foot rmtsAn informational newsletter for Mpatients of APMA member podiatrists

YOU'VE GOT TO MOVE IT,I MOVE IT ESPECIALLY

WHEN TRAVELLINGDeep Vein Thrombosis (DVT) and

How to Prevent Clots during Traveltravel this summer? It you'll be spend-

ing long periods of time sitting still (either in your car or onan airplane) you may want to take heed of deep vein throm-bosis (DV1). What is DVT? It can be painful and danger-ous if you don't know what it is and how to identify it whileyou're travelling.

DVT can affect anyone but is most prevalent in adults over60 years of age. DVT mainly affects the larger veins in thelower legs and thighs. A blood clot can develop and blockblood flow, causing pain and swelling. A blood clot thatbreaks free and moves through the bloodstream is called anembolism. An embolism can lodge in the brain, heart, orlungs and cause severe damage.

The risk factors for DVT and blood clots include:• long periods of bed rest;• cigarette smoking;• fractures in the pelvis or legs;• giving birth within the last 6 months;• heart failure;• medications such as estrogen and birth control pills;• obesity; and• recent surgery.

There are ways to avoid DVT if you happen to have anyof these risk factors. First and foremost, moving yourlegs often during long plane trips, car trips, and othersituations in which you are sitting or lying down for long

periods of time can help prevent DVT. You can do anklecircles, knee bends, and thigh lifts right in your seat. It'salso important to get up and move during plane travel. Ifyou are travelling by car. stop periodically and walk for afew minuies. By moving around, you decrease your riskof DVT significantly.

Clinical evidence suggests that wearing compression socks ortights while travelling reduces the incidence of D\'T on longflights, especially if you have any of the risk factors identifiedabove. These products help improve circulation, which canbe particularly important to decrease the risk of DVT.

BayCity Assoc. in Podiatry, Inc.3901 Liberty StErie, Pa. 16509814-864-2360

Dr. Frederick J. TomassiDr. Daniel J. Olson

Member

"NMAnacursa Padisuic Medical Associatia,,

footprints Page 2M!

External Fixation\iu onl y h,ivc noticed 11101-C IN Onk V.0 iic:tc 1t:,n hi: LI i

their feet and ankles lately. This hardwaic is an external lixi-

tion device, and it 's there to aid in healing and bone growth.

External fixation can be used for Fractures, fusions (removing

the joint surface and healing two bones together), diabetic foot

reconstruction, and even to immobilize the foot and ankle to allow

wounds to heal. It is called external fixation" because the device

is outside of the body,as opposed to screws or plates that you

cannot see that may be surgically implanted. Each method has

advantages and indications for certain situations.

External fixation is a method of immobilizing hones to allow a

fracture 10 heal External Fixation is accomplished by placing pins

or screws into the bone on both sides of the fracture. The pins are

then secured together outside the skin with clamps and rods. The

clamps and rods are known as the-external frame.

The advantage of this external frame is that it can be manipu-

lated in three dimensions to place the foot and ankle in the

proper position, which is especially important in complicated

foot and ankle reconstruction. Other advantages of external

These coriplica.edlookug. htt!I\ dc" ftc.- ire alitillici impiii

tant technology available to the podiatric surgeon to treat a

variety of foot and ankle conditions.

Doctors of podiatric medicine are podiatric physicians and

surgeons, also known as podiatrists, qualified by their educa-

tion, training, and experience to diagnose and treat conditions

affecting the foot, ankle, and related structures of the leg.

:n\.uI tic that

quickly and easily

applied and gives ac-

cess to wounds that

may he present with

trauma. The risk

of infection at the

site of the fracture is

minimal, but there

is a risk of infect ion

where the pins are

inserted through the

skin into the hone

"Show-biz Toes"—What Are They Really Worth?If you read the tabloids or watch entertainment television, you may have learned recently that some movie stars are opting for cos-

metic foot surgery. These stars of screen and stage are choosing to undergo surgery to correct, unsightly problems that are not affecting

their gait or comfort; they are having surgery just to look better. While some surgical procedures that are done to correct painful

problems often have cosmetic implications, opting for foot surgery without pain may not be a good choice to make.

According to the American Podiatric Medical Association (APMA), surgical procedures of the foot and ankle are general 1';

performed for relief of pain, restoration of function, and reconstruction of deformities. They may have the additional

benefit of improved appearance. Surgical procedures performed for aesthetic purposes carry the same risks as

those performed for medical reasons. Patients considering surgery of the foot or ankle, whether for medi-

cal or aesthetic reasons, are advised to consult a member of the APMA."

Choosing to undergo any surgical procedure requires careful consideration. Podia-

trists performing surgery for medical or aesthetic reasons should have appropriate

training, experience, and credentials to perform surgery properly, manage post-

operative care, and treat possible complications.

Dociors Of pocliat nc medicine are podliflrk physicians and surgeons. also known as podiatrists, qualified by their cdui.i

training, and experience to diagnose and treat conditions affecting the foot, ankle, and related structures of the leg.

This patient information newsletteris supported by an educational

grant from Spenco, Inc.

AMERICAN PODIATRIC MEDICAL ASSOCIATION9312 Old Georgetown Road, Bethesda, MD 20814-1621

• www.apma.orgSPENCO

foot rAlitsAn informational newsletter for patients of APMA member riodatrisls

Shocking Results for your Heel PainRunners have it, and movie stars have it. this of people have itin the morning when they get out of bed. We get it after a trip tothe mall or the grocery store. What is it? It's heel pain, medicallyknown as plantar fasciitis, and it's non-discriminating and can be

really annoying.

Just think for a moment about that lonely hone in the bottomof your foot, the heel bone. This bone, the largest in our foot,withstands a great deal of abuse as we cram it into our shoes day

after day and subject it to our full weight with every step on hardsurfaces. With such abuse, it's no wonder that plantar fasciitis isa problem for so many of us. Podiatrists say thai heel pain is thenumber-one complaint of patients.

Common treatments like anti-inflammatory medications, cortisoneinjections, stretching exercises, and custom orthotics (shoe inserts)can often clear up the problem. In some cases, however, patientscontinue to have pain after trying these traditional conservativetreatments, and so more aggressive treatment may be advised.

Enter Extracorporeal Shock Wave Therapy, or ESWT. whichhas emerged as an effective treatment option for patients withchronic plantar fasciitis. ESWT delivers focused shock waves to

an intense, but very short, energy wave traveling faster than thespeed of sound. The word "extra-corporeal" means "outside thebody" and refers to the fact that the shock waves are generated

outside the body.

Shock wave therapy is thought to work by inducing niicrotraumato the tissue that is affected by plantar fasciiiis. This microtraumainitiates a healing response by the body. This healing responsecauses blood vessel formation and increased delivery of nutrients

to the affected area. The microirauma is thought to stimulate arepair process and relieve the symptoms of plantar fasciitis.

Low-energy shock wave treatments can be given as a series of three

or more treatments. The low-energy shock waves are generally notpainful, or can be mildly painful. On the other hand, high-energyshock wave treatments are given at one session. High-energyshock wave treatments are quite painful, and some type of anesthe-sia is needed. Either a regional block or general anesthesia can headministered for the high-energy treatments.

Your podiatrist has extensive training in the diagnosis and treat-ment of all manner of foot conditions. Take advantage of yourdoctor's expertise to alleviate your heel pain.

l pain. A shock wave is

--'— __

BayCity Assoc. in Podiatry, Inc.3901 Liberty St.Erie, Pa. 16509814-864-2360

Dr. Frederick J. TomassiDr. Daniel J. Olson

Member

MMAPodtnr M,,,hrI AoUtt,,.,

. PO't'footprintsSelf-Assessment of your Feet -When to See a PodiatristEvery local drugstore has aisles of "do-it-yourself" medical fixes. Foryour feet they have blister and corn pads, insoles, fungus sprays, and nailclippers. So when you have foot and ankle problems, how do you knowwhen to deal with them at home using over-the-counter (OTC) products

and when to sec the podiatrist?

• Blisters on your feet can often be handled at home without profes-sional intervention, lithe blister pops, cover it with a sterile dressingor Band-aid and watch it carefully to make sure it heals properly.

• If you suspect that you have an ingrown nail. it is best not to useOTC products. See your podiatrist as soon as possible to avoid thepossibility of infection. The doctor can safely remove the ingrownnail and may be able to alleviate the problem entirely for the future.

• OTC wart removal medication is relatively mild but can cause ulcer-ations if left on too long. You can try to alleviate warts on the feetwith these products, but the podiatrist has more effective medicationsand can also do simple procedures to rid you of wails. Wart remov-ers should never be used if you have neurupathy except under thesupervision of a podiatric physician.

• Despite numerous blogs and articles about treating onychomycosis(fungal nails) and warts with Vicks VapoRub, duct tape, bleach, whitevinegar, and other household items, there are no scientific data orevidenced-based research studies to support these treatment options.

• Sprains and strains can be treated at home initially with the "RICEtreatment"- rest, ice, compression, and elevation. If swelling is per-sistent, a visit to the podiatrist's office is in order to determine if there

are any broken bones.

Occasionally home remedies can cause a new p101)1cm or make existingproblems worse, so use them all in moderation. Anyone with diabetesor a peripheral vascular disease PVD) who has loot and ankle problemsshould always opt to visit the podiatrist for even minor concerns. Peoplewho do not have diabetes or PVT) should also be wary of pain, colorchanges, drainage, swelling, heat, or open areas in or on any part of thefoot or ankle. These signs warrant a professional's experience in dealingWith the problem.

These Shoes Were Made fi ,for Walking (and Running)Evaluating the Life of Your Athletic Shoes

Just like milk in your refrigerator and cans in ',

your pantry,your athletic shoes have a specthc -,AN

shell life. Unfortunately, shoes have no expira-tion date noted on the bottom. Nevertheless,there are a number of factors that you shouldconsider before sending your shoes "out to pasture."

How long your athletic shoes will last depends on several factors, in-cluding how often you wear them, where you run or walk, how yourfoot functions, and your workout conditions and mileage. Contraryto popular opinion, however, you cannot always tell whether a shoe isworn out by visual inspection. With the technologies available today,the outer sole can hold up and not show deterioration even after theshock absorption and stability capacities of the shoe are gone.

Wearing old athletic shoes, specifically for running, or wearing thewrong type of shoes for your foot or for a specific sport can lead toinjuries. For example, running in a shoe that no longer providestraction, support, and cushioning can lead to a number of musculo-skeletal complaints, among them heel pain, shin splints, and stressfractures. A basic rule of thumb for runners is to replace shoes every300-500 miles. Other factors to consider are:

• Type of shoe/type of foot: Ask your podiatrist about specific shoesthat are best for your loot type. Some shoes are designed to ac-commodate prunarion or supinanon, and your doctor can give you

good masons to choose one brand over another.

• Environment: A humid climate can contribute to a shoe's rapidbreakdown because running in a wet shoe will overstretch the up-per part of the shoe while over-compressing the lower part.

• Body type: Your body weight is a big factor in determining whichshoe is best for you. In general, the more you weigh, the morecushioning your feet will need to withstand the impact.

• Usage: The amount you wear your shoe and how many miles youlog can also affect the life of your shoe. Runners and walkers caneasily track their mileage. Shoes used outside will break down"ore rapidly than those in the gym.

ut half-way through the life of your shoes, buy a second pair tote in during workouts. Having a newer pair as a point of reference

ill also help you identify the feel of shoes that have run their course.

it feet can last a lifetime, but your shoes are not designed to do the'e. Replace worn athletic shoes as often as needed and work withJr podiatrist to keep your feet healthy and injury-free.

Doctors of podiatric medicine are pudiitr 11, 111', 1, 1;111 md surgeons, also known as podiatrists, qualified by their education,

training, and experience to diagnose and treat conditions affecting the foot, ankle, and related structures of the leg.

This patient information newsletter

is supported by an educationalgrant from Spenco, Inc.

AMERICAN PODIATRIC MEDICAL ASSOCIATION9312 Old Georgetown Road, Bethesda, MD 20814-1621

• www.apma.orgSPENCO'( nit V