements.  The joint capsule is made up of individual ligaments on the inside and outside of the ankle joint, that contain or support the ankle joint itself.

The joint capsule/ankle ligaments around the ankle joint resist too much motion in the ankle joint, with the goal of protecting the ankle joint against injury.   BUT, sometimes the force is greater than the strength of the ligaments, and the ligaments fail.  How do they fail?  They fail by stretching, tearing, or rupturing off of the bone.  And sometimes, if the force is so great that the ligaments rupture off of the bone, the bones may break!  In as many as 4 different places in the ankle, and occasionally in the foot as well! 

In Bale's circumstance, the forced twisting of his ankle joint was so powerful that the ankle ligaments failed, and ripped off of the bone.  In young athletic individuals as Bale, it is often necessary to reattach the ankle ligament to the bone in the operating room.  Sometimes the ligament is so shredded that surgeons make a new ankle ligament from tendon to replace what was damaged.  When the most destructive type of ankle injury occurs and fractures, surgeons must put the pieces back together with plates, screws, pins, and rods.    Let's hope this isn't the case for Garet Bale.

For more information about ankle injuries, treatments, etc, visit our website at www.podiatristofnaples.com

NEUROPATHY IN MY FEET? WHAT IS THIS, WHY DO I HAVE IT, & WHAT CAN I DO ABOUT IT??

30% of the population suffers from idiopathic neuropathy, which is neuropathy from an unknown cause.  But what IS neuropathy?  Neuropathy is a disorder of the nerves.  Neuropathy presents as symptoms in the hands, more often the feet, such as tingling, numbness, burning, the feeling of bugs crawling on the skin, and in the worst cases, shooting pains.  Although 30% of neuropathy is a from an unknown cause, another 30% is from a Known cause.... DIABETES.  A few other causes are chronic alcoholism, shingles, medications, AIDS, deficiencies in vitamins, cancer drugs, toxins, and certain diseases/disorders.

 Why does my diabetes cause neuropathy?  Patients with diabetes whose glucose/sugar has been out of control for longstanding periods of time develop neuropathy.  Simply put, the disease effects your nerves when you do not take control of your sugar levels.  Usually the symptoms start in the fingers as numbness first.  Eventually the symptoms are felt in the toes and feet.  Neuropathy IS reversible up to a certain point, but irreversible once the glucose has been uncontrolled for too long.  Many diabetic patients complain of no feeling on the bottom of both of their feet!  This is when trouble can occur.... if you can't feel it, you don't know it!  In other words, a diabetic patient with neuropathy (or any patient with neuropathy) may step on something and never realize the skin is broken on the bottom of the foot.  Bacteria may contaminate this opening, leading to an ulceration and infection.  It's at this point that you may hear of diabetic patients with ulcerations, infections, and in the worst cases, amputations!

How is neuropathy treated?   There are many treatments for neuropathy that are dependant on each individual case.  These include vitamin supplements, prescription medications, diet and glucose/sugar control, and various non-invasive therapies.  The most important treatment is PREVENTION, in the case of diabetes.  Although uncontrollable in some cases, neuropathy is preventable and controllable in Diabetes.  Diet and sugar maintenance are paramount in effectively minimizing the effect of neuropathy.  But remember, chronic longterm uncontrolled sugar = irreversible neuropathy.  When this neuropathy is associated with Pain, the problem is magnified.

For more information about neuropathy, visit us as www.podiatristofnaples.com

Ashton Kutcher born with Webbed Toes!!

Celebrity Ashton Kutcher is no stranger to a good sense of humor.  Ashton has publically announced having been born with webbed toes!  He has been so confident and unashamed as to Show the public this deformity on numerous occasions, even on the Oprah Winfrey show!

Ashton was born with a condition called Syndactyly.  Syndactyly is a condition in which two or more digits (fingers OR toes), are fused together.  Instead of functioning individually, they function as one unit because the skin between the digits is fused.  There is no visible separation between the affected digits, and the digits may resemble a “webbed foot” or a “webbed toe.”

Surprisingly, in normal fetal development, all toes and fingers are webbed!  The separation of the digits occurs naturally during development at approximately 16 weeks.  In the case of Mr. Funny himself, Ashton Kutcher, he was born without the enzyme that dissolves the skin between his two toes. 

Syndactyly usually is not a symptomatic condition, rather, a cosmetic concern.  There are surgical options available to reconstruct webbed toes in some cases.  Ironically, there are other cases in which surgeons purposely Syndactylize digits!!

For more information on Syndactyly and/or Syndactylization, visit us at www.podiatristofnaples.com

Halle Berry & Kate Hudson have extra toes!!!!

Celebrities Halle Berry and Kate Hudson were both born with a condition called Polydactyly.  Polydactyly is a deformity in which an individual is born with one or more extra digits of the hands or feet.  This is usually an isolated deformity resulting from a genetic mutation, but can also be found associated with other syndromes.

Polydactyly in the feet presents as an extra toe, most commonly a fully developed extra ‘pinky’ toe.  Although the extra toe may appear to be fully developed, oftentimes the bones of the toe are not, leading to a limp floppy toe that can be quite uncomfortable.  Treatments include paddings, strappings, over-the-counter inserts or custom orthotics, and shoegear modifications.  Surgical treatment is a serious consideration in Polydactyly when the condition is either symptomatic or a cosmetic concern for patients, especially concerned parents of children born with this condition. 

With all of the plastic surgery happening in the celebrity world, it comes as a surprise that the beautiful Halle Berry and Kate Hudson did not have their extra toes surgically corrected!!  It goes to show, not many people are looking at your feet!! 

Contact Dr. Malinoski with any questions or concerns, and/or more information www.podiatristofnaples.com

MY CHILD HAS FLAT FEET ..... TO TREAT OR NOT TO TREAT??

MY CHILD HAS FLAT FEET....TO TREAT OR NOT TO TREAT??

Much controversy exists among medical specialists and parents of children with "flat feet." As there is much debate in the medical literature whether treatment of children with a non-painful, but an obvious and visible flatfoot deformity can prove beneficial.
A normal foot can be described as one having an arch, which is that space between the big toe and the heel on the inside of both feet. This area should be elevated off of the ground while standing, and shaped like a cave or arch. There should be enough space there that you could slide a couple of fingers underneath of your foot, as if your fingers are entering the 'cave.' This gentle curvature of the arch is also visible while the foot is off of the ground/not standing or walking. Those individuals with flatfeet are missing that cave or arch, and this side of the foot touches the ground, sometimes so incredibly flat that the foot actually makes a suction-type sound with every step! In extreme cases, the arch is so collapsed that one may walk on the inside of the ankle!
Depending on the severity of the flatfeet, there are many treatment options. Options include, in specific cases, serial casting (a series of casts applied over time to babies in hopes of correcting the deformity), over-the-counter arch supports or custom orthotics, and surgical reconstruction in the most painful & deformed cases.
A common misunderstanding is that All flatfeet should be treated with arch supports or custom orthotics. This is false. The most import consideration is age of the patient. Many parents present to the pediatrician or podiatric surgeon requesting orthotics for their child's flatfeet. Newsflash! Childrens' feet appear flat until the age of 4 or 6! Prior to, the arch is not fully developed, and often masked by "baby fat.'' It is not uncommon for parents to begin noticing and become concerned about the flattened appearance of the feet during this time. Parents being parents, present their complaint, and oftentimes their children are prescribed orthotics without a flatfoot deformity at all. We end up 'treating the parents,' when orthotics were not necessary to begin with, disrupting the natural growth of the soft tissues and bones in the child's foot, which could prove detrimental in the future.
Next we enter children after age 6, when the arch begins to appear. During this age, usually, either the children are complaining of pain in the arches during and/or after play, OR, parents notice the flattened appearance of the foot. Over the counter inserts or custom orthotics would of course be indicated in the children complaining of pain. And in the most extreme cases, surgery. But what about those without pain, but with obvious flatfeet?? This is where it becomes tricky. An important question to ask is "Does mom or dad, brothers or sisters, grandmother or grandfather have flatfeet? Any were these flatfeet problematic?" Flatfeet are hereditary. If there is a relative with symptomatic flatfeet, then the likelihood of the child developing symptomatic flatfeet is increased. However, that is Not Always the case. There is some medical literature that supports custom orthotics to stop the progression of flatfeet in children. It is certainly worth a try!
Some children have SEVERELY painful flatfoot deformities that require surgical reconstruction for pain-relief. These cases are few and far in between, but do exist in every podiatry practice.
In summary, some of the most famous professional athletes have flatfeet. Some of them are painful, others are not. Some need treatment, others do not. The decision is purely individual in each case. The answer cannot be found in any medical journal, informational blog or reading material. If there is a concern, the child needs to be examined.
To have your child examined for the severity of their flatfeet, email Dr. Malinoski via her website at www.podiatristofnaples.com

GOUT IN MY FOOT/TOE!!!!???

GOUT IN MY BIG TOE....???

Everyone has heard of the term GOUT.  But not many individuals are familiar with what Gout truly is, unless they've experienced gout's agonizing pain personally, or watched a loved-one temporarily suffer the symptoms.

Gout is a disorder of metabolism.  It all starts with something called Purines.  Purines are found in the foods that we eat.  Purine-rich foods include such indulgences like alcohol, particularly beer, meats, seafood, and certain vegetables and legumes.  These purines are naturally broken down via metabolism in the human body, into a product called Uric Acid.  The Uric Acid is excreted through our kidneys. The breakdown of purines into uric acid is a natural process in human metabolism.  BUT, when our body has difficulty excreting the uric acid, That is exactly when gout flare-ups begin.  This excess of uric acid builds up into certain joints of the body, and in the foot, the most common location is in the big toe joint.

Why does the body have difficulty excreting the uric acid??  Most frequently, after ingestion of these protein-rich foods, the body cannot keep up with excreting the extra uric acid, and these uric acid levels build up.  Sometimes, there is a defect in one's metabolism where the individual is missing a certain enzyme that breaks the purines down into uric acid, resulting in excessive uric acid build-up with nowhere to go!

This abundance of uric acid likes to live in certain locations in the human skeleton, like knees, elbows, ears, and in the big toes!  Once settled into their favorite location, the area becomes extremely red, swollen, and painful!  So painful that a common description of pain is "so uncomfortable that a bedsheet touching my toe is excruciating!!"

Again, the initial presentation of gout in the big toe presents as a red, hot, and swollen toe/joint that is significantly painful.  Xrays are usually taken in the office, but it takes approximately 10 years for xrays to show xray signs.  So remember that they xrays probably won't show anything at all, but soft tissue swelling. 

Gout is a diagnosis based on your doctors clinical suspicion.  In other words, we suspect gout when the patient presents with the red, hot, swollen joint,  has a history of gout, has eaten purine-rich foods recently, and sometimes when they've bumped or stubbed the toe.  ( That's right, sometimes trauma can precipitate a gout attack!). 

What treatment should you expect if you present to your foot doctor with gout?  Simply stated.....xrays, possibly a cortisone injection into the joint to break up inflammation and pain, an oral medication specifically prescribed for acute gout, and labwork to review your uric acid levels.   That's it!  Usually, the symptoms are improved in a day or two, and resolved in 5-7 days.  Sometimes patients are prescribed gout medications to take daily for life to protect you from future gout flare-ups. 

What can you do to protect yourself from another painful gout flare-up?  First and foremost...diet control!  Limit those purine-rich foods mentioned above!  Gout is nicknamed "The Rich Man's Disease."  Why??  Because those purine-rich foods like meat and seafood are expensive!  Secondly, take your gout medication daily to prevent a new flare-up.

Although gout has a predilection for certain populations, it can affect anyone.  We are seeing patients with symptomatic gout in surprisingly young ages recently.

For more information about Gout and any other lower extremity question or problem, email Dr. Malinoski via her website at www.podiatristofnaples.com

FOOT INJURIES COMMON AMONG STAND-UP PADDLE BOARDERS (SUP'ERS).

FOOT INJURIES COMMON AMONG STAND-UP PADDLE BOARDERS (SUP'ERS).

Stand-up paddleboarding, AKA SUP'ing, has become a popular leisurely activity as well as competitive event on the Gulf Coast of Florida.  Last May, the First Annual Stand-Up Paddle Championship was held at Madeira Beach.  This year’s event is scheduled in Madeira Beach at the end of this month, check out GCSUPS.com.  SUP’ing has taken off in Florida!

I went SUP’ing for the first time one week ago with an experienced friend, who spent many days SUP’ing amongst the waves of Hawaii.  Not only was this a new experience for me, it was also surprising for my friend!  Being used to riding the rough swirling waves of HI, my buddy was quite surprised, and almost bored! 

Although the Gulf Coast waters are flat, SUP’ing continues to be a workout!  The moment I was able to find my balance on the board, I immediately felt the muscles of my core working and pumping.  Surprisingly, my shoulders and arm exhaustion were secondary to the aching arches of my feet from gripping the board so tightly for the sole purpose of not embarrassing myself with a fall!  After all, we were SUP’ing along the Gulf Coast of beach-goers in April!

Studies show that the most common injuries from SUP’ing are upper musculoskeletal in nature, AKA shoulder, elbow, and arm tendonitis -- from paddling, of course.  No surprise to me, tendonitis of the feet and/or ankles is a close second!  The feet attempt to find the balance on your board, and react abruptly to centralize your body, gravity, and forces to keep your body on the board.  If your core is weak, your feet are the first to respond, and the first to compensate for and pick up the slack of your core balance problems.  Foot and ankle cramping, aching, pain, and tendonitis follow!

For more information on how to properly safeguard your feet and ankles against injuries from Paddleboarding/SUP’ing, email Dr. Malinoski via her website at www.podiatristofnaples.com

It’s not as simple as flipping onto your head when your feet and ankles ache!! My experienced friend ‘SUP’ing’ last week)…