Portsmouth Foot & Ankle - Blog
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.
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
What You Need To Know About Plantar Warts
So, what is a wart anyways?
- 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.
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
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.
One 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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