Can’t Walk On My Foot

Remember, the following is just general medical advice. For best advice, visit a foot specialist or an emergency room physician in your area.

If you can’t put any weight on your injured foot, there’s really no point in waiting to see if the injury gets better on your own. If you can’t walk on your leg now, you’re not going to be able to walk comfortably tomorrow, so don’t just wait around hoping for a miracle. Instead, our best advice is the same advice we gave in the disclaimer message above – go see a physician as soon as possible.

They’ll be able to take a closer look at your foot in person and provide you with an individualized diagnosis and treatment plan. Odds are they’ll confirm their diagnosis with the help of an imaging test like an x-ray or MRI. This will allow them to see which specific areas have been affected by the trauma you’ve experienced, and it will help them chart a specific course of recovery. Until you know what’s going on with your foot or ankle, you won’t be able to treat the issue appropriately.

What Injuries Could Cause The Inability To Bear Weight?

Here’s a look at some of the more common injuries that can lead to the inability to bear partial or any weight on the area:

• Sever ankle sprains
• Ankle fractures
• Foot fractures
• Achilles tendon tears
• Nerve compression

Even though they may lead to the inability to bear weight, these injuries are not the same and will all require their own treatment plans, so you need to get to the bottom of your foot pain. Again, the best way to do that is by setting up a consultation with a foot and ankle specialist, or by heading to a local emergency department or urgent care facility. Being unable to bear weight through your foot is a serious issue, and you’re going to need professional care if you want to make a full recovery.

The post I Can’t Put Any Weight On My Foot – Next Steps appeared first on Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon.

If you’re a frequent reader of our blog, you no doubt have heard that we are offering virtual visits so that patients can see a provider from the comfort of their home. While this was initially started as a response to COVID-19, it has become clear that we need to continue offering online visits to patients in order to best serve them.

When it comes to scheduling and preparing for a virtual visit, there are a couple of things you’ll want to know. In today’s blog, we share some tips to help you prepare for your virtual visit with Dr. Silverman.

Preparing For Your Virtual Appointment

On the day of your appointment, gather any medical information you want to share with Dr. Silverman. If you need to forward imaging results, do this prior to your appointment. Next, find a quiet place to conduct the meeting. Depending on your condition, it may be worthwhile to have space in front or behind you in case any physical tasks need to be performed. A hallway makes a great location because you can walk down it, which will allow us to visualize your gait should we want to examine your stride. Good lighting is also helpful!

Some patients also find it beneficial to wear earbuds during the meeting. This generally helps to improve the audio quality, and it can give you a little more privacy if you’re not the only one home at the time of the appointment.

From there, treat it as you would any other appointment. Be open and honest about your symptoms and current treatment options, and be willing to listen. We know these virtual visits may feel a little different, but they still allow us to provide you with a high level of care, and that’s what really counts. We’ll be able to provide guidance on what your next steps should be and how we can assist with the process.

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Preventing Ankle and Foot Swelling

Here’s a look at five strategies for reducing and preventing swelling in your feet and ankles.

1. Compression socks – Compression socks are a great passive prevention technique. These tighter socks provide compression and in turn prevent fluid from pooling in your lower extremities. Find a pair of compression socks if you’re dealing with foot or ankle swelling, but make sure that’s not your only treatment option.

2. Exercise and Movement – Exercise and activities like walking can help to prevent ankle and foot swelling. When we sit or stand in one spot for too long, fluid can build up in our feet. By moving and exercising, we can naturally prevent this pooling from taking place while also strengthening crucial foot structures.

3. Elevation – No, you don’t need to move to Denver in order to reduce swelling in your feet. Simply elevate your legs by putting a pillow or towel underneath them when you’re in bed, or lean back in your recliner. This will help to prevent fluid buildup in your feet, which will in turn decrease swelling.

4. Weight Loss – An added benefit of exercise is that it can help you lose weight, which is another way to help prevent swelling in your ankles and feet. Weight loss has been shown to help limit swelling in your feet, so keep an eye on your diet as well as your activity levels.

5. Hydration – You’re actually more likely to have swollen ankles and feet if you’re under-hydrated, so really make sure that you are getting plenty of water on a daily basis. Drinking less water promotes swelling because fluids can’t easily leave the foot area, so drink an appropriate amount of water (8-10 glasses) a day.

The post 5 Ways To Treat Swollen Ankles and Feet appeared first on Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon.

“What type of treatment do you do for Achilles bursitis? What are the typical costs involved? Basically I have heel pain on the back of my heel after running or jumping, less pain but some after biking. Feels worse right after waking up in the morning and then gets better as the day goes on. I have a high deductible with Blue Cross Blue Shield.”

Thanks for your question! I’ll answer all parts of your question, but first I just want to quickly talk about symptoms of Achilles bursitis.

Diagnosing Achilles Bursitis

Achilles bursitis or Insertional Achilles tendinitis is diagnosed by posterior heel pain. The pain is aggravated by running and other activities that stress the Achilles tendon. Inflammation begins behind the Calcaneus bone prominence known as the Haglund’s Process. To prevent damage to the Achilles, the retro-calcaneal bursa swells. When this is chronic, the bursitis turns to inflammation and eventually, in a manner up for debate as to how, progresses to insertional Achilles tendon tearing. This tearing progresses to calcification and functional tears (the scar tissue that forms is lengthened and dysfunctional).

Treating Achilles Bursitis

Non-surgical management is often attempted regardless of stage of the condition. A heel lift prevents ankle dorsiflexion and may allow for resolution of the bursitis. A cast or a cast boot will relieve pressure on the degenerative tearing, and in some circumstances allow for strengthening of the tissue to tolerate normal stress. Physical therapy can be helpful by modalities such as heat, ultrasound, frictional massage, stretching and eccentric strengthening exercises. Sometimes, very bright physical therapists pick up gait and functional abnormalities that contributed to development of the condition and can work to re-train you to function better.

More often, if scar tissue has formed, patients must accept a decrease in intense, chronic activity to prevent the pain from returning. Some patients will accept this restriction. Others will not, and they opt for surgery. Since this is a functional problem, insurance coverage has not been a problem.

Procedural Costs

At this point, a doctor will order more tests to be done. Most commonly, an MRI is performed which provides information about the status of the tendon and can determine the location of maximum tendon damage and permanent tendon damage. Calcifications can be mapped similarly. An MRI costs at least $1,500.

We use an Ultrasound technology to evaluate the entire Achilles tendon. The Ultrasound is a significant cost savings, as it costs less than $100 and provides the same necessary information. In fact, an MRI can pick up other information about related problems in the foot and ankle.

Surgery is variable. Age, amount of degeneration, activity level, location of calcification among other factors determine which set of procedures is the right choice. Surgery includes a facility fee, an anesthesiologist evaluation, and management and post-operative physical therapy. This is expensive and often exceeds most deductibles.

I hope this information was helpful, and please let me know if you have any further questions.

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My toe looks crooked

Did you know that more than half of American women suffer from bunions? In fact, nine out of ten individuals who suffer from bunions are female. So what causes a bunion to develop?

• Small, tight fitting shoes that compress the toes. Pointed shoes are notoriously known for causing bunions.
• Genetics. Feel free to blame your mother if she passed her bunions down to you.
• Foot injuries, like breaks or sprains, can lead to the development of bunions.

Symptoms of Bunions

When a bunion develops, the joint in your big toe gets larger and begins to protrude to the side. This can make it difficult to fit into shoes, which can exacerbate the problem. If your big toe gets severely out of line, it can actually push the rest of the toes on your foot out of alignment. This pressure can push your second toe towards your middle toe, sometimes causing it to overlap.

For these reasons and many more, it’s important to recognize the early symptoms of bunions so you can fix the problem before it gets worse. Some of the symptoms of bunions include:

• Crooked, enlarged joint connecting to the big toe.
• The area around the joint may be red and tender.
• Wearing any type of shoe may be painful or uncomfortable.
• Inflammation in the joint.

When left untreated, bunions will gradually make it more painful to walk or wear shoes. It can also lead to the development of arthritis in your feet.

If you’re diagnosed with a bunion

As with any disease, prevention is the best way to minimize your likelihood of developing a bunion. Always wear shoes that fit comfortably, and avoid shoes that are tipped or pointed. If you are diagnosed with a bunion, oftentimes surgery can be avoided.

The first step in fixing your bunion is to find shoes that don’t make the problem worse. Head to your local shoe store and find a pair that doesn’t compact your foot when you walk. You can also have your current shoes stretched at a footwear or shoe repair shop, so you don’t need to throw away your favorite pair of tennis shoes.

Another way to alleviate the pain caused by bunions is by getting extra padding or cushioning in your shoes. Local drugstores like Walgreens or CVS sell bunion pads that are specifically designed to take pressure of your joint. You can also purchase a “spacer” which prevents your second toe from pushing into your middle toe. Your doctor may also prescribe regular or custom orthotic inserts to prevent bunions form worsening.

Lastly, over-the-counter pain relievers like acetaminophen and ibuprofen can help with pain and joint inflammation. Ask your friendly foot specialist for more information about pain relievers for bunions.

In a companion post in the future, we’ll explore the surgical treatment options and recovery protocols associated with bunions.

Related source:  AAOS

The post Bunions: Signs, Symptoms and Diagnosis appeared first on Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon.

Non-surgical treatment

We briefly touched on the non-surgical treatment options in last week’s post.  The most common method for patients who opt to forgo surgery is to practice the RICE method, which stands for:

• Rest
• Ice
• Compression
• Elevation

The most important step in the RICE method is rest.  Oftentimes people try to compensate for their injury by limping through their day.  This is problematic for many reasons.  First, since your foot is already in a weakened state, putting any pressure on the area could lead to damage to the surrounding region.  If you don’t give your foot ample time to rest, the bruising or swelling may linger for much longer than anticipated.  Also, you could end up suffering an injury to another part of your body because other body parts are compensating for the extra weight you can’t place on your foot.  Oftentimes patients who try to work through their foot fracture will experience back or hip pain because of the added stress being placed on these areas.

Another common treatment method in non-surgical fractures is casting or splinting.  A cast or walking boot can help stabilize your foot while keeping the rest of your body aligned.

Surgical treatment

If your fracture is severe enough to require surgery, your doctor will preform a minimally invasive operation to ensure the bones in your foot heal properly.  Your doctor will preform a surgical operation known as an “internal fixation procedure”.  Generally, there are two types of internal fixation surgeries:

• Internal fixation with pins – When smaller bones in the foot break, a doctor can use pins to ensure that the bones heal in place.  The pins are placed around the fractured area so the bone reconnects properly.
• Internal fixation with plates and screws – Plates are screws may be used if pins won’t sufficiently address the fracture.  The plate is screwed in place to stabilize the affected region as it heals.

Recovering from a fractured foot

Because your foot is comprised of so many small bones, the recovery time can differ depending on which bone you break.  While the timeline may be slightly different, the process is essentially the same.  Your bones heal in a three-step process:

Step 1:  Inflammation

The healing process begins immediately after you fracture your foot.  Blood cells will clot in the fractured area so that extra oxygen, minerals and calcium can reach the affected area.  These will help expedite the healing process.  Inflammation is the body’s natural response to injury.  The inflammation step usually lasts 7-10 days.

Step 2:  Soft Tissue Healing

In step 2 of the recovery process, your body begins to stabilize the fracture by replacing the clotted blood with fibrous tissue and cartilage.  The tissue is very weak and susceptible to breakage, so it’s important to minimize the amount of pressure you place on your foot.  It usually takes 3-6 weeks for soft tissue to develop around the fracture area.

Step 3:  Bone Healing

The final stage in the healing process involves the formation of a hard callus that unifies the broken bone back in its original place.  The soft tissue around the fractured area begins to harden, and the progress can be tracked by X-ray imaging.  A person can usually return to full sporting activities once the hard callus has formed, which typically occurs 6-12 weeks after the initial injury.

Related source:  AAOS, Buzzle.com

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Causes of Concussions

Concussions occur when the head sustains a blunt trauma.  Some common ways athletes suffer concussions include:

• Helmet-to-helmet collisions in football
• Fouls that result in a player hitting their head on the court in basketball
• Collisions between a baserunner and catcher at home plate
• Knocking heads with an opponent when jumping for a header in soccer
• Hitting you head on the ice while playing hockey

Symptoms of Concussions

Athletes who suffer a concussion may display a wide variety of symptoms.  Some players get knocked out cold, while others exhibit nearly no signs of a concussion.  Symptoms of a concussion include:

• Loss of consciousness
• Cognitive impairment (feeling like you’re in a fog, delayed reaction times, etc)
• Headache
• Sensitivity to light
• Loss of short term memory
• Blurred vision

Short-Term Concussion Management

Because your brain heals differently than a fracture injury like a broken bone, concussions should be taken very seriously.  If a player exhibits any of the previously listed symptoms, a proper protocol should be implemented to prevent any further damage.  Although teams may have a slightly modified protocol, here is a basic outline for the proper steps to take if someone suffers a concussion.

1)  Remove the player from the game – It doesn’t matter whether it’s an exhibition game or the Superbowl.  Jeopardizing a player’s health in the short term is not worth the risk of the health complications down the road.

2)  Have a trainer or team physician evaluate the player – Make sure a specialist examines the player to see if a emergency measures need to be taken.  They will also check to see if the player has suffered a neck or spine injury.

3)  The player should be closely monitored after the injury – Do not leave the athlete alone in the first few hours after the injury.  Sometimes a concussion can trigger a seizure, so it’s a good practice to keep a close eye on the individual.  Also, make sure the player doesn’t drive home from the game or practice, as any medical emergency would be made worse if it happened behind the wheel.

4)  Visit a specialist – Depending on the availability of medical personnel available at the time of the injury, a person should schedule a visit with their local clinic to ensure the injury receives adequate professional monitoring.  The doctor can also recommend a course or treatment or specialized gear to protect the head in the future.

5)  Take time off – Although some experts say it should be longer, most patients can begin to return to sporting activities 7-10 days after suffering the concussion.  If a person experiences concussion-like symptoms during athletic activities, they should stop immediately.

Long-term Concussion Management

Concussions can have health impacts long after a player has stopped playing a sport.  A person cannot rehab from a concussion the same way they’d recover from a torn ACL, but there are some ways to combat long term concussion symptoms.  These include:

• Wearing protective headgear to prevent future injuries
• Switching sports to take up an activity with less physical contact
• Carrying sunglasses with you at all times if you suffer from sensitivity to light
• Challenging your brain with puzzles or activities if you suffer from memory loss
• Regularly visit a specialist to examine cognitive changes over time

Participation in sports can be a great way to make new friends and stay in shape, but proper precautions should be taken in the event of an injury.  Learn the signs of a concussion so you know what to do if one of your teammates suffers a head injury.

Related source:  Medscapr

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Causes of Flatfeet

• Flatfeet can occur during the growth of a child through natural body developments.
• About 20% of the population suffers from flatfeet, although most individuals will have no symptoms.
• Tight calf muscles and tarsal coalition (abnormal bone growth) can also cause rigid or flexible flat feet.
• Flatfeet is usually a genetic condition.

Symptoms of Flatfeet

• A flattened foot arch that is accompanied by an outward splaying of the feet.
• General achiness in the foot, especially if the child is very active.
• A slight limp is present in some cases.
• Tightness in the calf.
• Pain in the inside region of the ankle and in the Achilles tendon.

Non-surgical treatment

As stated above, a large portion of people who suffer from flatfeet don’t exhibit any symptoms or experience foot pain.  Of the people that do experience pain, most can be treated with non-surgical options.  Your doctor will conduct what is known as a “jack test” to determine if you have flexible or rigid deformities in your feet.  Flexible flatfeet is much more common than rigid flatfeet.  Because flexible flatfeet is much more common, and because it is associated with a muscle issue as opposed to a bone issue, we’ll discuss treatment options for flexible flatfeet below.

• Calf stretching – Calf stretching is key to relieving tightness, which can cause pain in children who suffer from flatfeet.  Parents should make sure their children stretch their calf and feet each day so the muscles can stretch out before physical activity.  A good practice is to have your child stretch their legs, ankles and feet with some simple movements when they wake up each day.
• Activity Modification – Sometimes children can experience chronic foot discomfort because the muscles aren’t given ample time to heal.  A short, 1-2 week period of limited physical or sporting activities can lead to decreased irritation in the foot and calf.
• Comfort shoes and shoe inserts – Your doctor may recommend new shoes or an orthopedic shoe insert to help alleviate some of the stress your child puts on their foot.  Shoes with a slight heel can help stretch out the calf muscle as they move, and inserts can help lessen the pressure placed on the foot.  Parents should consult a specialist about each option as prolonged arch support inserts can actually weaken muscles in the foot which can contribute to the symptoms of flatfeet.

Surgical treatment

Surgical treatment of flexible flatfeet is rare, but it is an option if non-surgical options fail.

• Gastrocnemius recession – A gastrocnemius recession involves lengthening the tight portion of the Achilles tendon.  This addresses the most common cause of flatfeet.  This procedure will alleviate the pain, but it will not necessarily lead to the development of an arch in the foot, although it is possible that one may develop once the tendon is lengthened.
• Lateral lengthening – This procedure involves cutting into the calcaneus to lengthen the arch of the foot.  It is usually preformed in conjunction with a gastrocnemius recession.
• Subtalar Arthroresis – This procedure is a little controversial as it involves placing a device in the foot to shift the heel bone and create an arch.  Removal of the device is often required, but many patients develop an arch once the soft tissue heals.

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As a pre-med student majoring in Biochemistry and Psychology at the University of Minnesota, College of Biological Sciences, it is a dream of mine to become a surgeon. My passion for surgery was truly ignited when my mentor, Dr. Silverman, first brought me into the operating room.

Recently, my psychology research supervisor, Kevin Stanek, shared an interesting video with me that illustrates how language and distance barriers can lead to complications during surgery.

This video emphasizes the importance of communication in teaching surgical techniques worldwide. It explores the possibility of simultaneous translation made possible by technological advances. I have watched Dr. Silverman perform minimally invasive procedures several times, and the idea of teaching something as precise and complex as surgery over computer screen all the way across the world to someone who speaks a completely different language is mind-boggling.

Having moved to another country eight years ago from China, I understand how extremely difficult it is to communicate with others when you can’t even make out the syllables. This would help to spread surgical techniques while reducing cost in training surgeons, and it would make saving lives and improving health care a more reachable goal in third world countries.

Having a real time translator to help train surgeons would reduce the cost of training, the time spent on traveling, and it would greatly benefit regions with limited resources. This new way of communicating would also facilitate the bidirectional exchange of knowledge, which would allow surgeons to achieve better patient outcomes. This would be an efficient way to improve healthcare, but more research is needed.

Mr. Stanek said further research on this project to gather empirical data will allow us “to indicate how effective the new training and communication methods are”.  He also believes our goal “should not only be to improve the current standard of training/care in developing and difficult-to-reach regions, but rather to enable them to provide a standard of care that approaches ‘world-class’”.

It would make a world of difference to be able to communicate with surgeons in different parts of the world in their native language. Ideas would be freely exchanged and surgical techniques would be improved. This would vastly change the face of medicine, especially in the field of surgery. It would be exciting to see this technology put into practice during my lifetime, which would help solve a problem that has caused me a great deal of stress, and it would save the lives of millions.

Author Bio:

Bowei “Lulu” Song is a sophomore, majoring in Biochem and Psych at the University of Minnesota College of Biological Sciences. She is also a volunteer for aurora, research at Regions and Dr. Ones at the U of MN, and a student adviser for CESP.  She speaks Chinese, practices yoga, and likes to salsa dance.

The post Steven Schwaitzberg: A Universal Translator for Surgeons appeared first on Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon.

1)       Check out the website –It’s always a good idea to check out your doctor’s website before calling to set up an appointment.  Many offices have multiple locations, so you can save yourself some time by driving to the nearest clinic.  Also, some medical centers have different specialties, so make sure the office you are about to call is equipped to handle your ailment.

2)      Know your preferred date and time –You may not have your calendar in front of you when you call, but have a general day and time in mind.  If you don’t have a specific time period, just tell the receptionist whether you’d prefer morning or afternoon.  Also, the earlier in advance you call, the more availability.  If you know Thursday is your day off, don’t wait until after work on Wednesday to try to schedule an appointment.

3)      Have the right papers with you – For a quick and painless phone call, it’s best to have the right information with you when you call.  Two important documents are your calendar and your insurance card.  It might seem like you are saving some time by trying to schedule an appointment while you’re driving in your car, but the call is going to take at least twice as long and you may not be able to schedule a visit without the proper information.  Have your calendar open and your insurance card next to you when you call.  Not only will this prevent you from scheduling a visit during your child’s soccer game, but it also makes it easier for us to collect the necessary medical information.

4)      Know your contact number – You would be amazed at how many people do not know their own cell phone number.  Make sure you know a good contact phone number in case we need to get a hold of you.  Also, it doesn’t hurt to memorize your spouse’s phone number in case you want to put a secondary phone number on file.

5)      Concisely explain your symptoms – There’s a time and a place for thoroughly explaining your symptoms, but it’s not during your initial phone call.  Receptionists have a limited amount of space to document your “reason for visit” so simply saying “I may have broke the big toe on my right foot” is much better than going into a story of how you were running late for your child’s piano recital because your husband had to work late and you stubbed your toe on your way out the door.

If you follow these simple steps, you can quickly and painlessly schedule a visit.  We want to give you the best experience possible, and that begins the moment you pick up the phone to give us a call.

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