"My Foot Hurts Even When My Sheets Touch It!!

“MY FOOT HURTS EVEN WHEN MY SHEETS TOUCH IT!!”

If this is a complaint that you have, you may have a condition called GOUT. Gout has various other names, such as metabolic arthritis or Podagra. Almost 1 million people in the United States have Gout.
Even Benjamin Franklin, who lived from 1706 to 1790, had Gout. Gout plagued Franklin so much, that he even wrote an essay titled, “Dialogue between Franklin and The Gout” on October 22, 1780. Other famous people afflicted with gout include President Thomas Jefferson, King Henry VIII of England, Charles Darwin, Alexander the Great, and Voltaire.

What is Gout?
Gout is a buildup of uric acid crystals in and around joints in the body. Gout only attacks one joint at a time. A gouty attack is when these uric acid crystals in the joint buildup, causing exquisite pain, redness and warmth. The joint can become so sensitive, that even the slightest touch can elicit an excruciating amount of pain.

A common complaint is, “My foot hurts even when the sheets touch it.” These attacks can last from hours to days. An acute gouty attack is self-limiting, however medication is necessary in most cases to reduce the pain and the inflammation.

Gout can occur in any joint; however, there are joints that are more commonly affected. These include the big toe, ankles, knees, wrists, and elbows. Rarely, uric acid has also been found in the ears, vocal cords, and the spinal cord.

How does the uric acid build up in the joints? Gout essentially is a metabolic disorder. It happens when the body has a malfunction in processing and eliminating uric acid sufficiently; it can also happen when the body has a genetic tendency to generate more uric acid than the body needs. The uric acid that gets deposited in the joints turn into crystals called tophi. These tophi can become very painful, especially during an acute attack of Gout.


Some people are more at risk of getting gout than others.
Some of the risk factors of gout include:
1. Obesity
2. Moderate to High Alcohol Consumption
3. Abnormal Kidney function
4. Hypertension
5. Some prescription drugs may also exacerbate gout.

DIAGNOSIS & TREATMENT:
Diagnosis of gout can be made by your podiatrist, by just inspection of your big toe or ankle joint. A more definitive diagnosis can be made by joint aspiration of the fluid in the joint. This fluid is taken from the joint and sent for pathology to identify the uric acid crystals. Blood Tests to check for the uric acid in the blood can also be done.

It is essential to go to your podiatrist or doctor if you have symptoms that are similar to gout. If left untreated, multiple acute gouty attacks can lead to a chronic condition of gout. This can further lead to decrease in kidney function, and the formation of kidney stones.

Your podiatrist may treat a gouty attack with pain relievers and Anti-inflammatory medication as a first line of treatment. Some medications can also lower the blood uric acid by preventing uric acid production in the body.

PREVENTION:
Once gout is diagnosed, there are many ways to prevent any further attacks of gout. These include weight loss, decrease in alcohol consumption, sufficient fluid intake, and a change in diet.
Foods rich in purine (the product which is converted to uric acid in the body) should be avoided. There are many foods rich in purine. These include, shellfish, meat, organ meat (liver, kidney, etc), fried foods, roasted nuts, etc… You can speak with your podiatrist regarding what foods to avoid, and what foods to moderate if you do have gout. Acid forming foods should also be avoided.

If you have any or all of the above symptoms of pain and tenderness, redness or inflammation, consult your Podiatrist immediately.

Diagnosis, Treatment and more importantly Preventing future attacks of gout is essential in keeping your body healthy.

 

Don’t Forget to Thank Your Feet this Thanksgiving! By Dr. Sharon S. Joag

Day after day, Month after month and year after year, your feet really do take on a beating.  They do a lot of work, carrying all of our body weight around all day long.  And during the holiday season, they take on even more.  Everything we do to our bodies affects our feet; from high heeled shoes, to the foot that we end up eating. 

So, this holiday season, start it off right; start by taking care of one of most important, yet one of the most neglected parts of our bodies, our FEET! 

1.     
Wear comfortable shoes that compliment your foot type.  For your dress shoes, try brands like Dr. Comfort, Ecco, or Clark’s shoes.  They have a bit more padding and arch support, and more importantly, they have a bit more width to accommodate your toes.  Trying to squeeze our toes into little stilettoes, and those narrow heels may look pretty amazing, but they are a disaster for your feet. 
Wearing narrow high heels can lead to painful hammertoes, bunions, neuromas, and many other foot problems.  If you must wear high heels, make sure you have a comfortable pair of shoes you can change into by the end of the night, when you are getting home from work, or going home from a party or dinner.  If you need advice on what type of shoes to wear, consult your Podiatrist.  Having a high or a low arch will define the type of shoe that best suits your feet.

2.       
Try Reflexology!This alternative massage therapy has been around for thousands of years, and it is still around for a reason.  Your reflexologist may do a lymphatic drainage as part of your foot treatment.  If you have swollen feet at the end of the day, or if you have chronic swelling called “pitting edema”, that just will not go away, lymphatic drainage is for you. 
Lymphatic Drainage is a form of manual therapy that helps to remove the excess fluid in your feet and legs and manually pushes this fluid toward your heart and lungs.  Lymphatic drainage will help to bring back your energy, and improve your circulation.  This can be done as often as is needed; once a week, or once every two weeks. 

      Eat a Healthy, Balanced Diet.  That does not mean that you need to restrict your diet, but it does mean that you need to become a conscious eater.  Putting less meat, and more vegetables on your plate is the general rule to follow.  But it is also important to eat in moderation; never eat too much of anything. 
A diet that is not balanced, and healthy can lead to Systemic Diseases, such as Diabetes Type II.  Diabetes in turn, can affect every system in the body.  An unhealthy diet, rich in purines, such as red meats and alcohol, can lead to Gout.  Knowing and thinking about what you are putting into your body is crucial. 

4.       
Walk, Exercise, Just MOVE. Take a walk during your lunch break.  Especially if your job is at a desk.  Your circulation will improve, as each time you flex your calf muscle, you are actually helping to circulate blood in your legs.
And if time permits, put your feet up at work every now and then.  You will notice that you will get a boost of energy by doing this. 

This Thanksgiving, take care of your feet, and they will take care of you!  

Have you heard of Dr.'s Remedy?

In the United States, it is legal for beauty products to contain chemicals which are linked to Cancer, Learning disabilities, infertility and chronic disease. Most of the nail polish found in pharmacies and convenience stores have toxic materials such as DBP, Toluene, and Formaldehyde in it.
The nail polish called Dr.'s Remedy on the other hand has naturally occurring substances such as tea tree oil, garlic bulb extract as well as Vitamin C and E and Wheat proteins. Children, especially girls, who wear nail polish on occasion and end up biting their nails and chipping their nail polish off, should be using this new natural nail polish.

WHY IS REGULAR NAIL POLISH SO BAD?

The nail polish that we buy in our stores today and in the United States are filled with DBP, or dibutyl phthalate, which has been proven to have links with infertility and birth defects; Toluene or methylbenzene, is also used as an inhalant for intoxicating properties, but is no longer used since it has been shown to cause neurological damage. Finally, formaldehyde is also a substance in nail polish; it is proven to cause cancer and it isused since it aids in the durability and the longevity of the product.

These links to cancer, birth defects and infertility should ward you off regular nail polish for good.

WHY SHOULD YOU USE DR'S REMEDY NAIL POLISH?

Dr.'s Remedy is one of the brands of nail polish, developed by two Podiatrists, which have all naturally occurring substances, and are not harmful to the body. In fact, the substances used have significant antifungal, antibacterial and antiviral properties.

A few of the main products are listed below with their beneficial properties.

1- Tea tree oil: from the leaves of the Melaleuca alternifornia plant. It is an anti-septic as well as an anti-fungal.

2- Garlic Bulb Extract: contains Allicin. It is an anti-bacterial, an antifungal as well as an antiviral.

3- Vitamin C and E: for the skin and nails.

4-Wheat protein: to increase shine, and has moisture-binding properties.

WHAT IS A DVT?

Have you ever heard of a DVT, but are not sure exactly what it is?

A DVT stands for a Deep Venous Thrombosis. More than one Million people suffer from DVT's each year, and out of those, 100,000 people die of a DVT each year in the United States. A DVT does not descriminate, and it can and has affected people of all ages.

A DVT is a blood clot or thrombosis which is in a deep vein in the leg or the pelvis. An embolism is also another name for a blood clot, like a PE or a pulmonary embolism which is a blood clot which travels to the lungs but originates in the leg.

Symptoms of a DVT which you can actually see in the leg include
1- Significant swelling of one leg compared to another

2- Pain and tenderness of one leg which is unrelated to a trauma.

Some signs of a PE or Pulmonary Embolism are
1- Shortness of Breath
2- Chest pain, especially while breathing in
3-Coughing up Blood
4-Sudden Collapse

Some of the risk factors which may lead to blood clots include:

1- Major surgery

2-Cancer
3-Trauma to the leg
4-Immobility

5-Pregnancy

6-Birth control or hormone replacement therapy
7-History of a prior DVT or PE
8-Obesity

There are several ways in which to prevent a DVT from occurring. Mainly, you must stay active and move your legs frequently. Making sure you take walks each and every day is very important. By doing this, you will also maintain your weight at a certain level.
If you smoke, you must stop or try to stop smoking; as a smoker you have a greater risk of developing a DVT or a PE.

If you do have any chest pain, you must report this right away!

The treatment for a DVT is immediate. You will be admitted to the hospital and you will be placed on anticoagulant therapy, such as coumadin or heparin in order to thin your blood. This will decrease the ability of the blood to clot, thereby preventing any new clots from forming in your body, and not allowing the existing clots from getting any bigger. Your doctor may also give you compression stockings to wear daily in an effort to prevent future clots.

The best treatment for a DVT is prevention! Make sure you walk on a daily basis, and eat a balanced diet.

Quailbrook Senior Center, Somerset , New Jersey

Senior Centers are places where seniors can engage in activities together during the day. It is a place to commence in friendship, and spirit.
At these centers, various activities are provided. Breakfast and Lunch are also included, as well as excursions to and from grocery stores, post offices, etc.. which may be difficult for the seniors to get to themselves. Many of the members are no longer able to drive and depend on such centers to provide mental and emotional support.
As a Podiatrist, I have found that many seniors also appreciate podiatric services to be available at the senior center. The seniors find comfort that a medical professional is able to deliver their services in a senior facility.
We visited such a center last week, in Somerset, NJ. The seniors were more than happy to see us, and found it much easier than having to travel to a doctor's office; They would have to find a relative who would have to take them there; and that could take months.

What is a Bunion?

A bunion is a bump on the side or on top of your big toe joint, which may hurt while wearing shoes or walking.

Your bunions may get red, swollen or painful. If the bunion causes persistent pain and tenderness, then it is time to seek medical treatment.

In the picture above, you can see that the bunion has caused a hammertoe of the 2nd toe. The big toe has actually pushed the 2nd toe out of its place, lifting the 2nd toe up.

DEAR DR. SHARON…….

My son is 10 years old and he has been having heel pain for the past few months. I have noticed that it gets worse when he plays sports and when he is on his feet for a long time. I have tried changing his shoes to give him more support and cushion for his feet, but it has not been helping. I am concerned about his feet and I would like some advice. Why is he getting this heel pain? What can I do help get rid of his heel pain?
Tabatha: Clifton, New Jersey

Dear Tabatha,

Heel pain is very common in children active in sports, especially with children around 8-12 years of age. Around that age, kids have an open growth plate at the heel. The typical age for these “growing pains” at the heel is from ages 8-10 in girls and ages 10-12 in boys. The heel is especially painful in kids who are active in sports such as soccer, and gymnastics where there is continual pounding at the bottom of the foot near the heel. Other sports, such as basketball and football can also elicit the heel pain.

The growth plate, as the illustration shows is at the back of the heel is where your son is most likely getting his pain. When there is injury to the growth plate from constant pressure or trauma to the heel, the heel will become painful and inflamed.

The foot is one of the first parts of the body to grow to its adult size. This usually happens by age 15. At this age, the heel pain will disappear. The bones of the foot therefore, actually grow faster than the muscles and tendons surrounding it. The calf muscle which is attached to the back of the heel may be tight as well and cause the heel to become more painful.

If your child does experience this pain, it is a good idea to go to your medical doctor or podiatrist to have an Xray taken. This Xray will show if there is an open growth plate or if there is a fracture at the heel. If after taking an Xray, you find that your son does have heel pain, your Podiatrist will be able to help you and your son work together to get rid of or to alleviate the pain.

Some of the things that may alleviate your son’s heel pain are as follows.

1. Make sure that he decreases his sports related activities to see if the symptoms will improve.
2. After he is through with his sports at the end of the day, placing ice at the heel is helpful to decrease the swelling and pain.
3. Make sure that your son has a heel cushion in his shoe. Your podiatrist maybe able to give you advice on the type of heel cushion to use. And make sure that he does not walk around barefoot.
4. Try adding a heel raise in the shoe to take the stress of the calf muscle at the back of the heel which may be causing increased pain and stress on the heel.
5. Stretching exercises for your calf muscles may also be helpful for your son to alleviate the pain. Your podiatrist can teach you to do some stretching exercises for the heel.

This type of heel pain is also called Sever’s Disease or Calcaneal Apophysitis. Sever’s Disease is very different from the heel pain that adults experience in their heel. Usually adults have pain due to a stretch in their plantar fascia or tissue which is under the foot, and not due to the heel bone itself. The adult heel pain is called Plantar Fasciitis.

HOW MANY BONES ARE IN YOUR FOOT?

HOW MANY BONES ARE IN YOUR FOOT?
By Dr. Sharon Joag

Did you know that you have 26 bones in your foot alone? Some say that we have 28 bones. The two extra bones that are counted are under the (1st Metatarsal Head), or the ball of the foot. They are called sesamoid bones.

These two tiny bones in our feet can cause us extreme pain, especially if we are engaging in certain types of athletic activities.

Have you ever had pain when you move your big toe, especially when you move it up?

Have you ever had pain and swelling at the ball of your foot when standing, walking, running or jumping?

If you answered yes to any of these questions, then there maybe something wrong with the sesamoid bones in your foot.

One of the most common injuries of the sesamoid bones is Turf toe. Turf toe is essentially the jamming of the big toe into the 1st metatarsal head. When this happens, the capsule tears around the 1st Metatarsalphalangeal Joint, or the Joint at the base of the big toe. When the capsule tears, it is extremely painful and could cause joint dislocation or instability. Turf toe is the result of injuries caused by jumping, especially in soccer or basketball.

Another injury is sesamoiditis, or an inflammation of the sesamoid bones. Since the sesamoid bones are at the ball of the foot, any stress placed on this area, especially repeated stress near the big toe can cause pain. Typically, Sesamoiditis occurs in runners as they have constant pressure on the balls of their feet. In fact, some runners relate that they “only run on ‘their’ toes”. Sports that involve jumping can also bring on Sesamoiditis. Jumping injuries typically involve Basketball players and Football players. Another big group of people Sesamoiditis affects are dancers. Dancers, ballet and otherwise spend a great deal of time on their toes and on the balls of their feet. Many dancers, other than ballet dancers wear high heels while dancing. Wearing high heels can also contribute to sesamoiditis.

If the sesamoid bone is split in two, it is called a bipartite sesamoid. Some people are born with bipartite sesamoid bones. Even though the two bones are not broken, with repeated stress to the area, with running, walking, jumping, (or any activity which places stress on the ball of the foot) the bipartite sesamoid may rub on each other, causing some pain and inflammation.

Sometimes the sesamoid bones may actually fracture. This occurs by landing hard on the ball of the foot from a certain height. A sesamoid stress fracture occurs from overuse. It can occur from a constant pressure or pounding on the ball of the foot over time.

If you experience any symptoms of pain and swelling at the ball of the foot, or pain when you lift up your big toe, it is important for you to see your doctor. Your Podiatrist will take an Xray to see if you have a sesamoid fracture or any other injury of the sesamoids, such as Turf toe. Your

Podiatrist will be able to recommend a treatment plan, based on your injury.

MY FOOT HURTS: TAKING CARE OF YOUR FEET DURING PREGNANCY

As wonderful as motherhood is, those 9 months prior to giving birth can take a toll, especially on our feet.

During pregnancy, a woman will gain weight, as she should. This rapid gain in weight, around the waist will naturally change the center of gravity of the expectant mother. Since most of the weight will be in the front, in order to balance the body, the woman has to sway backwards. This causes a lordosis of the spine.

This new position of the body changes the weight and pressure on various joints of the lower extremity, including the knees, legs, and feet.

Some of the typical pain expectant mothers experience is the result of excess weight gain and fluid collection in the ankles and feet. This swelling can result in ingrown toenails, which need to be treated right away before an infection can set in.

Some women’s feet will actually increase in size during pregnancy, which may or may not return to normal after giving birth.
· Support stockings may help with the increase in fluid in the area around the ankles and the feet. These stockings should be waist high. They should be worn first thing in the morning so that during the course of the day, when the feet start to swell, the stockings will keep the swelling in check.
· Elevate the feet and legs whenever possible to limit the swelling and be sure to wear comfortable shoes that do not compress the feet or ankles.

Other effects of pregnancy on the feet include over pronation. This is also due to the increase in weight over a relatively short period of time combined with a change in hormones. Some hormones released during pregnancy will relax the muscles and ligaments in your body to allow vaginal birth. These hormones may also relax the ligaments in your feet. The pressure on the feet from an increase in weight along with ligament laxity will cause the feet to pronate.
· Often arch supports may help to alleviate some of the pain caused by over pronation. Arch supports will also enable you to have more stability during ambulation. The arch supports should be placed in a wide shoe which does not place pressure on the ankles or the feet.

Some women experience heel pain, also known as plantar fasciitis. This is a result of over pronation due to the increase in weight.
· Again, an arch support or a full orthotic may help.
· Daily Stretching exercises will alleviate the pain in the arch. Your podiatrist will be able to teach you certain stretching exercises that target the plantar fascia. The plantar fascia is a band of tissue that supports your arch, and starts at the heel, extending into the toes.

Other pain includes cramping in the feet and legs. This cramping can be the result of pressure on the veins in the pelvic area, which decreases the venous blood flow to the legs and feet. Cramping usually occurs in the 2nd trimester and occurs typically at night.

· In order to alleviate cramping, make sure to move your ankles and legs at frequent intervals.
· Some women benefit from a light massage of the legs and feet.
· Other women benefit from swimming. This exercise allows you to move your legs and muscles easily.

HEALTH BENEFITS FOR WOMEN WHO LIFT WEIGHTS

By: Sharon S. Joag


1. YOU WILL BECOME PHYSICALLY STRONGER: This is called Functional Fitness
Resistance training will enable you to do daily activities much easier since it increases your strength. Muscles which are worked against resistance increase in strength.
Your chores around the home will seem easier to do.


-IMPROVES ATHLETIC PERFORMANCE AND DECREASES INJURY.
-BUILDS STRONGER CONNECTIVE TISSUE AND INCREASES JOINT STABILITY BY STRENGTHENING JOINTS.


-Women at any age, even in their 70’s and 80’s have built up significant strength with weight training. Resistance training helps to fight aging by maintaining lean muscle tissue and increasing bone density.


-Women in their mid-30’s start to lose 5-10% of muscle strength each decade.

2. GAIN STRENGTH WITHOUT BULK


A long standing myth is that women who lift weights risk growing muscles like a man! This is just a MYTH.


Because women have more estrogen and less testosterone, women gain more tone and definition and less hypertrophy or bulk. Men gain muscle hypertrophy. Therefore, no matter how much a woman works out, she can never gain as much muscle as a man. This can only happen with hormone supplementation or hormone imbalance.


Another myth is that lifting weights makes women gain weight! This is not true.
You will not gain weight by lifting weights. Instead, you will actually be able to control your weight by toning your muscles. Muscle is more dense than fat, however, it takes up less space than fat. Also, muscle cells, even at rest burn more calories than fat cells.


With age, your metabolic rate decreases. That means that there is a decrease in the rate at which your body uses calories. By strength training, you offset the loss in muscle tissue that occurs when you age. You also increase your metabolic rate and prevent age-related weight gain.

3. DECREASED RISK OF OSTEOPOROSIS
Weight training increases spinal bone mineral density by 13% in 6 months. This with adequate calcium can be the best defense against osteoporosis, because it decreases the risk of fracture. Therefore, weight training improves balance, bone density, and muscle mass.

4. DECREASES THE RISK OF HEART DISEASE; and CANCER
Decreases LDL cholesterol
Increases HDL cholesterol
Decreases BP
Decreases body fat.
Decreases appetite.

5. DECREASES RISK OF DIABETES MELLITUS
-Weight training can increase glucose utilization in the body by 23% in 4 months.


6. EXERCISE INCREASES:
-Cardiac function
- Insulin sensitivity
-Bone density

7. EXERCISE HELPS ARTHRITIS:

This happens as stronger muscles can take the pressure off the inflamed joints.

9. IMPROVES PSYCHOLOGICAL HEALTH
- Fights depression: In a study done on depression, it showed that 10 weeks of strength training decreased symptoms of depression more successfully than standard counseling.
-Increased confidence and Self-esteem.
-Decreased anxiety

STUDY ON WOMEN AFTER TREATMENT FOR BREAST CANCER:
- In a study done in 2001 at St. Paul/Minneapolis, Minnesota, on two groups of women, both of whom underwent treatment of Breast Cancer within the last 3 years. One group was assigned to an exercise group and the other group of women had no exercise regimen to follow. The Exercise group met twice a week for 3 months and were then encouraged to continue the exercises for another 3 months.


Both groups were later asked questions regarding their physical well-being, mental happiness, and sexual activity.


The women who had done exercise felt that they had increased their strength over all. They had increased speed, self-confidence and a feeling of control over their bodies.
The women who did not exercise did not have such a feeling of well-being and were more depressed in general.


GUIDELINES BY THE AMERICAN HEART ASSOCIATION AND THE AMERICAN COLLEGE OF SPORTS MEDICINE:
-All individuals should do 8-10 repetitions for each of the major muscle groups: Biceps; Quadriceps; and Hamstrings.-Resistance exercises should be done on 2 or more non-consecutive days of the week.


These may seem to be simple rules to live by, but you will be surprised at how many people including yourself actually follows these guidelines.


As you start lifting weights and become stronger, you will also become more active and will have more energy.



Your overall body balance will improve.



Weight training will keep your body weight and your waist line healthy.



Your overall positive mood and increased energy will enhance your life.

YOUR CHILD’S FOOT: WHY DO CHILDREN TOE WALK?

Toddlers from age 1 to about 3 yrs of age may often exhibit toe walking. By age 2 to 3 the toe walking should disappear. Persistent toe walking after age 2, especially toe walking on one leg may be a cause for concern. A common problem associated with toe walking is Cerebral palsy, Autism, and Duchenne Muscular Dystrophy to name a few. These underlying disorders should be identified early on. A neurological examination needs to be done, including a test for language and developmental delays. If there are no developmental delays or muscle spasticity, then your child has what is known as “idiopathic toe walking”.

The most common problem neuromuscular disorder amongst toe walkers is Cerebral palsy (CP), affecting 1-7 in 1000 children. Not all children afflicted with CP are toe walkers. Less than 50% of children with CP walk on their toes. Another cause is Duchenne Muscular Dystrophy, a paralytic muscular disease, where children typically will walk on their toes.Spastic CP results in muscle spasticity, and is a common cause of toe walking.

Muscle spasticity can result from Spastic CP as well as from Spinal Cord lesions. Spinal cord lesions can be congenital, traumatic or acquired. It is important for you to see your Podiatrist as well as your Pediatrician regarding these disorders.

If your child is otherwise healthy, without any neuromuscular disorders, then your child may have what is called “Idiopathic toe walking”. This simply means that there is no defined cause for the toe walking. Toe walkers under this category may just have a habit of walking on their toes. Others may have a congenitally short Achilles tendon. However toe walking may also be associated with a short Achilles tendon. Casting or physical therapy and even surgery may be necessary to stretch and lengthen the calf muscles of the shortened Achilles tendon.

PHYSICAL EXAMINATION

A thorough physical examination must be done to evaluate where the deformity is originating from. The physical examination will determine where the spasticity or contracture of the Achilles tendon is coming from. Your Podiatrist or Pediatrician should be able to determine spasticity of the hamstrings or hip flexors. This exam may also involve a gait analysis or observation of your child walking at a regular pace.

TREATMENT

Toe walking which is not neuromuscular in origin (called idiopathic toe walking), has several first line treatment measures which can be incorporated. Some of treatments for a short Achilles tendon include stretching exercises, casting and orthotics. Remember, a toddler, under the age of 3 should just be observed.

On modality that is non-surgical and has good results is the molded ankle-foot orthosis (MAFO). This device fits in a regular shoe or sneaker, and a calf sock will conceal the device effectively. The MAFO allows only specific motions while walking and prevents your child from toe walking, since it does not allow the heel to come off the ground. With every step your child takes, the Achilles tendon is stretched. Most children have to wear this device for 6 to 8 months.

Even while wearing this device, (the MAFO) in the shoes, regular stretching should be incorporated during the day. Your podiatrist or pediatrician can teach you these exercises to stretch the Achilles tendon regularly.

With more severe cases, serial casting may be necessary to stretch the Achilles tendon. These casts are changed weekly and the Achilles tendon is manipulated and stretched more with each cast.

Toe walking which is more severe or is due to an underlying neuromuscular disorder will not be corrected with the above modalities. Surgical intervention may be the next line of treatment.

The most common surgical correction of the short Achilles tendon is lengthening of the tendon.

Your podiatrist or pediatrician will determine whether the toe walking is isolated to the heel or if the knees and/or the hips are contributing to the toe walking. All this needs to be determined prior to performing any surgery.

It is important to see your Podiatrist or Pediatrician if your child is walking on their toes beyond the age of 3.

How often do you look at your child’s feet?

Now that the weather is starting to warm up, you will have your children in slippers and sandals more often. This may be the best time to notice the way your child walks, and to observe their feet.

Even before your child starts to walk, you should observe their feet. Do they look “normal” to you? If you notice your baby’s feet turning in more than usual, or turning out excessively, you should consult your pediatrician and podiatric physician immediately. Some severe foot deformities, if caught early can be treated, preventing further complications when the child’s foot matures.

From birth to age 1, the foot grows tremendously. During this time, any abnormal pressure placed on the foot can lead to a deformity. The bones of the foot are very soft and moldable.

While your child in still in the crib, make sure to allow them to move around freely, especially allow the feet to move freely. Try not to keep your child in one position for too long. In order to allow the foot to grow normally, you must try to limit your child’s shoe wear, unless you are going outside of home. At home, keep your child’s foot in socks, or even barefoot. Excessive shoe wear can restrict growth and can place abnormal pressures on the foot bones, preventing them from growing normally.

When your child begins to walk, watch for their feet turning in while they walk or turning out excessively. Your podiatrist will be able to tell you where the deformity may be coming from. If caught early enough, bracing, orthotics, and casting can be used to correct the deformity. More severe deformities need surgical intervention.

Some common foot problems that you can encounter and that you should look for are:
1. Ingrown toenails which need to be treated immediately, before they result in an infection.
2. Warts, which children pick up on the soles of their feet. Warts are caused by a virus. There are various treatment options which your podiatrist can go over with you.
3. Metatarsus adductus, which is when the foot bends abnormally from the arch of the foot towards to toes. This can normally be corrected with just casting or orthotics, depending on the age of the child and the severity of the deformity.
4. Toe walking can be caused by several conditions. A mild condition can be corrected with stretching, and physical therapy. If the toe walking is persistent and cannot be treated with therapy or exercises, other causes of the toe walking have to be evaluated. These include neuromuscular deformities, including Cerebral Palsy, Muscular Dystrophy, Limb length discrepancies, and a short Achilles tendon.
5. In-toeing is when the toes point inwards while your child walks instead of pointing straight ahead. In-toeing can cause the child to trip and fall excessively. If this lasts until the child is 1 ½ to 2 years old, you should seek medical attention. You podiatrist can evaluate the severity of the problem, and can suggest various treatment options, including orthotics or casting.
6. Out-toeing is not as common as in-toeing. Out-toeing is when the toes point outwards while your child walks. At about the age of 2 you may notice a sight out-toeing of your child as part of the normal development. If this out-toeing is excessive, it can also be treated if caught early.

There are many other deformities of the foot which can be found in children. These are less common and are more severe than the deformities listed above. These include deformities such as clubfoot and vertical talus.

If you notice any abnormality of the foot or ankle in your child, or if your child has pain, and trips and falls a great deal while walking, then it may be a good idea to see your pediatrician as well as your podiatrist for evaluation.

Early diagnosis and treatment of a foot deformity in children is essential for normal growth of a child foot.

By: Sharon Joag, DPM

GOUT: Foods You Can Eat

Guidelines by the American Medical Association

Foods should be:

- high in complex carbohydrates (fiber-rich whole grains, fruits, and vegetables)- low in protein (15% of calories and sources should be soy, lean meats, or poultry)- no more than 30% of calories in fat (with only 10% animal fats)

Foods that make up a low purine diet include:

-Fresh cherries, strawberries, blueberries, and other red-blue berriesBananas, pineapple (high in bromelain, a protease enzyme, said to be a tx for gout)Celery, tomatoes, Vegetables including kale, cabbage, parsley, green-leafy vegetables

-Foods high in vitamin C (red cabbage, red bell peppers, tangerines, mandarins, oranges, potatoes)Drink fruit juices and purified water (8 glasses of water per day)

-Low-fat dairy products (cheese, milk, butter, ice cream, and tapioca)
-Complex carbohydrates (breads, cereals, pasta, rice, as well as aforementioned vegetables and fruits)
-Chocolate, cocoa, coffee, tea, carbonated beverages, only diet sodasEssential fatty acids (tuna and salmon, flaxseed, nuts, seeds)
-Tofu, although a legume and made from soybeans, may be a better choice than meat

Foods considered moderately high in purines, but may not raise the risk of gout are:

-asparagus, cauliflower, mushrooms, peas, spinach, whole grain breads and cereals, chicken, duck, ham, turkey, kidney and lima beans.

***All foods containing protein have a purine component.

GOUT: Foods you should moderateGuidelines by the
American Medical Association
· Alcohol - especially beer and wine.
· Organ meats - this includes liver, kidney, heart and tongue, etc.
· Yeast.
· Certain fish and shell fish - herring, sardines, anchovies, mussels, shrimp and scallops are known foods that cause gout.
· Gravies, rich and creamy sauces, consommé (boullion)and meat extracts.
· Mushrooms, cauliflower, asparagus, spinach, peas, beans, and lentils.
· Sweetbreads.

Foods that are moderately high in purines and should be avoided on a gout diet include bacon, turkey, trout, goose, pheasant, veal, mutton, haddock (marine fish) and salmon.

GOUT: Foods to Avoid or to Moderate

1. Oranges/Apples

2. Foods high in fructose (which can increase uric acid levels):
a. Sweetened soft drinks
b. Corn Syrup

3. Foods that cause increased purine production or cause the system to produce uric acid should be avoided. Purine gets broken down into uric acid in the body
a. Red Meats/Eggs/Poultry/ Processed Meats (hot dogs, lunch meats)/
Fish: Sardines,Herring, Anchovies, Roe, Scallops/Meat Gravies/
Shellfish: Mussels & Oysters/Organ Meats (heart, liver, kidney, brain, tongue)
b. Broth/Boullion
c. Fried foods/ Foods cooked in Oil (heated oil destroys Vitamin E)
d. Roasted nuts/ dried fruits
e. Rich Foods (Cakes, Sugar Products, White Flour Products)
f. Caffeine
g. Beans, Lentils, Cauliflower,asparagus, mushrooms, peas, dark Green Veggies
h. Oatmeal
i. Yeast Products

4. Acid Forming Foods

a. Artificial Sweeteners/Sugar/Brown Sugar/Table Salt
b. Carbonated drinks/Beer/Coffee/Liquor/Black Tea/Alcohol
c. Cigarettes
d. Flour (white wheat)/Pastries/cakes (from white flour)/Breads/white rice
e. Goat/Lamb/Pork/Deer/Rabbit/Turkey
f. Chocolate
g. Custard with white sugar
h. Jams/Jellies
i. Pasta
j. Vinegar

“MY FOOT HURTS EVEN WHEN MY SHEETS TOUCH IT!!”

If this is a complaint that you have, you may have a condition called GOUT. Gout has various other names, such as metabolic arthritis or Podagra. Almost 1 million people in the United States have Gout.

Even Benjamin Franklin, who lived from 1706 to 1790, had Gout. Gout plagued Franklin so much, that he even wrote an essay titled, “Dialogue between Franklin and The Gout” on October 22, 1780. Other famous people afflicted with gout include President Thomas Jefferson, King Henry VIII of England, Charles Darwin, Alexander the Great, and Voltaire.

What is Gout?

Gout is a buildup of uric acid crystals in and around joints in the body. Gout only attacks one joint at a time. A gouty attack is when these uric acid crystals in the joint buildup, causing exquisite pain, redness and warmth. The joint can become so sensitive, that even the slightest touch can elicit an excruciating amount of pain. A common complaint is, “My foot hurts even when the sheets touch it.” These attacks can last from hours to days. An acute gouty attack is self-limiting, however medication is necessary in most cases to reduce the pain and the inflammation.

Gout can occur in any joint; however, there are joints that are more commonly affected. These include the big toe, ankles, knees, wrists, and elbows. Rarely, uric acid has also been found in the ears, vocal cords, and the spinal cord.

How does the uric acid build up in the joints? Gout essentially is a metabolic disorder. It happens when the body has a malfunction in processing and eliminating uric acid sufficiently; it can also happen when the body has a genetic tendency to generate more uric acid than the body needs. The uric acid that gets deposited in the joints turn into crystals called tophi. This tophi can become very painful, especially during an acute attack of Gout.

Risk Factors for GoutSome people are more at risk of getting gout than others. Some of the risk factors of gout include:

1. Obesity
2. Moderate to High Alcohol Consumption
3. Abnormal Kidney function
4. Hypertension
5. Some prescription drugs may also exacerbate gout.

DIAGNOSIS & TREATMENT:
Diagnosis of gout can be made by your podiatrist, by just inspection of your big toe or ankle joint. A more definitive diagnosis can be made by joint aspiration of the fluid in the joint. This fluid is taken from the joint and sent for pathology to identify the uric acid crystals. Blood Tests to check for the uric acid in the blood can also be done.

It is essential to go to your podiatrist or doctor if you have symptoms that are similar to gout. If left untreated, multiple acute gouty attacks can lead to a chronic condition of gout. This can further lead to decrease in kidney function, and the formation of kidney stones.

Your podiatrist may treat a gouty attack with pain relievers and Anti-inflammatory medication as a first line of treatment. Some medications can also lower the blood uric acid by preventing uric acid production in the body.

PREVENTION:
Once gout is diagnosed, there are many ways to prevent any further attacks of gout. These include weight loss, decrease in alcohol consumption, sufficient fluid intake, and a change in diet.
Foods rich in purine (the product which is converted to uric acid in the body) should be avoided. There are many foods rich in purine. These include, shellfish, meat, organ meat (liver, kidney, etc), fried foods, roasted nuts, etc… You can speak with your podiatrist regarding what foods to avoid, and what foods to moderate if you do have gout. Acid forming foods should also be avoided.

If you have any or all of the above symptoms of pain and tenderness, redness or inflammation, consult your Podiatrist immediately. Diagnosis, Treatment and more importantly Preventing future attacks of gout is essential in keeping your body healthy.

By: Sharon Joag, DPM

COMMON RUNNING INJURIES

Most running injuries are injuries of overuse. Running is unlike walking, in that it is a one-legged sport. During a run, only one foot is supporting the entire body weight at a time. Increased forces are generated on the foot. It is important to wear running shoes, which are designed for straight ahead motion.

Some of the running injuries are the result of wearing inappropriate shoe gear. Shoe gear that has become excessively worn or the wrong type of sneakers can contribute to running injuries. Also, too much training can cause injuries, called the “terrible two’s” according to Podiatrist, Dr. Pribut.

The “Terrible Too’s” are: “ Too much, Too soon, Too fast, Too often” all with “Too little rest”.
The 5 most common injuries encountered by runners are:

1. Knee and Hip pain: If you experience knee or hip pain, contact your doctor or orthopedist immediately. This maybe a sign of an injury to your knee or to the muscles in your leg or hip.

2. Shin splints: This is pain and inflammation of the muscle, the bone, or the area where the muscle attaches to the bone. Sometimes, the muscle compartment in your leg can get inflamed after exercise. This is called “Exercise- Induced Compartment Syndrome”, and can mimic shin splints. Compartment syndrome is an extremely serious condition that may require emergency surgery. Stress Fractures of the lower leg can also mimic shin splints.
If you ever experience pain in your leg after running, contact your podiatrist immediately. This could be a potentially serious condition.

3. Ankle Sprains: Sprains are very common to runners. Most sprains are minor and will resolve quickly with ice and compression. However, if your ankle sprain does not resolve in a few days, it is best to see your Podiatrist. You may have injured or torn the ligaments that support your ankle.

4. Achilles Tendinitis: This is a painful condition involving the tendon in the back of the ankle, called the Achilles Tendon. The Achilles Tendon can get injured at any point along the back of the ankle. If left untreated, there may be a risk of rupturing the tendon completely.

5. Plantar Fasciitis: This condition is a result of overuse of the Plantar Fascia on the bottom of the heel. The plantar fascia is a band of fibers that supports your arch. When these fibers are stretched out too much or have been overused, inflammation will cause pain at the bottom of the heel. This inflammation and pain will limit motion, and can result in a heel spur.

PREVENTING INJURIES:

If you are new at running or even if you are a seasoned runner, you may still encounter these injuries. The key is prevention. In order to prevent these injuries, you must take care of your body before you go on your run.

STRETCHING:

Proper stretching and Supportive Shoe gear are the keys to a successful runner. You must adequately stretch all of your muscles prior to engaging in any physical or sports-related activity, including running.
Some tips to keep in mind:

1. Don’t over stretch your muscles. If you feel a pull when you are stretching, don’t bounce; hold the stretch for 10 seconds and relax. Start again and push a little more each time. Make sure to stretch both sides.

2. Never rush through stretching. Stretching is the key to a successful workout. You have to warm up your muscles prior to any exercise. Muscle pulls and sprains are often the result of inadequate or minimal to no stretching prior to exercise.

3. If you are going on a long run, stretch your muscles, then continue your warm up with a fast paced walk or a jog. This will enable your muscles to warm up prior to the run.

4. Once you have completed your workout, stretch again. This will help you to cool down, and will increase your flexibility.

BUYING THE RIGHT SHOES:
The right shoes are also very important. Some tips to buying good, comfortable shoes. 1. Make sure that you measure your feet each time to purchase a new pair of shoes. Always stand up while measuring your feet. Over time, or shoe size may change. Feet often become wider over time.
2. Make sure that you try on your shoes in the store and walk around the store. Your heels should not slip out of the shoe while you are walking. Your toes should have enough wiggle room in the front of the shoe. Your toes should never be touching the top of the shoe.
3. Always measure both feet and find a shoe that fits the larger foot. Believe it or not, but most people have one foot slightly larger than the other.

Whether you are a walker or a new runner; or even if you have been running for years, a good site to visit is http://www.chirunning.com This is a new way of running which teaches you to engage your mind while you run or walk, in order to prevent injuries and optimize your running or walking experience.
Keep Exercising!

By: Sharon Joag, DPM

FOOT PAIN: “I THINK I MAY HAVE A WART”

Warts, also known as Verrucae are rough non-cancerous skin growths on the bottom of your feet. Warts are caused by the HPV (Human Papillomavirus), and cannot be seen by the naked eye. They maybe found as a single lesion or can be in a multiple clustered lesions. You may see small black dots at the center of the warty tissue. These black dots are not the wart, but the ends of tiny blood vessels.
There are many types of HPV viruses that can grow on many parts of your body. Plantar warts are one type, and most commonly grow at the pressure points on the bottom of your feet. Plantar warts can be very painful.
Some people are naturally resistant to the HPV virus; Others are more susceptible to the virus. Warts are contagious and can be transferred from person to person through any direct skin contact. Sometimes warts can disappear on their own, however most warts are present for months or even years without treatment, and can spread if not treated. When warts spread, they will grow in clusters called mosaic warts.

WHEN SHOULD YOU SEEK TREATMENT FOR WARTS?
Warts are self-limiting. Since they are caused by a virus, they may disappear on their own. However, most warts will remain for months or even years and can spread.

You should seek medical advice if your warts become painful, or if they are persistent and they multiply. If you have Diabetes or Circulatory Problems, consult a physician immediately.

Sometimes, you may not be sure that you have a wart. If this is the case, call your doctor to make the correct diagnosis. Sometimes, what may appear to be a wart may really be something more serious like a carcinoma (cancerous tumor) or a melanoma.
Most podiatrists are able to diagnose a wart just from the appearance of the lesion. However, a wart may appear as callus or a corn and may need to be pared down. A wart will show pinpoint bleeding (tiny blood vessels) at the center, but a callus will not. If identification still cannot be made, your podiatrist may send a sample of the tissue to the lab.
There are a variety of treatment options for eliminating a wart. Your Podiatrist will best be able to advise you on which treatment is best for you. If you are on steroids, have diabetes or are immunocompromised the treatment may be prolonged, and the wart may recur.

WHAT ARE THE TREATMENTS FOR A WART?
The first line of treatment usually includes applying various medications to try and either chemically burn the wart or to dry out the wart, using either salicylic acid or formalin solution. Another topical medication is Aladara Cream, used only to stimulate the skin’s immune response to the wart. If the topical medications do not help to eliminate the wart, a second line of treatment would be either lazer surgery or electrodessication to try and burn the wart.
Other treatments include duct tape, cryotherapy, cantharidin (a chemical found naturally in the Meloidae beetle) which causes the skin to blister and aids in elimination of the wart; Some less frequently used treatments include Interferon or Bleomycin injections, which helps the body to fight off the warts.

WHAT CAN YOU DO TO AVOID GETTING A WART?
Preventative measures can be taken to avoid getting a wart. Eliminate any direct contact with the wart, including your own if you already have one. You should change your shoes and socks daily and keep your feet clean and dry at all times. Warts form best in a wet environment. Excessive sweating can help the wart to thrive. Avoid going barefoot at public pools or at gym locker rooms.
There are many treatment options for eliminating a wart. Consult your podiatrist if you have any lesions that may appear to be a wart. The quicker a wart is diagnosed, the faster it can be eliminated before it starts to spread.

1. Cryotherapy (liquid nitrogen)
2. Sharp Excision of the wart
3. Lazer Surgery (CO2 or Pulse Dye)
4. Electrodessication of the wart (burning)
5. Cimetadine (tagamet)
6. Vitamin A
7. Salicylic Acid (compound W)
8. Lazerformaldehyde 10%
9. Duct tape
10. Cantharidin (chemical used to remove the wart): A chemical found naturally in many members of the beetle family, Meloidae which causes dermal blistering.
11. Interferon injections (interferon is a chemical that the body makes, and an injection of interferon helps the body to fight infection. Interferon is injected into warts for twice a week for 8 weeks, or until the warts are gone.
12. Bleomycin (Blenoxane): injection used infrequently to cure warts; at higher doses is a treatment for cancer.
13. Imiquimod (Aldara cream): Increases skin’s immune response to the wart by stimulating interferon production. Used most often for genital warts.
14. Candida injection at the site of the wart can stimulate the body’s immune system.

FOOT PAIN: DO YOU HAVE A NEUROMA?

Have you ever felt that burning, tingling, or maybe even a shooting pain under the ball of your foot, that you just can’t put your finger on? Sometimes it may feel as if you have something in your shoe, but there isn’t anything there when you go to look. Does the pain get worse at the end of the day, or when you get on a nice pair of dress shoes? Or maybe you have swelling between your toes…

If you do have some or all of these symptoms, you may have a neuroma.

A neuroma is really an inflammation and a thickening of the nerves between your toes. The most common place for a neuroma in the foot is between the 3rd and 4th toes, because the nerve here is the thickest of all the other intermetatarsal nerves. The inflammation of this nerve is called Morton’s Neuroma.

A number of factors may contribute to the formation of a neuroma. The underlying factor is either trauma or pressure on the nerve involved. Tight shoes, and high heels which squeeze the toes together and cause increased pressure on the nerve between the toes, could lead to the development of a neuroma. Biomechanical factors, such as having flat feet or high arched feet can also create increased pressure between the toes and can cause a neuroma.

Things that you could do at home to alleviate the discomfort and pain:
1. Wear wider shoes which have a wide toe box, so that your toes and your feet have room to move around.
2. Wear low heels or sneakers. Do not wear high heels.
3. Rest, ice and massage the area of pain. This may temporarily relieve your symptoms.
If the pain still persists for longer than 2 weeks and you have tried these home remedies, then you may have to contact your podiatrist for medical treatment of the neuroma.

A Podiatrist may recommend various treatment options, depending on how severe your neuroma is. The first thing a Podiatrist may do is to take an Xray. This will not show a neuroma, but it will help to rule out other causes of the pain in the ball of your foot, such as a stress fracture. A stress fracture can often be mistaken for a neuroma.

Treatment for a neurma includes:
1. Rx Medication (Anti-inflammatories, such as Motrin/Naprosyn) that will help to decrease the inflammation of the neuroma, and thereby decrease the pain.
2. Neuroma pads which will help to disperse the pressure from the affected area.
3. Custom Molded orthotics which will aid in the proper functioning of your foot, especially if the neuroma is caused by a biomechanical factor, such as a high arch or flat feet.
4. Steroid injections maybe an option. The steroid is mixed with an anesthetic and injected into the nerve.

This amount of steroid will not affect your body, but it will act as an anti-inflammatory to decrease the inflammation and the pain. 5. The last option to consider is a surgical option.

There are various surgical methods to remove a neuroma. One of the most conservative approaches is cryosurgery whereby an instrument is used to freeze the offending nerve. After the nerve is frozen, it will no longer cause any pain. Another common approach is to surgically remove the inflamed nerve which is causing the irritation and discomfort.

Contact your podiatrist if you notice that the pain and discomfort does not resolve with the home treatments mentioned above for the neuroma. Do not wait longer than 2 weeks if the symptoms are persistent. Diagnosis and treatment of a neuroma is essential in its early stages, and will help to avoid the need for surgery.

PSORIASIS

THINGS TO AVOID:
1. EtOH
2. Nuts (except Almonds)
3. Aromatic Spices (Mustard, Pepper, Curry)

THINGS TO EAT:
1. Fish
2. Beef
3. Venison
4. Poultry
5. Fruits
6. Vegetables
7. Pasta
8. Olives
9. Olive Oil
10. Saffron
11. Garlic
12. Onion
13. Herbs
14. Parsley
15. Eat fresh hand-pressed fruit juices, beet juice, carrot juice
16. yogurt, curd
17. Sauerkraut, pickles
18. Pepper
19. Citrus (may aggravate psoriasis)

NUTRITIONAL SUPPLEMENTS:
1. Unsaturated Fatty Acids: Evening Primrose Oil (6 capsules BID)
2. Fish Oil; Omega-3 Fatty Acids (can heal psoriatic lesions)
3. Vitamin A (75,000 IU/day for first 2 weeks à 50,000 IU/day for 2-3 months à 25,000 IU daily
4. Folic Acid 100-500 mcg/day
5. Vitamin B Complex
6. Vitamin B6
7. B12 Injections
8. Vitamin C with Bioflavonoids
9. Zinc
10. Lecithin (1 Tablespoon with 2 meals/day for the first month)
11. Multi-mineral supplement
12. Fumaric acid supplements: Used now in Europe.
Fumaric acid tablets, ointment, lotion, and scalp lotions are used in treatment.In healthy patients, fumaric acid is formed in the skin when it's exposed to sunlight. People with psoriasis appear to have a biochemical defect that requires prolonged exposure to the sun to produce it. ‘Fumaric acid ester capsules have been used in clinical trials in Switzerland and the Netherlands with excellent results. In a recent study, 8O percent of the 285 patients involved reported marked improvement, and 52 percent of those patients were completely cleared of psoriatic lesions.’

Fumaric Acid can take up to 3 months to work. One common side effect of the treatment is that in 14 days, you may feel that your symptoms are getting worse. However, this only lasts for a few days. The capsules are taken before meals with plenty of fluids.

SELF-CARE
Aromatherapy1
. Bergamot: To heal skin plaques
2. Lavender: To decrease itching
3. Melissa: for Irritated skin
4. Jasmine: for dry, sensitive skin
5. Geranium: for dry, irritating skin
6. Sandalwood-Mysore for dehydrated, inflamed, sensitive skin

Massage OilUse 2 drops of Calendula oil & one Drop Lavender Oil in 2 tablespoons of Almond Oil to massage into the affected area.

ExerciseTension may aggravate psoriasis therefore, frequent exercise, such as jogging to build up a sweat is recommended.

Topical Treatment
1. Apply seawater to skin with cotton several times a day.
2. Use Linseed or Avocado Oil
3. Topical Capsaicin cream can reduce scaling, thickness, redness and itching.
4. Aloe Vera gel

DIABETES & CHARCOT: WHAT IS CHARCOT?

If you have Diabetes or know someone who has Diabetes, this will be an important article for you to read. Charcot Deformity pronounced “Sharko” is condition that today is most prevalent in people who have Diabetes Mellitus as well as people with Neuropathy; Diabetes and Neuropathy are commonly related.

Typically, a Charcot foot appears to be red, hot and swollen. Charcot is a condition that causes softening and subsequent fractures of the bones in the foot due to a sudden trauma or constant repetitive micro trauma.

Usually a person with Diabetes who also has Neuropathy, or a loss of sensation in the foot, will not notice the Charcot until it starts affecting their daily routine. The Diabetic patient will start to notice that they are not able to fit into their shoes any longer, or they may notice an ulcer that has developed on the bottom of their foot for no apparent reason. By this time however, the

Charcot has already progressed significantly.
The best treatment for Charcot is prevention and early diagnosis and treatment.
Once the neuropathic patient gets a fracture, the body’s normal response is to increase the blood flow to the area to help to heal the affected bone. This increase in blood flow tends to wash out the calcium from the bone at the fracture point. This weakens the bone and the bone fractures even further and collapses. Due to the neuropathy or lack of sensation, the patient is unable to sense the fractures and the bone continues to go through the cycle of fracture and collapse.
The most common areas to be affected are the midfoot as well as the ankle.

PREVENTION: WHAT YOU SHOULD LOOK FOR
As I said earlier, the best treatment for Charcot is prevention and early diagnosis. In order to prevent Charcot Foot/Ankle, the Neuropathic patient, typically with Diabetes should adhere to strict guidelines, including:

1. Blood Sugar: Blood sugar should be monitored daily and kept under control.
2. You should have regular checkups with your Podiatrist. X-rays taken periodically is helpful in diagnosing Charcot early.
3. Make sure you check your feet daily, and if you notice signs, such as redness, swelling, and increase in temperature of the foot (a foot that feels warm or hot to the touch) contact your Podiatrist immediately.

Charcot deformity goes through several stages: Stage 0: This is when there are no signs of Charcot on X-ray, but there are some clinical signs such as redness and swelling.

Stage 1: This stage is due to trauma (sudden or micro trauma) to the foot and the bone starts to breakdown.
Stage 2: The bone begins to heal and there is increased blood flow to the area.Stage 3: The final stage is when the stable bone starts to form again.

Once Diagnosed, the Treatment includes:
1. Immobilization: complete non-weight bearing of the foot afflicted with Charcot is necessary. The patient must use crutches or a wheelchair. This may take months or even longer until the Charcot can heal.
2. Custom made shoes and Reduction in activity may be necessary after the deformity and the bone have healed. The custom shoes may aid in a more normal return to walking. The chances of a person developing Charcot on the opposite foot increases if they have had Charcot in one of the feet.
3. Finally, depending on the severity of the deformity, surgery may be required in some cases.
If you do notice any of these signs and symptoms of Charcot, as mentioned above; redness, swelling and an increase in temperature of the foot, Contact your Podiatrist Immediately.

This could indicate a very serious condition. If Charcot is not diagnosed and treated early, it could lead to a very serious deformity of the foot. In some cases surgery or even amputation may be necessary. Prevention and Early diagnosis of Charcot is Key.