Foot and Ankle Problems

By Ray Fosterrlf@mt-rushmore.net

 

Ankle sprains are the most common sports related injury. A condition popularly called "heel spurs" are responsible for a lot of discomfort and disability because it is difficult to get around if your feet hurt. Did you know that your diet and lifestyle could affect the health and comfort of your feet? Stay tuned for another exciting edition of NEWSTART HEALTHCARE.

Q 1 Dr. Foster, just how common are ankle sprains – and how can a person tell which to see their doctor about and which to put an ace bandage on themselves?

More than 23,000 people per day, including athletes and nonathletes, require medical care for ankle sprains in the United States (Kannus, 1991). Stated another way, incident cases have been estimated at 1 per 10,000 persons per day (Trevino, 1994).

Q2 Dr. Scribner, Are there any medical conditions that would predispose a person to having an ankle sprain?

Ankle sprains occur when the tensile strength of the ankle ligaments are exceeded by forces imposed on them. Obesity or malnutrition would contribute to the possibility of an ankle sprain. Excess weight contributing to excess forces at the ankle, and malnutrition by nutritionally weakened ligaments.

Q3 Dr. F Is it true that ligaments are stronger than bones?

Ligaments are stronger than bones when it comes to pull forces. Ligaments have no strength when it comes to push forces. Pressure directly down is best withstood by bones. This I am calling push forces. Pressure that is a pull along a bone or tendon is much better withstood by ligaments and tendons than by bones. Bones are designed to stand up under push pressure. Ligaments are designed to withstand pull pressure.

Q4 Dr. S How would you decide what sprains need to be considered serious and which could be self-treated?

There are several criteria that indicate severity of a sprain. Swelling and discoloration indicating bleeding are not good signs and indicate that something has been torn which would probably best be seen by your doctor. If there is little swelling and little pain with no discoloration, chances are that this is a mild sprain.

Q5 Dr. F How would you decide which sprains need an xray and which do not?

The only thing an Xray is going to tell you is whether the ankle bones are broken or not. If there is little or no swelling and there is no bruising, or only slight bruising, firm pressure on the bones can detect an undisplaced crack in the bones. If there is pain over the bones of the ankle in excess of over the ligaments of the ankle, an xray is indicated in my opinion.

Q6 Before we leave ankle sprains – is there anything else that you would like to say –-Dr. F?

 The ankle is one of the most interesting joints of the body. It is the most commonly injured and yet it is the joint that has the least arthritis. Knee joint and hip joint arthritis is much more common than ankle arthritis in spite of the fact that the ankle joint is most frequently injured. The reasons for this are probably not all known. Certainly trauma is not the determining factor in arthritis of the usual type. Activity and usage preserves our joints more than rest and repose.

Q7 What other ankle conditions are of importance for us to know about?

Dr. S. Ankle swelling is a very common condition that is not an ankle – but a heart problem usually. If you have swelling of your ankles, tell your doctor about it and ask him or her to check for heart failure. Discuss other causes of ankle swelling.

Dr. F Chronic ankle sprain or recurrent ankle sprains may be a problem that needs to be checked out by your doctor. If the ligaments around the ankle get stretched out and become loose, wearing high top shoes to support your ankles may be a good answer. If ankle support does not solve the problem, surgery may be indicated. Be sure that you have a reliable specialist before having surgery for chronic ankle sprains. It would be well to get a second opinion to make sure before having surgery.

Q8 What are the common medical conditions that show themselves in the feet, Dr. S?

Gout, and congestive heart failure often causes swelling of the ankles and feet. 

Q9 What are the common musculo-skeletal conditions that show themselves in the feet Dr. F?

Corns, callouses, bunions, claw toes, and heel spurs are very common conditions that have the potential for a lot of pain and disability.

Q10 What is the difference between corns and callouses?

A corn is often a viral condition and not a corn at all but a wart on the bottom of the foot. If it is over a bony prominence it can be more difficult to distinguish from a callous. A plantar wart is very painful and usually not over a pressure area. Callouses are always over pressure areas and are a natural response to excess pressure.

Q11 What is the best treatment for a plantar wart?

I learned an excellent treatment for this most distressing problem from a Doctor William Wagner, who is a leading orthopedic surgeon in the Los Angeles area that is probably best know for his work in diabetic feet. Dr. Wagner used to inject plantar warts with good success with a special medicine that was in time no longer manufactured. So he wondered what he could use in place of the medicine that he had such good success with for years. He discovered that it did not make any difference what he used, that ordinary local anesthetic worked as well as the patent medicine that he had been using.

Q12 How does Dr. Wagner use the local anaesthetic and how does it work to kill plantar warts?

He injects the local right into the base of the plantar wart. He believes that the local separated the wart from its blood supply which weakens the virus and the body’s immune system then kills the virus and the wart falls off to the great relief of the individual.

Q13 Are there other ways of treating plantar warts?

There are many ways of treating plantar warts. The more ways there is to treat something the more likely it is that none of them are excellent. We had a dog that grew great warts on its tongue. My Dad told me to give the dog vitamins and sure enough the warts went away. Plantar warts can be burned off and cut out. My experience with that is that there is a high recurrence rate. Vitamins and local injection probably work the best.

Q14 Are there any non surgical and non-injection treatments that work for warts?

A cut garlic clove held in place overnight with a bandaid or a slice of onion are remedies that use the know anti-virus properties of garlic and onions. The placebo effect of any treatment that you believe in has a 75% success rate which is not bad.

Q15 What are callouses?

A callouse is thickened skin over a bony prominence. In the old days when house work was done kneeling, housemaids would develop callouses on their knees.

Q16 Are callouses a problem?

If the callouses are on my feet, they are a great problem to me! Callouses can give a lot of pain and discomfort.

Q17 What is the treatment for callouses?

The principle is that the pressure needs to be relieved.

Q18 Where does the pressure come from?

Most of the time the excess pressure that causes painful callosities are from shoes that are too small. Get a bigger, especially a wider pair of shoes, and most of the foot pain that is so common will go away.

Q19 What else besides bigger shoes will treat painful foot callouses?

It depends on why the pressure is excessive. There is no operation that will work as well as well fitting shoes that are comfortable. However, if the feet are deformed from a fracture or from long years of wearing too tight and too pointed toed shoes, surgery may need to be considered. The principle is that the excess pressure must be relieved.

Q20 What about claw toes and hammar toes? What causes them and what can be done about them?

A claw toes is the result of muscle imbalance and may be part of diabetes with peripheral neuritis. It is particularly important that a diabetic look at and feel their feet daily for hot spots. If your hands are affected with peripheral neuritis so that you cannot feel your own hot spots in your feet, get someone else to feel your feet daily. Diabetes is responsible for more leg and foot amputations than any other cause in the USA. Prevention is much better than the best prosthesis or the best wheel chair.

Q21 So what can be done for claw or hammar toes?

Surgery is the best treatment for claw and hammar toes. The only alternate is custom made shoes or double depth shoes with custom made inserts to accommodate the hammared or clawed toes. The principle again is that the pressure off the tops and tips of the toes must be removed to relieve the pain and the callouses that develop there because of the deformity of the toes.