Friday, April 11, 2014

Will Jenrry Meijia's Bunion Bother Him the Rest Of the Season?

Jenrry Meija had to leave a spring training game after five innings in March because of pain from... a bunion.
So will Meija's bunion bother him the rest of the season? It likely will if the bunion continues to progress.
At the end of March, Terry Collins said that how long he could last in a game would determine his status as a starter. If the bunion continues to bother him, it would prevent his ability to start.
The Mets were attempting to decide between Mejia and Daisuke Matsuzaka as their fifth and final starter.
Pitching coach Dan Warthen had said, "They're both still fighting for a position on the team. They have both thrown extremely well so it's made it very difficult on all of us. Which is a nice thing to have."
Meija had said that his foot felt "good" and that he did not expect his bunion to be an issue. Something was going to be applied to relieve the pressure from the bunion.
"We've always liked Meija's stuff," Warthen said. "We'd just like to see him get deeper into the game without the high pitch counts and see how everything feels afterwards because he really has 'plus' stuff and if he commands the zone and gets hitters out then he deserves the position as well. A young, good arm."
Meija was obviously able to push through the pain from his bunion, since he made his second start of the season last night. In his first outing against the Reds Meija gave up just one run and struck out eight in six innings.
A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe. Bunions form when the toe moves out of place. The enlargement can cause friction and pressure as they rub against footwear. Over time, the movement of the big toe angles in toward other toes, sometimes overlapping a third toe. The growing enlargement then causes more irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists. Bunions can also lead to other toe deformities, like hammertoes.
Meija will have to monitor the progress of his bunion, wear padding, and an orthotic as well. He may need shoes that are wider in the toe box to compensate for his bunion. We'll monitor him throughout the season, as the pain from the bunion may prove too much for this pitcher.
References: NJ.com and SB Nation
If you need foot or ankle surgery and do not currently see a podiatrist, call our Bristol office to make an appointment.
Richard E. Ehle, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Bristol, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

Friday, March 14, 2014

How the Internet Has Changed Clubfoot Treatment

Clubfoot is a common birth defect, affecting 1 in every 1,000 newborns, and is characterized by feet that turn inward, forming a twisted U-shape.
Mary Synder was devastated to learn at her 19 week ultrasound that her unborn baby had clubfoot.
"It was terrifying," said Synder. "It was very emotional. We did a lot of testing and everything to make sure she was going to be OK, but you never really know until you see them when they're born."
Until a decade ago, 90 percent of babies born with clubfoot were treated with surgery that had to be done several times. This would lead to a buildup of scar tissue that could bring a lifetime of pain, arthritis, stiffness, and medical bills. A noninvasive solution along with an Internet campaign by parents changed treatment courses and outcomes.
Alice is now 6 and is seen every year by Dr. John Herzenberg, an orthopedic surgeon at Sinai Hospital in Baltimore. Alice follows all of his instructions: walk back and forth, stand on her tippy toes, and walk with her feet turned out like a duck.
For those who aren't familiar with clubfoot, Alice's feet look perfectly normal. They can turn out just like anyone who wasn't born with clubfoot.
Dr. Herzenberg used the Ponseti Method, which involves a series of full-leg casts that slowly turn out the patient's feet. Casts are changed every three to eight weeks. When it is time for the final cast, which stays on three weeks, a small incision is made above the Achilles tendon. The child will then wear at night special boots that are connected by a bar to ensure the feet stay in the right position.
This method was developed by Dr. Ignacio Ponseti at the University of Iowa in the 1950's when the Spanish physician discovered that an infant's feet could be trained to turn the correct way.
"In the past, before I learned Ponseti, guaranteed I would literally have had to do a surgical operation to take apart and pull together the entire foot," said Dr. Herzenberg.
The Ponseti method is almost painless and patients who have this treatment have a complete recovery with no long-term discomfort. It also costs less than surgery. Ponseti would spend 50 years trying to get other physicians to adopt this method, but would be largely unsuccessful.
"People were falling over themselves to do fancy invasive surgery, and this one strange old guy who speaks softly with a Spanish accent in Iowa was getting sort of ignored by the drumbeat of people who were in favor of surgery," said Dr. Herzenberg, who is one of the top physicians to see for this procedure.
Traditionally, surgeons are trained to operate, and that's how they can make more money. For orthopedists, the Ponseti method brings in less money. So for 50 years the Ponseti method stayed in Iowa.
But the internet changed that. Jennifer Trevillian's daughter was born with clubfoot in 2000 and doctors said surgery was the only course of action. "He started talking about her pending surgery before he physically examined her foot," Trevillian recalls.
Trevillian wasn't going to have any surgery for her daughter. On her new dial-up connection, she began to research the condition. Initially, she didn't find much, but she stumbled upon a support group on iVillage called NoSurgery4ClubFoot. Several days later she and her daughter traveled from Chatham, Michigan to Iowa to see Dr. Ponseti.
"In the amount of time that we would have just been waiting for her to be big enough to tolerate the anesthesia for the reconstructive surgery she was supposed to have, Dr. Ponseti completely corrected her foot," Trevillian said.
Trevillian became a proponent of the Ponseti method, setting up websites with her daughter's story, staying active on support groups, and spreading the message. Parents began to listen, and would travel long distances to find doctors who would perform the treatment.
"The way that the clubfoot treatment pendulum has swung is really a classic example of supply and demand- because once parents found out about it, they demanded it for their kids, and it really forced the medical industry to rethink the Ponseti method," said Trevillian.
Herzenberg agrees with Trevillian's statement. "Clubfoot is a real prototype for how the Internet has changed medicine and how parents have been the driving force in many ways," he says.
Now the Ponseti method is the treatment option of choice by physicians for clubfoot and is recommended by the American Academy of Orthopedic Surgeons. When done properly, 97 percent of children will never need surgery.
Reference: NPR
If you need foot or ankle surgery and do not currently see a podiatrist, call our Bristol office to make an appointment.
Richard E. Ehle, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Bristol, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

Friday, February 14, 2014

Myotonic Dystrophy and Foot Deformities

Myotonic dystrophy is one of the most common myopathies and is inherited through an autosomal dominant gene. Often, many members of the same family have this condition.
The manifestation of this disease does not appear until late adolescence or early adulthood. Early symptoms include muscle stiffness, cramping pains, or difficulty relaxing the grasp. Diagnosis is usually made through an electromyogram.
Characteristics of fully developed myotonic include long, thin, facial expressions with temporal and masseter weakness and frontal balding. The neck will look like a long swan's neck due to the weakness of the musculature. The voice has a nasal quality and speech can become dysarthric, meaning trouble pronouncing words. Swallowing may also be impaired. Cataracts and endocrine abnormalities, like disturbances of the adrenal, pancreatic, and gonadal function are also affected. In men, testicular atrophy is seen, and in females infertility.
Myotonic dystrophy should not be confused with myotonia congenita, also known as Thomsen's disease. In Thomsen's disease there is stiffness of the muscle with difficult in initial movements. No atrophy or mental retardation is found, with no physical limitation. After activity, the muscles loosen, and the patient's movements are almost normal.
Foot and ankle weakness presents early and is associated with stiffness and cramping pains. In general, foot deformities are not severe enough to need surgical correction. Treatment is directed towards the modification of the shoe. Shoe lifts, pads, and wedges are used to help prevent painful feet and aid with gait. If the patient is able to keep up strength in their legs, footdrop can be alleviated by orthotics.
If you need foot or ankle surgery and do not currently see a podiatrist, call our Bristol office to make an appointment.
Richard E. Ehle, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Bristol, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

Friday, January 24, 2014

Guillain-Barre Syndrome And Foot Deformities

Guillain-Barre syndrome is a polyneuropathy that has associated muscle weakness in the upper and lower extremities, respiratory muscle weakness, and respiratory paralysis.
Recovering from the syndrome is possible and patients with mild cases may feel better at the end of a month. Patients who have severe cases  see a longer recovery time, typically years, with residual effects from the illness.
Diagnosis of the syndrome is made with the association of a preceding or accompanying illness that is along the same strains with polyradiculoneuropathy, muscle weakness, and cerebral fluid analysis.
Foot deformities associated with Guillain-Barre syndrome can be put into two categories: those that develop early, and those that develop later as the disease progresses.
Early foot problems include muscle weakness, with pain in the muscles of the thighs, legs, and toes. This pain can be unbearable at times. Treatment should be directed towards easing the pain with analgesics and physical therapy. The position of the lower thigh is important and can be supported by night splints at first and then orthotics. Until muscle strength has been achieved, these devices will be necessary.
Full recovery of the muscles can take up to 24 months. After this time, the likelihood of gaining any more strength and function should not be expected. In patients where muscle weakness is still experienced, the most common problems are foot drop and deformities secondary to the muscle imbalance.
Foot drop can be treated with orthotics and appropriate tendon transfers. Triple arthrodesis has been used to correct some foot deformities, which may include bunions due to muscle weakness.
If you need foot or ankle surgery and do not currently see a podiatrist, call our Bristol office to make an appointment.
Richard E. Ehle, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Bristol, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

Friday, November 8, 2013

Bunion Surgery: Don't Listen To Dr. Oz!

We know that a lot of people watch the Dr. Oz show and believe everything that comes out of his mouth to be the truth. Because if Dr. Oz said it, it must be true, right?
We've encountered this scenario with Dr. Oz and the gospel truth several times in the course of his show, including one of his most famous proclamations: Don't wear flip-flops! Podiatrists across the country pounded their heads into their desks, saying "We've been saying that for years!"
Last Wednesday Dr. Oz had on his program The People's Court judge Marilyn Milian to talk about bunion surgery. At first, we were excited to see him put the spotlight on this topic. Bunions are a common foot deformity we see in our practices, and some people, not all, require surgery to correct the bone.
Dr. Oz warned viewers immediately that surgery may not be the answer to your bunion problem. "Today we are talking about a painful and often crippling condition that could affect more than half of you at some point in your life," Oz said. "Many of you will turn to surgery, but will surgery cause more problems than the bunions themselves?"
Milian discussed her surgery, which was the second time she had it done on that foot. This is an important
fact, which is not factored in to the discussion. "The aftermath is very, very, very painful and involves slow recovery," said Judge Milian, who was in the eighth week of her recovery and said that at week four she was still in terrible pain.
We're not going to go into full detail here about the entire segment (you can watch it here), but what we gleaned from it did not make us happy. First of all, when bunion surgery is done for the second time, your podiatrist needs to go in and break the bone in order to correct the deformity. Not only are you dealing with the pain from the surgery, which can be different for everyone, but from the broken bone. Naturally, this will be more painful.
Secondly, those who are in pain from bunion surgery and have problems afterwards are often those who have not followed their podiatrist's post-surgical instructions to the T. They are likely not icing often enough, elevating, staying off their feet, and taking the prescribed medications. In my career of more than 30 years, patients who follow the directions I give them have great success and recovery. Those who do not follow my instructions suffer needlessly.
Third, how Dr. Oz portrayed the podiatric field and what we do was honestly insulting. He poked fun at the instruments we use during surgery, and overall made a mockery of our field. In case you haven't been paying attention, Dr. Oz, podiatry today is not what it was even 20 years ago. Our doctors have four years of medical school, followed by two to three years of a residency, which is standard across many specialties.
It is unfortunate that the report was severely one-sided. The segment had just one patient's account of having difficulties, and he did not even let the podiatrist who was on give a rebuttal. It is true that these procedures require several months to heal, but the overwhelming majority do well and have an improved ability to carry on daily functions more comfortably.
It is advisable to correct bunion deformities when they are moderate because as they progress they tend to be arthritic and the end result is not as positive and healing is more prolonged. We encourage anyone who has a bunion deformity to speak with a podiatrist, and not listen to a surgeon's advice. Please do not be dissuaded by one person's bad experience.
If you need foot or ankle surgery and do not currently see a podiatrist, call our Bristol office to make an appointment.
Richard E. Ehle, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Bristol, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

Friday, November 1, 2013

Victoria Beckham Considering Bunion Surgery

Victoria Beckham's bunions are so epic, they're part of popular culture.
The former Spice Girls singer and wife to soccer star David is reportedly considering surgery to correct the deformity.
Beckham was warned to have the surgery now or risk "serious problems."
The fashion designer has a notorious love of high heels, even wearing wedge sneakers when she was invited
to throw out the first pitch for a Los Angeles Dodgers game in 2007.
But there is only so long you can wear high heels and stilettos without consequence, and Beckham can expect a huge change in wardrobe if she doesn't have the surgery.
"Vic's been advised that her treatment must be done on both feet ASAP, otherwise, in less than two years, it could cause serious problems," an insider told the British magazine Heat.
"She's been told that if she allows her bunions to get worse, she may never be able to wear heels again."
Besides never being able to wear heels again, which is no tragedy, Beckham's feet will be more likely to get arthritis, face further disability, and have problems with her legs, hips, and spine because of gait issues from the bunions.
The thought of getting rid of her heels and wearing flats for the rest of her life is apparently filling Beckham with horror and she is realizing she needs to do something about her painful bunions.
"She's relenting and saying she would be swayed to do it this winter. At least that time of year, it's easier to keep her feet under wraps and wear flats," the insider said.
If you need foot or ankle surgery and do not currently see a podiatrist, call our Bristol office to make an appointment.
Richard E. Ehle, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Bristol, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

Friday, July 19, 2013

Tips To Follow When Recovering From Foot Surgery

It's likely you've been feeling a lot of anticipation as your foot or ankle surgery date approached. It is normal to feel anxious, scared, upset, worried, or frightened about surgery of any kind. Remember however, that foot and ankle surgeries are rarely life-threatening and the outcomes will make you feel happier and healthier!
After your surgery you will be discharged from the hospital 1-4 hours after the procedure has been completed. Overnight stays are rarely prescribed, but when you get to leave the hospital is determined by your podiatrist and case manager. Previous to your surgery we will go over your discharge instructions and make post-operative appointments. These are very important to keep.
Your podiatrist will give you a prescription for medications you can take at home. Make sure to fill them and take them as prescribed. If you had stopped taking any medications before your surgery, you may start taking them again.
You will need someone to drive you home and possibly stay with you for the rest of the day. Some patients, especially the elderly, may require more care at a nursing or rehabilitation center. If you require therapy, your podiatrist and nurse will let you know. Be sure to use all equipment your podiatrist has provided you with for your post-operative care: walking boot, walking cast, bandages, crutches, and special shoes. These will help you recover quickly, efficiently, and healthfully.
When you return home, watch for signs of infection, which may include redness, fever of 101 degrees or more, swelling, and/or drainage at the incision site. You should also watch for signs of decreased circulation to the foot and ankle, which may include increase in pain, toenail beds that turn blue in color, foot or leg turns pale, coldness of your foot or ankle, and/or tingling and numbness.
You will likely experience pain and numbness for as long as 24 hours after surgery because of the mild anesthesia used at the end of surgery. After this wears off it is normal to feel moderate discomfort in your foot or ankle, as well as the sensation of pinching and pulling. When you put your foot down you may also feel throbbing. These are all normal sensations and you should not be alarmed.
After surgery elevate your foot or ankle to help with the pain and swelling. You should take your pain medication for the first week after your surgery. Take it regularly, even if you are not in pain at that moment. Do not let your pain escalate to intolerable heights. Ice your affected area 20 minutes every hour.
You will go home with a surgical dressing on your foot. Do not remove the dressing, even if it has become loose, dirty, or wet. It is normal to see your dressing soak up discharge from your surgical incision. However, if the dressing rapidly becomes bloodied, soiled, or wet, call the office immediately.
Your podiatrist may have prescribed an antibiotic to prevent infection. It is important you take the entire course of medication to prevent infection in the surgical site. If you take birth control pill, you will have to use another form of contraception to prevent pregnancy.
After your dressing has been changed and bandages have been put on, you should try not to get them wet. Avoid taking a shower, as even when you put a shopping bag over your foot, leaks can occur and may potentially cause infections at the surgical site. Consider taking a bath instead as you can dangle your foot out of the bathtub while you are cleaning up.
If you need foot or ankle surgery and do not currently see a podiatrist, call our Bristol office to make an appointment.
Richard E. Ehle, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Bristol, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

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