Kyrie Irving's Sprained Foot

I am not typically a basketball fan.  In fact, it is probably on the bottom of my list of major professional sports.  However, after my first week at my new office, I am taking some time just to relax.  After all, this is the 1st weekend in a while on which I did not have to go work at the office preparing it to see patients.

As many of you know, I spent the 1st 29 years of my life in Northeastern Ohio.  I was born in Akron and my undergraduate degree is from The University of Akron.  I went to podiatry school in Cleveland and did my residency in the greater Cleveland area.

So, even though I am not a huge basketball fan, I pay attention when a team in Cleveland is doing well.  I do not think it is fair to call me fair-weather as I have been to plenty of Browns, Indians, Cavs, and minor league hockey games in downtown Cleveland and even in Richfield at the old Coliseum when these teams were not doing well.  I also really appreciate LeBron James returning to our hometown to try to bring the people of Northeastern Ohio a championship.

Therefore, I admit I have been following the Cavs.  Unfortunately, with Kevin Love's season being over, I am concerned with Kyrie Irving.  Reports say he has a foot sprain and he is playing with a limp.  As a podiatrist, I wonder if there is more than a sprain.  I start to think about a stress fracture.  After all, a painful foot and limping is not normal.  Often, when someone keeps walking on a sore foot or ankle, it can make the condition worse and harder to treat.

I just hope that Kyrie's injury does not worsen as he and Lebron compliment each other well and would not want any long term problems.

As I type this at the end of the 3rd quarter of game 4 vs. the Bulls, things certainly do not look good for the Cavs.  However, in sports anything can happen.

5 common things medical professionals can overlook with treating the foot and ankle

To continue my "5 things" thoughts from earlier in the year, I want to focus on some of the things I see that medical professionals can commonly overlook when treating foot and ankle issues.  This list includes some things that I, myself, might not always have noticed at first glance as a podiatrist.

1) Poor circulation:  There is a common misconception, especially with general medical practitioners, that if one can feel a pulse and the foot is warm then the circulation is OK.  I have seen many patients that I have diagnosed with peripheral vascular disease in the lower extremity that has been overlooked by some pretty well-trained and respected clinicians.  Often times, these patients are told it is just their neuropathy or arthritis.  I always become suspicious when a patient admits cramping at night, when they have been or are a smoker, and when they have a history of cardiac bypass and stenting.  A simple doppler test that is abnormal can give an indication to me that can be followed up by other studies.

2) Stress fractures:  A stress fracture in the foot (usually a metatarsal) is often overlooked.  These can be "hairline" fractures caused from injury or non-traumatic simply from a change in activity.  Problem is, normal everyday x-rays usually do not show an early stress fracture.  These are read as negative by radiologists who do not have an opportunity to examine the patient.  (These studies are, in fact, negative most of the time).  I have treated true painful stress fractures for several weeks diagnosed clearly by MRI that not once showed up on regular x-rays.  If a patient comes in with a swollen foot more painful after activity, I tell my patients, "if it looks like a duck, and quacks like a duck, it's probably a duck."  In other words, if I think it is a stress fracture due to what I see, I can do little wrong by treating it as such with immobilization.  Usually, if a stress fracture is caught earlier it resolves more quickly.

3) Not giving an injection when appropriate:  With a lot of conditions we treat, injections are very helpful.  I often see, and was guilty of this earlier in my career, doctors with-hold injections in favor of conservative treatment.  This is fine, if after discussion with the patient, that is what is desired.  However, I have seen people who do not mind injections come in with severe heel or acute arthritis inflammation that have went to other doctors and were given very little treatment.  If appropriate, an injection of a corticosteroid can quickly and safely give a patient great relief.  There is nothing wrong with giving an injection on an initial visit if indicated.

4) Giving an injection when inappropriate:  On the other hand, I have seen injections given when they likely maybe should not have.  Fortunately, it is rare to cause significant harm from giving an injection, but doing so may delay resolution of the condition or frustrate a patient because other treatment is often not given and only temporary relief is gained.  A stress fracture is a perfect example.  A quality practitioner will often get a negative x-ray and inject a painful foot.  If a stress fracture is present, the corticosteriod can delay healing if injected in the area of the fracture.  Also, I have seen injections in areas that are debatable for injecting.  A good example is a tendon.  Corticosteroids can increase the risk of tendon damage and rupture.  Thankfully it is not common, but, in my opinion, conservative immobilization can often heal these patients without taking this risk.

5) Not advising a patient on footwear:  Especially here in Florida, flip-flops and flimsy shoes are common all year.  I have seen patients treated by more than one other doctor when no one talked to the patient about his or her shoes at all.  Many foot and ankle problems will not resolve if people do not at least change their shoes or shoe wearing habits a little.  Sometimes a change in shoes to something more supportive will be all it takes to alleviate foot pain.

So there is my list of "5 common things medical professionals can overlook with treating the foot and ankle."  Please keep in mind that good practitioners disagree on how to appropriately treat many conditions.  I do not make this list to criticize, but instead just highlight some things I have learned throughout my over 10 years of experience as a podiatrist.

A Stress Fracture from Golf?

Yes, it is true.  The best swimmer in the world injured his foot, not by kicking a pool deck, but from golfing.  I read the article and found that it wasn't actually from golf itself but from walking the golf course.  Apparently, Phelps walked something like 20 miles over the course of the tournament.  This lead to the injury, a stress fracture of his foot.

There is a lesson in this for all of us.  A stress fracture can occur over time.  It does not have to be a single instance.  In fact, in my experience, Phelps is a perfect example of what can lead to a stress fracture.  It is usually when we walk too much or wear a new or ill-fitting pair of shoes and are too active that leads to stress on the bone.

A stress fracture can lead to a swollen foot that is very painful to walk on.  It does not always even show up on x-ray but left unchecked can lead to a complete break in the bone (usually a metatarsal).  This can be much more difficult to treat and may even require surgery to repair.  Therefore, it is important to see your podiatrist right away with any foot pain.

Alex Ovechkin's Broken Foot

As I have said before, I am a Penguins fan so I am biased to say Sidney Crosby is the best player in the world.  However, last evening, the Washington Capital's captain beat Sidney Crosby out by winning the Hart Trophy as the NHL's MVP.

As a podiatrist, I was also interested to learn that Ovechkin played a few playoff games and for Team Russia with a broken left foot.  Surprisingly he admitted not telling doctors about it until after the season.  It is thought that he sustained a "hairline fracture" blocking a shot in the Capitals / Rangers playoff series.

This, in my opinion, is unwise as a hairline fracture or "stress fracture" can become a "full fracture" and lead to a break in the bone that can heal in a poor position or not well.  Sometimes surgery, especially in a pro athlere, is then needed.

Usually stress fractures cause swelling in the foot and pain especially after being on the foot for awhile.  I have seen countless stress fractures that are not visible on x-ray but very evident on MRI.  Therefore, just because one recieves a normal x-ray reading does not mean nothing is wrong.  Any foot pain, especially with severe swelling, should not be overlooked.

It's That Time of Year Again

I admit I am a bit late talking about this, but being from the North I am not quite used to putting up Christmas decorations in 75 degree weather.  As the holiday season approaches, may of us are undoubtedly busy and on our feet.  Some of us do a lot more walking with all our holiday shopping than we are used to.  Our feet and ankles don't like this sudden increase in activity and this is when we set ourselves up for "overuse injuries."  These injuries include: stress fractures, tendonitis, plantar fasciitis, as well as pain from any arthritis that might be present.

Of course we want to avoid foot and ankle pain, so the best advice I can give is to wear a supportive shoe.  If you do experience foot pain after a long day shopping, icing is a safe way to bring down pain and inflammation.  If the icing still does not help, do not put off seeing a podiatrist as often these conditions can just worsen and be more difficult to deal with and also take longer to treat.

Barefoot running

There is a lot of discussion in the media right now involving barefoot running.  Many people claim it is a wonderful way to run.  However, as a podiatrist, I will have to say I can not agree that it is safe.  Many different things have to be considered.  Does the runner have a high arch foot?  If this is the case, I do not believe that the foot can adapt to the ground well.  This sets the runner up for stress fractures and degenerative arthritis.  If the runner has a low arch or "flatfoot,"  I believe that this will make it hard for the runner to go through the propulsive phase of running setting him or her up for tendinitis and various deformities such as hammertoes and bunions.  The running surface also needs to be considered.  A sandy beach is probably better than concrete.  When a patient tells me going barefoot is natural, I often tell them that even if that is true, the ground we often walk on is not.  I tend to believe shoes are important, especially when we are active.  I have seen a lot of injuries from barefoot activity.

Moving

Here I go again, it is moving time for my family.  Over Thanksgiving weekend, my entire family made the long trip down to Florida from Pittsburgh.  This reminds me of the many patients I have had that have ended up with various foot problems while moving or helping a friend or family member move.  Those that are not used to being on their feet often experience certain over-use injuries such as stress fractures, tendonitis, and plantar fasciitis.  Even over the past week I have developed some occasional arch pain.  The best way to prevent problems is to wear a good supportive shoe and orthotic.  (Yes I have heard of people unpacking barefoot).  Of course should problems develop make sure you see your local podiatrist.