Portsmouth Foot & Ankle - Blog

By Reid Christie, DPM
February 22, 2018
Category: Foot Pain
Tags: surgery   big toe   arthritis   fusion   mtpj  
I Can’t Move My Big Toe
 
One of the more common complaints heard in our office setting is pain with any movement of the big toe joint.  And the most common underlying cause of pain in this area is arthritis.  Arthritis can occur in almost any of the joints in the foot, but the first metatarsal phalangeal joint (big toe joint) is one of the most often affected due to a variety of reasons.  Once arthritis is present within the big toe joint, it can be progressive and worsen with time if preventative measures aren’t taken. 
 
The most common preventative measures for arthritis include cortisone injection therapy (Read More: Cortisone Just a Band-Aid?) or custom orthotics (Read More: Orthotics 101).  Early intervention with these conservative measures can often prevent patients from ending up in surgery.
 
However, when the arthritis becomes too painful in the big toe joint and/or preventative measures fail often times surgical intervention is the best solution. The surgery I often perform on patients with arthritic joints is a fusion (or arthrodesis).  A fusion of the joint is when the joint is essentially removed and it no longer allows motion.  The thought process behind this procedure is that the pain is occurring within a deformed joint, so if the joint is removed the pain will resolve. The biggest part of the procedure that patients worry about is the fact their big toe will no longer bend up and down.  While this sounds like an undesirable result, the fact is that patients are still active and perform normal activities and exercise following this procedure.  When this procedure is discussed with patients, two things must be emphasized:  first, there will be relief of pain, and second, normal daily activities and exercise may be resumed once the arthrodesis heals. 
 
The following case photos are from a patient who had undergone a bunion procedure six years prior, however started having pain two years following her procedure.  After a long discussion with the patient, it was concluded that an arthrodesis of her big toe joint was the best long term solution.  Patient is currently in the post-operative time frame and healing without complication.
 
before and after photo
 
 
By Allen Clark, DPM
February 15, 2018
Category: Foot Care
Tags: winter   frostbite   cold   exposure  


Frostbite is a real danger in New England. Hands and feet account for 90% of all cold related injuries. Men are affected by it more than women by a ratio of 10:1. 

Frostbite occurs when the tissues of the body are reduced to a temperature that stops blood flow. As fluids in the body cool they can slow to a halt. 

When the core temperature of the body decreases significantly, the body reacts by shunting blood away from non-vital organs and limbs.  As the fingers and toes are the furthest from the center of the body, they are easily cooled.  Without blood reaching the tissues the affected parts begin to die. In extreme cases of frostbite in children, growth plates are affected resulting in abnormal growth of bones. 

Frostbitten fingers and toes may be salvaged if re-warmed and cared for properly. It is important to get the person to warm place where they do not risk becoming cold again. Medical attention is absolutely necessary. There are medications and procedures that can improve outcomes if sought out in a timely manner. The degree of irreversible damage is more closely related to the length of time that tissue remains frozen rather than the absolute temperature change. 

Things to be careful of when going into cold temperatures:

Tight shoes, tight ski boots, standing in the snow or ice, smoking.  Be sure to keep your fingers and toes warm with thick socks, keep your feet dry, wear protective shoes that are waterproof.  If you have neuropathy in the feet be extra careful and warm your feet regularly.

More Winter Reads: Winter is Here... Protect your Feet!  |  Winter Injuries  |  Polar Vortex  |  Its getting colder!

 

Dr. Allen Clark

By Reid Christie, DPM
January 31, 2018
Category: Injury

Achilles Tendon Rupture

Achilles’ tendon injuries comprise a significant portion of sports (and everyday) injuries of the foot and ankle. The injuries can be as minor as tendonitis or as major as a tendon rupture. Highlighted today will be the latter and the surgical intervention that followed. 

To completely understand an Achilles tendon rupture, it must first be understood how the tendon itself functions.  The tendon is comprised of two muscles in the back of the leg coming together to form a single tendon which attaches at the posterior heel.  These two muscles, the gastrocnemius muscle and the soleus muscle, both function to plantarflex the foot and ankle and assist in propulsion during the gait cycle. 

Injuries occur when too much stress is exhibited upon the tendon through explosive movements (such as a quick, propulsive movement or a quick, dorsiflexory movement about the ankle).  One of the most commonly reported symptoms at the time of injury is that it feels as though the back of the leg was kicked or hit by someone. 

The tendon can rupture in a few different spots, and this dictates the type of repair that is required. 

Insertional rupture is when the tendon rips away from the back of the calcaneus (heel bone). This requires reattaching the tendon to the bone through surgery. 

A little higher up in the tendon is a portion known as the watershed region. This is the most common area for an Achilles’ tendon to rupture due to a decreased blood supply to the area. This often times requires direct, end to end repair of the tendon (if possible). 

Lastly, and even higher up, the tendon can tear or rupture in what is known as the “midsubstance” region.  When this occurs, direct repair is preferred, but not always possible. So what happens when direct repair of the tendon is not possible? When direct repair is not possible the next best option is often times what is referred to as a tendon transfer, which essentially moves a tendon to a new location and ultimately gives it a new function.  Most often times the tendon of choice would be the flexor hallucis longus tendon.  When rerouting this tendon, the main goal of the procedure is to re-establish the plantarflexory force (up and down motion) of the ankle. The FHL tendon is transferred into the calcaneal bone (heel bone) and with proper healing and rehabilitation, the function is restored. 

  • (Pictured below is the flexor hallucis longus tendon before it is rerouted into the calcaneus) 

  • Read More: Achilles Tendonitis

LINKS:

Dr. Reid Christie 

Appointment Request 

 Nashua Office

 

By Dr. Reid Christie
January 08, 2018
Category: Skin Problem
Tags: plantar war   foot wart   lesion   virus  

What You Need To Know About Plantar Warts

 
One of the most common complaints that walks through the door is “I think I have a plantar wart.” 
 
In my own experience, this claim is accurate only a small portion of the time, however.  There are many different differential diagnoses that could explain the lesion, but a few characteristics lead physicians to accurately diagnose plantar warts.   
 

So, what is a wart anyways? 

A wart is hyperplasia keratotic tissue caused by a virus. The virus responsible for plantar warts is called the Human Papillomavirus.  There are multiple different subtypes of this virus, however there are a few subtypes responsible for these specific lesions. The virus finds its way through the outer layer of skin via a cut or opening in the skin.  Once the virus finds its way through the skin, a verruca lesion will start to develop from the bottom layer of the skin and proliferate outward through hyperplasia of keratotic tissue. The development of this lesion could take weeks or months, however. Left untreated the lesion can cause spreading of more lesions, grow in circumference, or continue to grow in protruding fashion.
 

Defining Characteristics

  • Small black dots within the lesion -  These are referred to as “petechia” which are tiny blood vessels beneath the skin. 
  • Pinpoint  bleeding - Another characteristic of verruca lesions is that when the outer most layer of skin is sharply debrided away from the lesion, one would note pinpoint bleeding.
  • Disruption of skin lines -  A wart develops from the base layer (or basement membrane) of the skin, and once it proliferates outward through the remaining layers of skin, it will eventually come through the top layer of skin where skin striae (skin lines on the soles of our feet, akin to lines that make up fingerprints on our hands) are observed.  If skin striae are seen crossing over the top of the lesion, it is not a wart. 
  • Tenderness - Most often patients will complain of tenderness associated with the lesion, and painful to walk on.
Once the lesion has been accurately diagnosed, the correct treatment plan can then be pursued by the physician. The most common treatments offered here at Portsmouth Foot and Ankle include Cutera Laser (Laser Treatments) which uses heat to cauterize (kill) the virus and underlying blood supply to the lesion. This method often times may take between three and seven treatments before resolution of the lesion is noted. The Cutera Laser is not the best option for all lesions, however. Other treatments include topical agents, such as a Formalin solution or Salicylic Acid.  The other option for persistent lesions is surgical excision of the lesion. The lesion pictured below was excised surgically. 
 
If you are concerned that you may have a verruca lesion (wart), we recommend speaking with a podiatric physician for prompt and accurate diagnosis and treatment.
 
 
 
By Dr. Baczewski
January 02, 2018
Category: Foot Pain
Tags: infection   surgery   toenail   ingrown nail   youtube video  

INGROWN NAIL SURGERY is the most common in office procedure we perform at Portsmouth Foot and Ankle. However, this procedure really seems to scare our patients. Often they wait until the nail becomes very painful, and even infected, to deal with the issue. The have a variety of reasons for waiting. We wanted to take a moment and address them because we don't want you to wait!

I waited to come in because...

1. “I watched a YouTube video and it looked really awful so I didn’t want to come in”.  We agree. There are some brutal videos out there. Please don't watch them. We invite you to watch one of ours below (if you are into that sort of thing) but otherwise we honestly suggest that you JUST DON'T. It looks far worse than it really is. TO WATCH OUR VIDEO - click on the photo or follow this link: https://youtu.be/LkEORW8k3KU

nail surgery video

2. "I had a bad experience at an ER/urgent care/primary care and I didn't want to have to do it again." Trust us, the discomfort you may have experienced in the past can often be lessened by our expertise because pain can vary greatly depending on how the numbing injection is delivered and how the procedure is performed. 

3. "It's going to hurt!" You will be given local anesthesia at the beginning of the procedure to numb the toe involved. This part is not comfortable (I’m not going to lie to you) but it takes about 45 seconds to numb up the toe. At PFA, we pride ourselves on trying to even make the injections as comfortable as possible. Once numb, you may feel pressure or movement but no pain. When done properly, by a podiatrist, nail surgery should be fairly low on the pain spectrum. 

4. "It is never going to heal right or grow normally again!"  The majority of nail surgeries performed heal without complications. Most people can’t even tell a nail surgery was done. Some of them occasionally require a second surgery soon after (or much later on down the road) but most only require one procedure. There is also a permanent procedure for "stubborn" (repeat ingrowns) where we cauterize the nail root (just in the corner of the ingrown), which allows the remainder of the nail to grow as normal but the ingrown portion does not grow back. Cosmetically this is barely noticeable if done properly.

5. "I tried a home remedy or something I saw on the internet first..."  Cutting a “v” shape in the nail, or placing a piece of cotton at the corner, does not encourage the nail to grow any differently and will not relieve an ingrown. Don't bother with DIY methods, ingrown nails can develop into an infection fast and you should see a doctor.

Baczewski PodiatristOne of my favorite things about doing nail procedures is my patient’s reactions afterwards. Often I hear “that’s it?” or “you’re done already?” and even “wow! I didn’t feel anything after the numbing!” because it is that quick and painless (once you are numb)!

 If you suspect that you have an ingrown nail (read more: Ingrown Nails) or if you know that you have one and have been putting off professional treatment for it contact us now! Appointment Request or Contact Us  at Portsmouth Foot and Ankle in Portsmouth and Nashua, NH.           

Related Reading - How To: Trim Toenails 

Meet The Doctor! Dr. Natasha Baczewski





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