Wednesday, April 24, 2013

The Doma, A Two-Toed Tribe

The Doma, also known as Vadoma, or Wadoma, are a tribe living in north Zimbabwe, in the Urungwe and Sipolilo areas on the Zambezi river.
A small minority of this tribe have something in common: they have a foot deformity condition called ectrodactyl. Ectrodactyl is a condition when the three middle toes are not present on the foot; only the outer two toes are present and turned in. This has resulted in the tribe being called "two-toed" or "ostrich footed".
Ectrodactyl is an autosomal dominant condition derived from a single mutation on chromosome number seven. Those who have this deformity are not handicapped and integrate well into the tribe. The condition continues because of the small genetic pool among the Vadoma and tribal law that forbids marrying outside the tribe. It is believed this deformity may be a help in climbing trees.
Ectrodactyl is also known as a split foot malformation and it can be described as "claw-like". Those with ectrodactyl can also have hearing loss. It does occur throughout the world, in 1 in 90:000 births while limb defects occur in 1 in 1000 births. Ectrodactyl occurs in animals as well, affecting cats, dogs, mice, salamanders, cows, chickens, and others.
The Vadoma are an example of the genetic effects of a small population size and genetic defects with their deep inbreeding. They are also an isolated tribe, and have developed and maintained ectrodactyl better than other groups.
If you have a foot deformity, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

Wednesday, April 17, 2013

What Shoes Are Good For My Bunion?

As podiatrists, we've seen it before. Women come hobbling into the office and tell us they can't stand the pain from their bunion any longer. They plead with us, "Make this pain go away!". And we are more than happy to help, of course. During our consultation, I will often look at the patient's shoes and what I see gives me podiatric nightmares.
High heels. Stilettos. Pointy-toed shoes. Too-tight shoes. Too-small shoes. Yes, these are all shoes that will aggravate a bunion, yet my patients with bunions don't seem to realize the damage they are doing.
While bunions are not caused by the shoes you put on your foot, if you already have a bunion, you will be helping the deformity to progress much quicker. Here's why your favorite shoes are causing your bunion to get bigger:
  • Tight shoes. Peep-toe and pointed-toe shoes are bunion's best friends! The tight and small toe box compresses toes together and leads to a slight or severe realignment of the big toe, which is a bunion. Try this: take your hand, and with your other hand, squish your fingers together. Now hold it there for 8 hours. How do your fingers, especially your thumb, feel after that? Probably not so good.
  • High heels. Yes, we know, high heels make you feel sexy and feminine. How does that bunion make you feel? Still sexy? It's certainly very sexy to look at, isn't it??? Any time you put your feet in shoes higher than two inches, you are shifting your entire body weight forward, creating this massive pressure, up to seven times, and weight on your toes and balls of your feet. Ever wake up in the night and your arm has fallen asleep because you were lying on it funny? That's how your feet feel at the end of the day, after being in high heels.
  • Flat feet. Flat feet are often something you cannot help- flat feet can be genetic. People with flat feet often wear ballet flats, which are just as bad as high heels and pointy-toe shoes as aggravating bunions! Ballet flats have no arch support and this makes a primo environment for a bunion to worsen. 
So what shoes are good for a bunion? The American Podiatric Medical Association has a list of Seal Accepted footwear. You can check out the whole list, but companies to look for are: Orthaheel, The Walking Company, Chaco, Inc., Dansko, Dockers, Aetrex, Patagonia Footwear, Clarks, Merrell. These are shoes that are going to cost you more, but when you buy fewer, smarter pairs, you feet will thank you in the long run.
Reference: APMA
If you have a foot deformity, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

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Wednesday, April 10, 2013

Will Yoga Help My Bunion?

When you have a bunion, you're sometimes so desperate to avoid pain, you'll try anything. Over-the-counter
remedies, medications, and herbal remedies, anything that will make that bunion stop hurting. Sometimes these remedies will help relieve the symptoms and pain, but they will not stop the progression of the bunion.
Some patients will ask if exercise will help their bunion, and while there are several types that will, most exercise will aggravate your bunion. For all yogies out there, good news! Yoga is one type of exercise that will help alleviate the symptoms of bunion pain.
Yoga instructor Jennifer LaRue Huget was asked by a client if yoga would reverse the progression of her bunion. The client had heard that by putting the affected foot up against a slanted wall or board and stretching out the other leg, you could stop bunions from forming.
Huget looked up in her favorite health book, Yoga as Medicine by Timothy McCall, but couldn't find the answer she was looking for. So she called McCall, editor of Yoga Journal, and asked him. He had never heard of the pose her client was talking about, but had heard of a pose that may help spread out the toes and metatarsals (Stand with feet side by side, a few inches apart and step the affected foot forward. Sickle your foot inward and rotate the heel inward and lower it down.).
McCall had heard of a woman whose bunion stopped progressing after she practiced a certain yoga move, but he couldn't remember which move it was. But, he acknowledged that bunions are a bone problem, and likely wouldn't be healed by yoga.
Yes, bunions are a bone problem with little that can be done to stop its progression. Patients who wear high heels or tight shoes can slow progression by switching to other shoes, and orthotics are often found to be helpful, but bunions are a mechanical problem with the bone.
"Once bones become altered, that wouldn't be very easy to change," says McCall, even with yoga and strength building exercises. "Spreading the toes and metatarsals, creating space, perhaps could undo some of the damage" done by wearing too tight shoes.
McCall feels that "People want to apply yoga in a quick-fix way. But to help with most chronic conditions, you need to establish a pattern of regular practice over the long term. If you have a bunion and you do yoga almost every day for the next several years, you will certainly feel better. But I don't think your bunion will be fixed."
Dr. Rock Positano, a nonsurgical foot specialist at the Hospital for Special Surgery in NYC, agrees. "When you develop a bunion, the big toe is not functioning as well as it should. So other parts of the foot, like muscles, tendons, and ligaments, have to take up that slack. Yoga gives more strength and flexibility to the area around the bunion and takes some of the stress off the big toe, making the foot work more efficiently. Anything that gives the foot more stability and more flexibility is good for a bunion deformity because it allows the other parts of the foot to pick up the slack for what the big toe is not doing."
I would have to agree as well. When starting a yoga regimen, I would not go in expecting that your bunion is going to be cured- the progression will reverse and it will disappear. The only way a bunion can be "reversed" is through surgery. Your pain, discomfort, and symptoms however, may be alleviated and you may be able to go longer before having surgery.
Reference: Washington Post and Allure.
If you have a foot deformity, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

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Wednesday, April 3, 2013

What Is Podoconiosis?

In this country, it's likely you've never heard of podoconiosis before. Podoconiosis is a disease of the lymph vessels of the lower extremities that is caused by chronic exposure to irritant soils. It is the second most common cause of elephantiasis and is characterized by prominent swelling of the lower extremities, especially the feet and ankles, and leads to disability and deformity.
The history of the condition goes back to the 19th century, when parasitic filariae were discovered to be the cause of elephantiasis, also known as tropical lymphedema. It was believed, at the time, that filaria was the sole cause of the disease, but it became apparent that the distribution of the two conditions did not overlap and scientists recognized that some forms of elephantiasis were not associated with filariae. Ernest W. Price, a British surgeon living in Ethiopia in the 1970's and 1980's studied the lymph nodes and vessels of those afflicted with the disease. Using a light microscope, he discovered macrophage cells weighed down with micro-particles in the lymph nodes of the affected extremity. Then, using an electron microscope, he found the presence of silicon, aluminum, and other soil metals. Price demonstrated that the lymphatic vessels of these patients experienced edema, and eventually collagenization that leads to complete blockage.
The primary symptom of podoconiosis is swelling and deformity of the feet and ankles. The swelling can be either soft and fluid, or hard and fibrotic. Multiple firm nodules will develop over time, as well as hyperkeratotic papillomata that resembles moss. Because of this, podoconiosis is also known as Mossy Foot. Before lymphatic failure, the patient may exhibit itching, burning, hyperkeratosis, plantar edema, and rigid digits. Like with elephantiasis, fusion of the toes, ulceration, and bacterial infection may occur. The disease has an acute component where some patients have moments of foot and ankle warmth, firmness, and pain.
Podoconiosis is most commonly seen in highland areas of Africa, India, and Central America. The highest rates of occurrence are in Uganda, Tanzania, Kenya, Rwanda, Burundi, Sudan, and Ethopia, where the prevalence is as high as 9%. Nearly four million people worldwide suffer from this disease. The incidence of podoconiosis increases with age, due to the cumulative exposure to irritant soil. It is rare to see podoconiosis in children 0-5 years old, and the incidence rapidly rises in the 6-20 age group, with the highest percentage in the 45 plus age group.
Prevention and treatment are characterized by avoidance of the irritant soil . Wearing shoes is the most crucial thing in preventing this disease and further deformity. In Rwanda, where the incidence of the disease is high, the government has banned walking barefoot in public to curtain soil-born disease like podoconiosis.
Even once the disease has begun, vigorous daily washing with soap and water, application of an emollient, and the nightly elevation of the affected extremity has been shown to reduce swelling and disability. Compression wrapping has been shown to be effective in other forms of lymphedema, but this therapy has not been proven in podoconiosis.
If you have a foot deformity, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.


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