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.

All About Those Bunions

Is your big toe crowding the rest of your toes?  Is there a firm lump on the side of your big toe?  Do you have pain from the pressure of your shoes causing you to flinch while walking? Is finding a shoe that fits comfortably difficult? If you are experiencing any of these symptoms then you may have a bunion.

Bunions, also called hallux valgus or hallux abducto valgus (HAV), form a firm bump on the inside edge of the foot at the base of the big toe.  This causes the big toe to move out of place.  When a bunion forms on the big toe, the toe moves toward the other toes and causes the lump to become bigger and can create pain.  Pain occurs because pressure from the shoe on the bunion or from pressure inside the joint.

A main factor for bunion growth is wearing footwear that is too tight.  When you wear tight footwear your toes are squeezed together and create unnecessary pressure.  Not only footwear, but faulty foot mechanics and a combination of the way you walk can cause bunions.  And of course foot injuries, people with neuromuscular problems and activities such as ballet dancing can also be linked to the formation of bunions.     

There are non-surgical and surgical treatments for bunions, but your options would depend on the severity of your feet.  Changing your shoes to provide more room, taping and padding your foot into a normal position, and having shoe inserts or orthotics can help reduce symptoms and prevent bunions from becoming worse.  

However, discussing your options and having your feet looked at can help in making the right decision for treatment.  It’s important to get bunions looked at immediately as other issues can develop such as hammer toes, corns, calluses and ingrown toenails.  

If you are experiencing bunion symptoms and pain call our office to set up an appointment with Dr. Garvin at www.doctorgarvin.com

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

X-ray Machines 101

How do X-Ray Machines Work? 

An x-ray is an energetic wavelength of electromagnetic radiation that is emitted from within an x- ray machine at it’s generator. X-ray machines work very similarly to how light bulbs function. They receive their power from a wall outlet, as does a light bulb; through alternating current, or AC power. Through the use of a step-up, and step-down transformers, a diode (for conversion to direct current from alternating current), and a heating filament to boil off electrons; electrons are emitted from a cathode and directed towards a negatively charged anode by applying a strong potential difference in current. Once these electrons collide with a tungsten target found on the anode, photons are emitted and directed out of the x-ray machine and into the patient at their respective tissue. 

An example of a podiatric specific x-ray machine is pictured below.

Are x-ray machines safe? 

Before photons, in the form of x-ray radiation are absorbed by patient tissue they’re filtered, and aimed for precision and safety. A health care practitioners number one goal in using an x-ray machine is to maintain safety, all the while attempting to generate a high contrast image to be developed, and utilized in proper diagnosis of respective pathologies. To ensure that “soft radiation”, or low energy radiation (that is not useful for images) isn’t absorbed by the patient, aluminum filters are utilized. These filters are measured in millimeters, and are required by law to be used in all x-ray machines. In addition to the aluminum filter, lead aprons are worn by patients and x-ray technicians to prevent x-ray radiation from being absorbed unnecessarily, in relation to unaffected tissues. 

In short, yes, x-ray machines are made safe for use because physicians receive extensive education on how x-ray machines work, and what the ramifications of miss-use are. For example, the average podiatrist has received 2 years of radiology courses during podiatry school, 2 years of clinical experience in school under the observation of experienced physicians, and another 3-4 years during their tenure in residency programs to prepare them to use, and read x-ray machines and images known as radiographs. 

Why is it important for patients to have x-rays taken? 

Radiographs are extremely important in the diagnostic process that physicians 

must undergo to successfully treat a patient. Often times debilitating conditions pertaining to a patients foot, ankle, or lower leg are superficial, and an x-ray is not needed. However, once a physician is confident a condition is not diagnosable through superficial observation, percussion and palpation, x-rays are generally ordered to observe if a pathology exists in the bony tissue. 

Without a radiograph a physician would never be able to observe subcutaneous conditions 

affecting the bone, like foot and ankle fractures. A lack of radiographs would put all types of 

medicine back to an antiquated state that has not been prevalent since the early 1890’s, prior to Wilhelm Rontgen’s discovery of the x-ray. 

Sandal weather is here - Prepare your feet!

What are Corns and Calluses?

Corns and calluses are both formed by hyperkeratosis. This term simply means a thickening of the skin. These can form on many of the superficial surfaces of the body (most commonly on the feet!) for a variety of reasons. Typically, corns are sore and painful due to the friction that is occurring at the site, which is also their cause. Calluses are also caused by a thickening of the skin, but are more often associated with the excess synthesis of skin at a site as a protective mechanism. For example, many people develop calluses on their hands due to repetitive work like gardening. Calluses are also formed at areas of abnormal bony synthesis like bones spurs. 

Why should you be concerned about a Corn or Callus?

Hyperkeratosis certainly isn’t a reason to visit the emergency room. However, it is an important concern because it means that excessive use, and abnormal friction is occurring at that localized area of epidermis (most outer layer of skin). This is not only a cosmetic issue, but is often times painful and debilitating depending on severity. More importantly than the buildup of skin itself though, is the actual cause of the localized hyperkeratosis. This excess production of localized dermis is generally due to things such as poor fitting shoes, abnormalities of the toes, like hammertoes, unusual bony prominences such as bunions, and abnormalities of an individual's gait. All of these conditions are great reasons to setup an appointment with Dr. Michael Garvin! His goal is to empathetically alleviate his patient’s foot ailments with as minimally invasive procedures as possible.

 

To make an appointment, simply call one of his offices, both located in Port St. Lucie, Florida; the East office- 772-335-7171, & the West office-772-871-6020, or e-mail him at info@doctorgarvin.com . http://doctorgarvin.com/contact.html

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!