Podiatrists Save Diabetic Feet!

25.8 million, or 8.3% of the American population (Children & Adults) are currently suffering from Diabetes Mellitus. Awareness and prevention of diabetes mellitus is finally starting to rise in America, however, the incidence of the disease is still increasing. With that said, the role of a podiatrist in a diabetic’s overall health care cannot be understated. To quantify that; more diabetics die every year due to complications that arise from diabetically induced ulcers than prostate and breast cancer each. 


In 2010, at the American Podiatric Medical Association (APMA) annual scientific meeting Vicky Driver, MS, DPM introduced a study conducted by Thomson Reuters, showing that care by a podiatric physician (defined as at least one preventative, pre-ulcer visit) was associated with a nearly 29 percent lower risk of amputation and 24 percent lower risk of hospitalization.


If you’re a diabetic, and annually visiting a podiatric physician isn't part of your overall health care plan please reconsider this practice. Dr. Michael Garvin of Port Saint Lucie, Florida has been treating diabetic patients for over 20 years. He is a board certified podiatric physician and is accepting new patients. His goal is always to provide the most comprehensive care possible for diabetic patients as he understands the pitfalls of miscare for these patients. For information and directions to his office please click here.





Sources cited:
1.http://www.apma.org/MainMenu/News/New-Study-Proves-Care-by-Podiatrists-Dramatically-Decreases-Lower-Limb-Amputation.aspx

2. http://www.diabetes.org/diabetes-basics/diabetes-statistics/

The Importance of Physical Therapy

Physical Therapy (PT) may be one of the most underrated modalities in all of medicine depending on the perspective taken. It focuses primarily on quality of life and movement. This is an aspect of medicine that has been addressed by many different professions, but never been made the mainstay of their practice like it is for a physical therapist (PT). Patients suffering from almost every disease can greatly benefit from the treatment of a PT. Unlike doctors of other sorts (Physical therapists now receive a doctoral degree), a physical therapist’s goal is more than treating a disease when it manifests. Their goal is to restore a patient's quality of life after and during their sickness. They work with their patients on a daily basis to restore function and life back to the areas that have been damaged or compromised due to disease and injury. There is a role for a PT in almost every disease prevention and management case that exists.  Dr. Michael Garvin understands and utilizes this ideal in his daily practice. Dr. Garvin as a practitioner not only wants to treat patients suffering from foot and ankle conditions, but he wants to restore quality of life and prevent further complications.

Peripheral Neuropathy

Peripheral Neuropathy is a diseased state of the nerves in the peripheral nervous system; as commonly seen in the extremities of patients suffering from Diabetes Mellitus types 1 and 2. Peripheral neuropathy is not always caused by diabetes, and in fact can be caused by a variety of other factors such as autoimmune disorders (Rheumatoid Arthritis and Lupus), chronic kidney disease, HIV infections, low levels of vitamin B12, an underactive thyroid gland, and many different pharmaceutical drug classes. Peripheral neuropathy is often associated with diabetics though due to the rapidly increasing prevalence of type 2 diabetes in the United States. Diabetes is a blood sugar disorder that can compromise the vascular health of the body, and predominantly in the feet, eyes and kidneys. Over time if the disease is not properly treated and monitored, one of the ways it manifests is through peripheral neuropathy. Just like all tissues of the body, the nerves also need adequate blood supply. When the peripheral nerves blood supply becomes poor due to diabetes, the nerves become damage and diseased.

The signs and symptoms of peripheral neuropathy often start with a tingling, itching and burning sensation in the feet and legs. If left untreated peripheral neuropathy progresses and eventually will result in total loss of feeling in the areas affected. This loss of sensation in the feet and legs can cause abnormalities in an individuals gait, muscle weakness, dermatological issues, and a whole host of other serious issues. If any of these symptoms describe something you’re currently experiencing, or would like to know more about please visit Dr. Michael Garvin’s website for more information. He is a practicing Podiatrist in the Port Saint Lucie, Florida area.

 
 **This graphic illustrates the differences in vascularity of a treated diabetic foot, and a non-treated diabetic foot

Plantar Fasciitis (Heel Spurs)

Plantar fasciitis is inflammation of soft, connective tissue that spans from the calcaneus or heel of the foot, to the ball of the foot (metatarsal heads). Plantar fasciitis is the most common cause of heel pain. It is sometimes also referred to as Heel Spur Syndrome (HSS). There are 3 bands to the plantar fascia, or plantar aponeurosis. Most commonly the central band of the plantar aponeurosis is the culprit of pain due to it becoming inflammed. The causes of inflammation are diverse and can be due to a variety of abnormalities in gait and behavior. The most common cause in the average population is excessive pronation of the foot during walking and/or running. The plantar fascia acts to passively stabilize the arch of the foot, and also assists in propulsion during walking and running. Due to its frequency of use during daily activities (climbing stairs, walking, squatting down on the balls of your feet, etc) it is prone to becoming inflammed in some individuals. A very common complaint seen with plantar fasciitis is pain experienced after periods of inactivity, or rest (Post-static dyskinesia). It also generally continues to worsen throughout the day. 

Plantar fasciitis is a condition that can make daily life difficult and painful. If this sounds like a current or past issue please visit Dr. Michael Garvin’s website for additional information.

Dr. Michael Garvin has been practicing in the Port St. Lucie Florida area for years and utilizes minimally invasive methods to treat and alleviate plantar fasciitis. Call his East or West offices in Port St. Lucie at 772-335-7171, or 772-871-6020, respectively.

 

*The image above illustrates the plantar fascia being strained during propulsion

Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome is a condition that arises due to compression of the tibial nerve. This nerve runs under the medial malleolus. The compression is due to swelling of soft tissue structures that impede upon the nerve, and crowd it. This causes the nerve to become irritated and can cause shooting pain, tingling, numbness and other symptoms anywhere from the inside of the ankle to the bottom (plantar surface) of the foot. The onset of tarsal tunnel syndrome is often insidious, but occasionally can be sudden as well. Tarsal tunnel syndrome is very fundamentally similar to carpal tunnel syndrome (occurs in the forearm/wrist) and can be caused by a variety of foot and biomechanical issues such as flat feet, ankle sprains, systemic diseases and more.

Tarsal tunnel syndrome is a serious condition and should not be neglected. Permanent nerve damage can take place if not properly treated in a timely manner.

If you live on or near the Treasure Coast area and are experiencing symptoms such as these, consider scheduling an appointment with Dr. Michael Garvin. He has treated tarsal tunnel syndrome and other podiatric conditions for years in Port Saint Lucie, Florida.

*The picture above depicts the structures involved in Tarsal Tunnel Syndrome

Onychomycosis (fungal infection of the toenails)

Onychomycosis is a very commonly encountered fungal infection of the nails seen in Podiatric practices. 

 

Generally, the first sign of a fungal nail is a yellow discoloration of the nail. Depending on the severity of the infection, nails can also become thickened or brittle, loose, and present with a generally rough texture. A distal subungual infection is the most common type. This simply means the infection often takes place at the end of the nail, and under it. The causative agents of onychomycosis are usually Dermatophytes (most often Trichophyton Rubrum). Yeast infections may also present in about 5% of patients due to a Candida Albicans infection.
Onychomycosis is generally a very straight forward and simple nail condition to treat. Podiatric physicians have found that oral and topical anti-fungals are often very effective in treating fungal infections. 

 

Dr. Michael Garvin of Port St. Lucie Florida is a board certified Podiatrist with a great deal of experience in treating fungal infections of all types. If you are looking for more information regarding fungal nails visit Dr. Garvin’s website here. You may also find information to schedule an appointment with Dr. Garvin here.

 

Haglund’s Deformity

Haglund’s deformity is characterized by pain on the back of the lateral heel. This is due to bony enlargement of the calcaneus, which in turn causes soft tissue swelling when rubbed against shoe gear. Often times in a Haglund’s deformity retrocalcaneal bursitis is present. This is simply irritation of a small fluid filled sac that lies between the Achilles tendon and the calcaneus. As previously stated, patients suffering from Haglund’s deformity generally present with symptoms of pain, redness and swelling on the back of the outside heel. 

Haglund’s deformity is sometimes referred to as a “pump bump” due to its presence being accredited to the “pump” style shoe that often cause it. However, Haglund’s deformity doesn’t only manifest due to calcaneal irritation from pump shoes. Mens dress shoes, ice skates, and any shoes with a rigid back can also cause this soft tissue swelling.
 
If Haglund’s deformity is a condition that parallels something you’re currently experiencing please visit Dr. Michael Garvin’s website for more information, or if you’re in the Port Saint Lucie, Florida area, schedule an appointment at one of his offices.

The Significance of Biomechanics

Biomechanics and a patient's foot health have a strong correlation. Biomechanics can be defined as the science of internal and external forces and their affect on the human body. An example of an internal force would be an individual's body weight. An example of an external force would be the ground's forces upwards on the foot during an individual's gait. 

 

Biomechanics have a strong correlation with an individual’s foot health because these aforementioned forces must be compensated for, so that the human foot properly adapts to this energy. If the foot is not able to adapt to these forces and improperly absorbs the energy created from gait, many pathological manifestations can occur. To name a few of the possible conditions derived from improper biomechanics: plantar fasciitis, shin splints, bunions, hammer toes, stress fractures, claw toes, and the list goes on. 

 

If you are experiencing pain during walking, running, jumping etc.. and think you may have any irregularities in your biomechanical processes, please contact one of Dr. Michael Garvin’s offices in Port Saint Lucie, Florida. Dr. Garvin has been analyzing patients biomechanics for many years and always seeks to treat and correct the underlying causes of pain. To obtain further information regarding your biomechanics and foot health please visit his website!


*This schematic depicts forces applied to the human skeleton that are experienced during normal walking.

Orthotics 101

An orthosis is a device used by podiatrists to correct an abnormality in a patient's gait, or provide additional cushion and control for a surgically corrected condition. Orthotics can be made out of a variety of different materials, and many times are made by a podiatrist in office. The materials chosen for fabrication of the device are generally contingent upon the condition being treated and cost effectiveness. Orthotics are often times one of a podiatrists favorite tools as it allows them to treat an extremely broad variety of foot-related ailments with a minimally invasive technique. Once the orthosis is made it can simply be placed into the patients shoe similarly as an insole would be.     

Most insurance companies will cover the cost of an orthotic and they’re often times the best treatment for patients. Especially patients who can’t afford to spend time off their feet with any kind of surgical recovery. Some conditions that are commonly treated with an orthotic, but certainly not limited to are bunions, tailors bunions, hallux limitus and rigidus, ankle equinus, plantar fasciitis, digital subluxations, Morton’s Neuroma, high arched feet/Pes Cavus, Diabetes related conditions, and many more. 

If you have any kind of foot related pain, or think you might be a candidate for an orthotic, don’t hesitate to call one of Dr. Michael Garvin’s offices in the Port Saint Lucie area in southeast Florida. 772-335-7171  Dr. Garvin has been practicing for years and has spent this time perfecting the art of healing and controlling patients foot problems with orthoses. 

Morton’s Neuroma

Morton’s Neuroma is classified as a nerve compression syndrome involving the common digital nerves found alongside the toes.  A neuroma is a growth or tumor of nerve tissue that can develop due to habitual pressure and irritation. This tumor that develops at the affected nerve is known as perineural fibrosis. Morton’s neuroma is most commonly seen at the 3rd common digital nerve, in the 3rd interspace of the forefoot near the toes. This condition is most common in women, and during middle age. The etiology of Morton’s neuroma surrounds nerve compression due to impingement of the nerve by a deep ligament, or the adjacent metatarsal heads. The compression that is the primary cause of this nerve irritation is generally caused by, but not limited to; shoes that have a narrow toe box, high heeled shoes, or pathologies that stem from irregularities in the gait cycle. 

The symptoms that generally present with a Morton’s neuroma are pain that radiates to the toes, or more proximally into the foot, burning, numbness and tingling. Additionally, the pain is often times described as sharp. Many patients will describe the feeling or sensation of having a pebble or sock bunched up under the ball of their foot. Pain usually worsens with walking, and is almost always further exacerbated by wearing shoes that cause compression at the metatarsal heads.

The diagnosis of a Morton’s neuroma is based upon clinical presentation. A podiatrist like Dr. Michael Garvin will use a variety of minimally invasive techniques to accurately diagnose this nerve condition, so patients can get back to being pain free as soon as possible. If any of these aforementioned symptoms sound similar to pain you’re currently experiencing do not hesitate to contact one of Dr. Garvin’s offices in Port Saint Lucie, Florida, or browse through his website for additional information.

A Look at The Gait Cycle & its Importance

The gait cycle can be defined as the interval of time from heel strike of a foot, to heel strike of that same foot, on the next step. In example, the gait cycle consists of a single footstep of say, the left foot that would take place during normal walking. To accomplish that single footstep made by the left lower extremity, the entire gait cycle must be executed. This is in addition to a great deal of other things that must take place for an individual to walk, but for simplification purposes we will only focus on the pedal aspects of the gait cycle. In essence, anytime an individual is walking they are repetitively carrying out the full gait cycle with each step that the individual takes.

The gait cycle is comprised of two major components; stance phase which is also known properly as closed kinetic chain, and the swing phase which is also known as open kinetic chain motion. To be precise, 62% of the gait cycle is occupied by the stance phase, or when the foot is in contact with the ground (weight bearing portion). The other 38% of the gait cycle is naturally comprised of swing phase, or when the foot is not in contact with the ground.

In podiatry it is imperative to dissect, and analyze these two major components of the gait cycle, and the gait cycle in whole. This allows a doctor to understand, diagnose, and treat all of the lower extremity pathologies that exist due to irregularities in an individual’s gait cycle.

To further review these components of the gait cycle, stance phase, or the weight bearing portion of the gait cycle can be sub-divided into three phases. Those are the contact period (when the foot initially strikes the ground), mid-stance, and toe-off (also known as propulsion). During contact period, the heel of the foot being observed is striking the ground, and almost simultaneously the forefoot of the same foot, is loaded with the force that is being transferred from the hind-foot to forefoot (this is when the majority of pronation* occurs). Next, mid-stance is immediately taking place. This is a transitional period that takes place after the contact period, but before the same heel lifts off the ground, and toe-off (propulsion) occurs. Supination** of the foot starts during mid-stance period, and does not end until immediately after toe-off. Lastly, propulsion or toe-off occurs. This is the third portion of the stance, or weight bearing phase of the gait cycle. Throughout toe-off the foot is being supinated, and the momentum of the lower extremity and the upper body is being directed forward to make forward progress (walking or running).

After these three sub-phases of the stance phase have occurred, the foot is immediately carried into swing phase. During swing phase the foot is elevated from the ground, and is being carried forward by a variety of the lower extremity musculature. This non-weight bearing portion of the gait cycle is where the most visually evident portion of forward progress is made.

To summarize, the complete gait cycle consists of stance phase and swing phase. Stance phase is further divided into contact, mid-stance and toe-off periods. Again, immediately after toe-off, swing phase takes place, and ends once the heel of this same foot strikes the ground again, to start the whole process over, hence the term gait cycle. Walking or running simply consists of the complete gait cycle alternating between the two limbs of an individual. In essence, the gait cycle of each foot has a converse relationship. For example, while the left foot is in stance phase, the right foot is in swing phase. This succinct process occurs throughout every step that is taken and most people have no idea it even exists. To clarify any potential confusion, there are certainly short periods in most gait cycles where both feet may be contacting the ground, or especially in running, both feet are not in contact with the ground. Yet, in general, the cycle occurring at each foot is alternating in a conducive manner for walking or running.

With a vast majority of the pathologies that podiatrists like Dr. Michael Garvin see, certain portions of a patients gait cycle have abnormalities that cause improper force transfer, and eventually translate to some type of disease manifestation-“something has to give”. These abnormalities of the gait cycle can occur for a great variety of reasons. These causes are all hugely important in the overall treatment, and prevention of further injuries to the patient’s foot, and their overall health. Dr. Garvin recognizes this, and does his best as a Podiatric physician to observe, listen, address, and heal his patients. 

If you feel you have an abnormal gait, or you have any kind of pain while walking, do not wait until you injure yourself to see a doctor. Call Dr. Garvin’s office and make an appointment at the East office- 772-335-7171, or the West office-772-871-6020, in Port St. Lucie Florida. Or e-mail him at info@doctorgarvin.com .

Below is a schematic of the gait cycle.

 
Below is a list of pathologies commonly seen in the lower extremity that often times manifest due to poor biomechanics (abnormalities in the gait cycle):

• Hallux Valgus (Bunion)
• Tailor’s Bunion
• Plantar Fasciitis
• Hammer Toe(s)
• Claw Toe(s)
• Generalized Heel pain
• Morton’s Neuroma
• Hallux Rigidus (“Pump Bump”)
• Shin Splints
• Tarsal Tunnel Syndrome

*pronation consists of tri-plane motion of the foot; dorsiflexion, eversion & abduction of the foot.
**Supination consists of tri-plane motion of the foot; plantarflexion, inversion & adduction of the foot.

Aging Feet: Can You Turn Back the Clock?

Let’s face it, we are all getting older.  Imagine the wear and tear on your feet from years of use and as our population ages, people are living longer and continue to be active.  Mobility is an area in life that is important to every age, but especially important to our aging population.  However, if foot problems make it difficult or impossible for our aging population to continue an independent lifestyle then it becomes a problem. And so far no one has found the ability to turn back the clock and restore our youthful years. 

Your feet can be the window to a podiatrist seeing symptoms of other conditions such as diabetes, arthritis, and circulatory disorder of the foot.  Crazy that our feet and their health can help prevent and warn us about other ailments in our body.  Foot problems can also lead to knee, hip, and lower back pain, which ultimately affect mobility.  

“Studies show that most Americans experience foot problems of a greater or lesser degree of seriousness at some time in their lives; nowhere near that many seek medical treatment, apparently because they mistakenly believe that discomfort and pain are normal and expectable.” 

It is not too late to take care of your aging feet.  Below are some tips to help you keep your feet healthy.

• Look at your feet often.  Make sure there are no cuts, blisters, or ingrown toenails.    
• If you are diabetic it’s important that you look at your feet every day.
• Dry feet thoroughly before you put socks or shoes on.
• Wear shoes that fit.  As you age your shoe size may change so it’s important to measure your feet before buying new shoes.  
• Take walks.  Walking is the best exercise for your feet.
• Trim or file your toenails straight across.
• Have your feet examined by a podiatrist twice a year.

If you would like to schedule an appointment to discuss how to keep your feet healthy and mobile please call our office. www.doctorgarvin.com

Ingrown Toenails

Onychocryptosis

An ingrown toenail, medically deemed onychocryptosis, is a very common complaint among patients in a podiatry office.  This condition usually begins with mild tenderness along the edge of a toenail where a portion of the nail border has penetrated the skin.  Over time, the toe may become increasingly painful to touch with localized redness and inflammation.  An infection may develop where the toe exhibits warmth, and pus begins to drain from the site where the nail has pierced the skin.

The severity of the nail’s appearance will vary.  Some will have a nail that appears incurvated and deeply embedded into the skin; others may have a small spike in a corner that penetrates down into the nail bed. Aside from penetrating the skin, a nail can apply pressure in the nail fold area without breaking the skin causing discomfort and mild pain.  This is not technically an “ingrown nail.”

Causes of ingrown nails range can from genetics to an improper shoe size wherein a shoe’s toebox can place pressure on the nail.  Direct trauma to the nail such as stubbing a toe, can alter the way in which the nail grows.  Nail fungus can alter the nails growth pattern as well. Preventative measures include proper nail trimming wherein the nail should be cut straight across without tapering the corners.  Proper fitting shoes can also help prevent ingrown nails.  It is best to seek advice from your podiatrist, and avoid “bathroom surgery.” 

Podiatric treatment for an ingrown nail that’s infected involves antibiotics in addition to soaking the foot in Epsom Salt.  It is important to keep an infection clean and monitor it daily for signs of worsening inflammation.  If a nail is simply ingrown but not infected, Dr. Garvin may trim the nail border to see if the nail will grow back properly.  In the case of reoccurring ingrown nails, Dr. Garvin will perform a simple surgical procedure that will remove the entire nail border permanently.

Our goal here at Foot and Ankle Specialist of the Treasure Coast is to keep you healthy and walking comfortably. There are often many conservative options for treatment with surgery typically the last one implemented. So stay healthy and keep your feet pain free!

Bunions

A bunion is an enlargement of bone or tissue around the joint at the base of the big toe. The big toe generally turns in toward the second toe and the tissues surrounding the joint becomes swollen, tender and often painful. Bunions occur more commonly in women and can sometimes run in families, making some individuals genetically pre-disposed to this condition. People born with abnormal bones in their feet are more likely to form a bunion. Wearing narrow-toed, high-heeled shoes can also lead to the development of a bunion. The condition may become painful as extra bone and a fluid-filled sac grows at the base of the big toe.

Most common reasons for the development of a bunion:                  

• If the foots shape puts too much pressure on the big toe joint.
• Because bunions can run in families, some experts believe that the inherited shape of the foot makes some people genetically pre-disposed to developing a bunion.
• If the foot rolls inward or pronates too much when walking. 
• Flat Feet.
• Wearing shoes that are too tight.

Any of these situations can apply significant pressure on the big toe joint, which over time; will force the big toe out of alignment, bending it toward the other toes.

Early diagnosis is critical. When a bunion first begins to develop, taking a few simple steps such as wearing foam pads on the foot to protect the bunion, or devices called spacers to separate the first and second toes at night can help avoid a worsening of the condition.

If the bunion gets worse, resulting in severe deformity or pain, surgery is the most effective approach to realign the toe, relieve the pain and remove the bony bump (bunionectomy). There are many different surgical techniques that can be used to treat this condition depending on the individual’s situation.

To help our patients get relief from bunion pain Dr. Garvin might recommend, wearing wider shoes, orthotics, or foot pads. Treatment such as oral anti-inflammatories and injections can also help to relieve discomfort. However, Dr. Garvin can perform same day procedures, which will have patients comfortable after just a few weeks of recovery.