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March Articles 2015

What Are Ankle/Foot Orthosis?

Ankle-foot orthosis are braces worn at the ankle that encompass some or all of the foot. Diseases that affect the musculature or weaken the affected area require orthosis to strengthen the muscles or rehabilitate them and other joints of the foot and ankle. Tight muscles that need to be lengthened and loosened also benefit from orthosis.

When we think of diseases that affect the musculature we think of the big boys: muscular dystrophy, cerebral palsy, polio and multiple sclerosis. We rarely think that arthritis and stroke can affect the musculature, but these are both conditions that can negatively affect the muscles in your foot and ankle.

However, the good news is that whatever trauma there is that affects those muscles, there is a way to correct it. The orthosis helps to control range of motion, provide support by stabilizing walking, correct deformities, and manage pain loads. A podiatrist would be consulted for those who have experienced direct trauma to the foot or ankle, have an arthritic condition that is affecting their joints, or has developed another kind of muscular disease.

Before the advent of modern orthosis devices, it wasn’t uncommon to see polio victims wearing metal braces from mid thigh to the bottom of the foot, or children wearing metal braces around their ankle and foot. However, both designs and materials have improved dramatically, allowing for new levels of comfort, functionality, and appearance. Many orthosis are now made from plastics in the shape of an L and designed to fit inside a corrective shoe. These can be rigid, buckling at the calf and extending the length of the foot to support the ankle. This same design except with a hinged ankle provides support while walking by normalizing the gait. In the past, boots lined with leather and fiberboard provided the rigidity needed for correction and support. Now corrective shoes are available with built up soles to correct the gait or manage pain by sharing it with another area when the foot spreads during walking.

The podiatrist would prescribe this orthosis in the rigid L shape because the foot moves on a hinge. If the hinge isn't functioning as intended due to an injury or malformation, the muscles tighten up, thus making it difficult to flex the foot. When we walk, the foot flexes and muscles stretch. This brace or orthosis would support the ankle and musculature during flexion of the foot, in much the same way a knee brace works. Corrective shoes are for people whose feet hit the ground backward, causing tight muscles and arch problems. Wedges and rocker bars on the heels correct the step to heel first and rock onto the ball of the foot, resulting in relaxed musculature and strengthened ankles.

Appearance also counts when we consider a particular support device, especially if the item is intended for regular, daily wear. The L shaped orthosis is contoured to the calf and flesh-colored, fitting into a sneaker or dress shoe. At present, corrective shoes are more attractive than past models, enabling patients wear such devices with greater comfort and confidence.

Every Day Foot Care

Our feet are of great importance in our everyday lives. The problem is that we tend to neglect them. When this becomes a habit, it can cause significant trouble. Ignoring foot problems can mean pain, limited mobility, and expensive doctor's visits. On the other hand, if the feet are cared for and looked after each day, they will perform without pain or complication.

Routine hygiene is the most basic way to care for the feet. Wash and dry them thoroughly everyday. Remember to get between the toes, and keep the toenails trimmed and short. If the feet feel dry or one can see visual signs of dryness or cracking, use a moisturizer designed for the feet.

When using moisturizer on the feet, try to avoid applying between the toes. If creams or lotions sit in that area, they can cause development of fungi and bacteria. When moisturizer is used between the toes, it can also cause the skin to macerate.

Shoes are also an important aspect of foot care to consider. When one is picking out shoes, make sure that they are the correct size. Shoes need to be snug, but not too tight. On the other hand, if the shoes are too loose they can cause foot problems as well. It is highly recommended that shopping for new shoes be done later in the day. The reason for this is that the feet will have settled and swelled to their full size by then. To keep your feet at their most healthy, avoid wearing high heels or flip flops too often. Instead, choose shoes that are good for your feet, and that pad the soles of your feet and support the arches and ankles.

Socks should also be worn daily with closed-toe shoes. They may feel hot during the summer months, but they absorb sweat and moisture and keep it off the feet. Without socks, the build up of sweat in a closed-toe she can cause fungi problems and athlete's foot.

The best thing to remember in every day foot care is that shoes do make a difference. If you spend much time on your feet, make sure that your shoes show no signs of wear and offer ample support for the arches and the overall foot. Additionally, try to engage in thorough foot cleaning and maintenance a part of your daily routine. If you keep these things in mind, your feet will stay healthy and safe.

Ankle Sprains

Ankle sprains can be quite the painful experience. Often times the injured person will experience limited mobility, swelling, and, depending on the severity, discoloration of the skin. This type of injury takes place when the ligaments are torn or stretched beyond their limits. Although this can occur in various areas of the body, the ankle is the most common site for a sprain.

There are multiple ways that the ankle can become injured like this. However, the simple act of walking may cause a sprain. If footing is lost or the person is walking on uneven terrain, local damage may occur. This may be especially so for athletes that continually push their limits, or for the person who has suffered from a previous accident involving the lower extremities.

In the majority of cases, medical attention is not required for a sprained ankle. Remedies for self-care at home include propping the ankle up, applying ice packs as needed, and remaining off your feet. Some may also find that wrapping with an ACE bandage and taking over-the-counter pain relievers are helpful. One of the most important things is to avoid further stress to the affected area.

Although rare, complications may arise and obtaining medical treatment may become necessary. A severe sprain can actually tear the ligament and even damage the muscle. When this occurs, the person may have to be off their feet for a prolonged period of time. Depending on the severity and nature of the damage, surgery and physical therapy may be required. Seeking out a podiatrist will help in making these decisions.

Sprained ankles are painful in nature, but those with severe unrelenting pain may have sustained a worse injury than previously though. If walking becomes too painful for the person to take more than a few steps, swelling becomes too severe, or if numbness or tingling is present, immediate medical attention should be sought. Mild to moderate bruising is common with a sprain but redness of the skin or worsening of the discoloration should not persist either.

One of the best treatments for an ankle sprain is to prevent it in the first place. Wearing appropriate shoes for the occasion, stretching before exercises and sports, and knowing your limits can aid in prevention. Those that have suffered from a previous sprain may want to consider additional support, such as a brace and regular exercises to strengthen the ankle.

Elderly and their Feet

While proper foot care is important for everybody, senior citizens have the tendency to be more susceptible to certain conditions and should therefore be well informed about problems that may arise and what they can do to properly avoid or treat them.

Some of the most common problems are foot ulcers, ingrown toenails, fallen arches, and fungal infection. A foot ulcer is an open sore on the foot and  can be a result of decreased sensation in the feet. An ingrown toenail is defined as when the nail grows into the side of the toe. Fallen arches are indicated by the instep of the foot collapsing. A fungal infection is a condition that results in deformed and discolored toenails.

In order to avoid these conditions it is recommended that the feet be inspected by the patient on a regular basis. If these inspections are carried out routinely, there is a good likelihood that problems can be identified before they become severe, or can even be avoided altogether. If any abnormality is discovered, it is important that the individual consult a doctor for diagnosis and information on treatment options.

Proper foot hygiene is also important. Making sure that you always have clean, dry socks on can be a major deterrent to many different problems including bacterial infections, foot odor, and certain types of fungus. Wet feet are a major cause of many of these problems.  If your socks get wet, it is important to change them. Walking around in wet socks may not only lead to various infections, but can irritate the skin and result in a number of various complications. Clean, dry feet are less likely to be affected by fungal and other infections.

As people age, the fat present on your feet begins to deteriorate. The protective nature of this fat keeps the feet healthy by providing a barrier and between your bones and the ground as well as giving the skin on the foot a certain amount of elasticity. This is one factor that causes elderly people to develop some serious foot issues. Foot moisturizers can be helpful to avoid certain problems associated with this. However, water-based moisturizers do not work as well for elderly people as they do for the young. Instead, it is more effective to use an emollient instead. An emollient is effective because it binds the water in the foot, keeping it from becoming absorbed too readily which will result in dry skin. They also have a special property called occlusion, which provides a layer of oil on the skin. This layer prevents the foot from drying up and can be very effective in treating dry skin disorders.  If you can keep the skin on your feet healthy, this will substantially reduce the number of foot problems you will encounter in old age.

Proper footwear is another way to keep feet healthy. Shoes that fit well and provide proper support help prevent ingrown toenails and fallen arches.          

Certain medical conditions such as diabetes or poor blood circulation increase the risk for foot issues. For individuals with any of these conditions it is extremely important to conduct regular foot inspections to make sure that there are no sores or infections present.

When Foot Surgery is Necessary

Foot surgery may be necessary for a variety of reasons, but it is normally reserved for cases in which less invasive procedures have failed to help with the problem. Cases in which surgery may be deemed necessary include, but are not limited to, surgically removing deformities of the foot (such as bone spurs and bunions), problems with arthritis that have caused severe bone issues within the foot, and reconstruction to attend to injuries caused by accidents and congenital malformation (such as club foot and flat feet). Foot surgery may be necessary for individuals of all ages and races.

If you find yourself in need of foot surgery, the reason why the surgery has been found to be necessary will dictate exactly what kind of surgery you need. If you have to have a growth, such as a bunion, removed, then you may undergo a bunionectomy. If your bones need to be realigned and fused together, then you may undergo a surgical fusion of the foot. If it is nerve pain and problems that you are enduring, then you may need to undergo surgery in which the tissue that surrounds the painful nerve is surgically removed. Normally other, less serious treatments are first applied when a problem is discovered, but if those treatments are found to be ineffective, surgical techniques are considered and used.

Even though surgery of the foot is usually reserved as a last resort by most physicians, there are some benefits if you and your doctor choose to use surgery to fix the problem. The first is that the pain associated with the issue is normally relieved, which means that you can finally resume the activities your foot problem was preventing you from participating in. The second benefit is that, once you have the surgery completed, the problem is generally eliminated since it has finally been addressed.

History of podiatry has shown that foot surgery techniques continue to advance every year. Endoscopic surgery is just one of the many advancements that have been made in the field of foot surgery. As technology improves, foot surgical techniques will also continue to improve. Many procedures can now be completed using a very small incision and smaller, more refined instruments. Because of these better tools, surgeries are becoming less invasive, and recovery time has become a great deal shorter. Shorter recovery periods mean that you will be back on your feet in no time.