Kelly Ripa's Broken Foot

Yesterday Kelly Ripa came out to host her morning show with a walking boot on her left foot.  It turns out that the day before she "stepped wrong" on a weight left on the floor during her dance class.  She later found out that she broke multiple bones in her foot after hearing a "bubble wrap" sound.  She is told that she does not need surgery but will require 6 weeks of immobilization in the boot.  I am not sure whether or not she was joking but she says for her it will be "more like 3."

As a podiatrist who treats foot fractures, I find this interesting.  Fractures anywhere in the body take at least 6 weeks to heal.  So she is not going to cut down her time to 3 weeks unless she wants to have a non-healing fracture or even further damage that may require surgery.

I also found interesting her choice of a shoe for the other foot.  (Apparently she was advised to wear an appropriate shoe on the other foot and refused according to her discussion on her show). One does want to balance a walking boot with a shoe of equal height on the other foot, but she is not weight bearing yet.  She is wearing a fairly high heel on her right foot and I certainly worry about a foot or ankle injury on the right limb as well.

The National

Since Orlando is only a couple hours away, I was excited to see that the National Scientific Seminar of the American Podiatric Medical Association was to be held in Orlando this year.  I decided that I would attend my first national conference and just returned home to Spring Hill.  Podiatrists from all over the country came to Orlando this past weekend.  I must say I was very impressed with the conference.  I have, of course, attended many conferences more regional in the past, but this one was so much bigger.

In addition to well respected speakers, the exhibit hall was great.  I have again found products and services to make the practice and care I provide to my patients even better.  I am eager to get to the office Monday morning and get to work!

A Personal Milestone

I am the type of person who does my best to avoid bragging.  I really do not have an ego and consider myself a fairly humble guy.  However, I am also a person who has been blessed with many experiences throughout my life and enjoy reflecting on my life.  July 2015, specifically July 10, 2015, marks the completion of 10 years in private practice.

I hope readers of this blog will bear with me as I have a little fun and look back on these 10 years:

Indianapolis:
July 11, 2005 - August 2008

As a doctor fresh out of residency, this was a time to grow in my career.  Medical school and residency does not do a lot to prepare someone for private practice and I learned a great deal during my 3 years here.  Indianapolis is a wonderful city and my wife and I will certainly treasure our time here.

Pittsburgh:
September 2008 - October 2011

I specifically lived and worked a little south of the city in the West Mifflin area.  (About 6 miles south of downtown).  Growing up in NE Ohio (and a Cleveland sports fan), I was not raised to love Pittsburgh, but it is a unique and beautiful city.  With me being from Akron, and my wife being from Dubois, PA, this put us exactly in between and 100 miles away from each of our hometowns.  In Pittsburgh, I learned a lot about caring for patients in the hospital setting and wound care.  These are certainly valuable skills.  The surgeries I performed here completed my requirements for board certification which I achieved during the end of my time here.

Winter Haven (Polk County), Florida:
November 2011 - April 2013

You can see from the Pittsburgh picture that snow was always part of my winters.  I was thrilled to move to "Winter Haven" and haven't seen snow since.  I would say that my experience here was concentrated on "practice management."  Having learned the medicine part pretty well, this allowed me to focus on learning how to run a practice.  More than just billing and coding, but also providing valuable services that give patients great outcomes.

Spring Hill, Florida (Absolute Healthcare, LLC):

April 2013 - April 2015

Coming to Spring Hill and working with a multi-specialty group was invaluable.  I have a great deal of respect for Dr. Gaurav Malhotra.  Working with an MD helped me figure out where I fit in with the medical team to care for patients.  Having only worked with podiatrists in the past I missed different viewpoints.  Medicine is changing, the primary physician is going to direct care in the future to cut down costs and focus on prevention.  Though no one really knows exactly where we are headed with all of this, my time here allowed me to better determine my role in patient care within the medical team.

Spring Hill, Florida (Donald J. Adamov, DPM, PA):

May 2015 - Present

Never would have I imagined, as a young doctor going into work for the 1st time on July 11, 2005 in Indianapolis, that 10 years later I would be practicing in my own practice 1000 miles south in Florida.  I moved around a lot in those 10 years, but the experience I gained has been so important in the forming of the philosophy of the care I provide my patients.  I appreciate the trust that my patients have placed in me.  I never take the responsibility of caring for my patients lightly.



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.

A Very Exciting Annoucement

Many of you may be aware that in December of 2014 I began transitioning from being an employed podiatrist at Absolute Healthcare to becoming a solo practitioner.  Late last year, Donald J. Adamov, DPM, PA was formed.  I decided that after close to 10 years in private practice, it was time to "give it a try" on my own.  I figured that I would be able to care for patients the best way I know how and could make my own decisions when it comes to the services I offer my patients.

This is why, I am so excited to announce, that effective Monday, May 4th, I will begin practicing at my new location:

1250 Mariner Blvd.
Spring Hill, Florida 34609
352-606-3950

The new office is just over 2 miles south of the old location at 3376 Mariner Blvd.  It is just south of the YMCA on the same side of the road.  Our office is in the plaza directly behind Susie's Grill.  We have purchased brand new comfortable treatment chairs as well as a state-of-the-art digital x-ray machine.  This machine will allow us to diagnose fractures and other bone problems during your visit.  We are also looking into offering more items to help treat our patients such as arch supports and other medical equipment.

The new office is in addition to adding an additional morning to see patients at the Spring Hill wound care center.  Now in addition to Thursday afternoon, I will be seeing patients Wednesday morning as well.  If you have a wound you can always see us at the Mariner office, and if appropriate, I can then follow-up with you at the wound center.

I look forward to seeing you at the new location!

 

Let's Play Hockey!

For a hockey fan like myself it is the greatest time of the year.  (OK, so maybe second greatest if your team makes the playoffs).  The season officially begins tonight and tomorrow my favorite team, the Penguins, and the local team, the Lightning, begin the season.  Because of this occasion, I feel it is appropriate to post my previous hockey blogs.

http://donaldjadamovdpm.blogspot.com/2013/06/alex-ovechkins-broken-foot.html

http://donaldjadamovdpm.blogspot.com/2013/03/kris-letangs-broken-toe.html

http://donaldjadamovdpm.blogspot.com/2013/02/erik-karlssons-achilles-laceration.html

http://donaldjadamovdpm.blogspot.com/2013/01/ice-hockey-is-back.html

http://donaldjadamovdpm.blogspot.com/2011/11/ice-hockey-and-foot-injuries.html

The Passing of Michael Johns

I was saddened to read that a few days ago, former American Idol contestant, Michael Johns, had passed away due to a blood clot after twisting his ankle.  I do not watch American Idol much anymore, but back in 2008 I rarely missed an episode.  I do remember Michael Johns competing.

At 35 years old this is a tragic loss.  Fortunately, blood clots after twisting an ankle leading to death are very rare.  However, blood clots in the legs are not uncommon.  The clot in the leg is not what is fatal but instead it is the blood clot "breaking off" and traveling to the lungs that can lead to death.  This is called a pulmonary embolism.

How do blood clots form in the legs?  Well, there are large veins in the legs and when a person does not move his or her legs for a long period of time there is no muscular activity to help the blood return to the heart.  This blood can then pool in a vein in the leg causing a deep vein thrombus (DVT).

I am not sure of the facts but it seems that Michael Johns twisted his ankle and it was causing him severe pain.  It was too painful to move and he probably stayed off of it.  A blood clot formed and likely traveled to the singer's lungs.

This could have been possibly prevented if the singer sought medical advice.  A possible sign of a DVT is severe calf pain and swelling.  If this happens seek medical attention right away.  An ultrasound can be done to determine if a DVT is present or a blood test called a D-dimer can be done to see if a clotting process is present.

RIP Michael Johns.  Hopefully, some good can come out of this tragedy by educating people on the dangers of this condition.

Way to go, Scouts!

I was quite interested in the recent story that Ann Curry was hiking in New York and was "rescued" by a group of boy scouts.  There are two reasons for this interest.  First, as is the topic of this blog, I am a podiatrist treating conditions of the foot and ankle.  The second reason is something not everyone may know about me; I was a boy scout.  In fact, I am an Eagle Scout.

I remember learning how to splint ankles and my first aid training but never had to put it into action like these young men.  I found it even more of a feel good story that most of these guys didn't even know that they were helping a celebrity.  Kudos to these young men!

Charcot Neuroarthropathy

A recent article just came out that shows there is an increase in the occurrence of "charcot foot."  This condition usually affects diabetic patients who have decreased sensation or "neuropathy."  The process is not completely understood, but essentially the foot starts breaking in the midfoot.  What are supposed to be hard bones can become like mush.  The condition is self limiting and eventually the bone destruction stops.  The bones then will heal.  The problem is not the process causing damage it is when the patient walks on this foot that is breaking.  It can deform the foot and the bones can heal leaving a "rocker bottom" foot that is difficult to walk on.  This can cause sores, or "ulcers."  These ulcers can become infected and patients can have to have an eventual amputation from the problems this condition can cause.

The key to treating "charcot foot" is prevention.  A diabetic patient that usually doesn't have foot pain should be seen as soon as possible as this could be the early start of the condition.  The condition is often misdiagnosed as an infection or gout as the foot can become red and swollen mimicking these conditions.

If caught early, strict immobilization is imperative.  If caught after the deformity has already lead to disfigurement of the foot, wounds often develop and special braces and offloading shoes are needed.  This often becomes a wound care center issue.

I am not writing this to scare people but instead educate them.  This condition is rare but is becoming more common as I am seeing in my practice.  The take home message is to go see your podiatrist as soon as possible if you have any foot pain, especially if you are a diabetic.

Two Years in Florida!

Those that know me, know that I like milestones.  I have been blessed to have the chance to experience many wonderful things in my life.  So, today is meaningful to me as I started practicing in Florida 2 years ago today.  Though it has taken some unexpected turns, I have enjoyed my time here and look forward to many more years as a northerner living in the sunshine state.

I think it is a good time to blog about my life and education.  This can be "my bio" as I have not really posted it on my blog yet.

The majority of my life was spend in Northeastern Ohio.  I was born in Akron and spent my entire childhood in Uniontown, Ohio.  A small town between Akron and Canton.  Growing up I always wanted to be a "surgeon."  I enjoyed activities at church, with scouting (I am an Eagle Scout), and playing the saxophone in band.

I graduated from Lake High School in Uniontown and my undergraduate degree is from the University of Akron.  My podiatry degree is from the Ohio College of Podiatric Medicine which is now the Kent State University College of Podiatric Medicine.  (This is interesting for an Akron grad).

I completed 3 years of training in podiatric medicine and surgery in the greater Cleveland area.  My training was affiliated with satellite hospitals of University Hospitals and The Cleveland Clinic as well as the podiatry school.  It was a well rounded program with lots of "hands on training."  On a personal level I married my wife, Heidi, during my second year of residency.

Upon graduation of residency, Heidi and I moved to Indianapolis where I started my career in private practice.  We enjoyed living there.  It had a smaller town feel with a lot to do.  I think some of the best restaurants are in Indy.  Living there over 3 years, we enjoyed all the city had to offer with the sports and auto racing to the culture.

In the fall of 2008 I decided to advance my career and Heidi and I also wanted to move closer to our hometowns and families.  Therefore, we moved to Pittsburgh.  This was 100 miles from my hometown and 100 miles from Heidi's hometown of DuBois, PA.  This was weird for a Browns fan from Ohio to live 6 miles south of downtown, but I fell in love with the Penguins as many know and also enjoyed following the Pirates.  However, sorry Steeler fans, never quite got into them.

The most significant event of our 3 years in Pittsburgh was the birth of our son.  Soon after that a job opportunity came up in Winter Haven and our family moved south.  We enjoyed our time in Winter Haven but transitioned to Spring Hill last April.

As one can see, I have lived in several places.  Great experiences for sure.  However, I certainly wouldn't mind settling here in Spring Hill, Florida and I am very excited as we continue to grow both professionally and as a family as we are expecting a baby girl next month!

5 things people do wrong for their feet

I was recently talking to a close colleague who is an internal medicine physician.  As people who read my blog know, I like to blog about sports injuries and celebrity foot problems.  However, this doctor was interested to know what I believe are the most common things people do wrong with regards to caring (or often times, not caring) for their feet.  I thought about it, and in my 10+ years of experience I had an answer, I thanked my colleague for the question and immediately answered it.  I think this information is worth sharing.

5 THINGS PEOPLE DO WRONG FOR THEIR FEET:

1) Ignore foot pain:  Many patients think that pain in their feet will just go away.  It could, but odds are it will get worse if not treated.  For example, heel pain can affect how you walk as a patient can often compensate by walking differently due to the pain.  Walking differently can lead to tendon pain in the other ankle or in a different part of the painful foot.  Additionally, pain in the foot or ankle is often inflammatory in nature.  Inflammation that is allowed to worsen can often be much more difficult to resolve than when treated earlier.

2) Going barefoot:  Especially down south, many people do not like to wear shoes.  However, this can have significant consequences.  Of course, there is always a chance of injury without the protection of footwear.  Cuts and scrapes can be especially harmful to a patient with poor circulation or feeling in his or her feet.  Additionally, when one goes barefoot there is no support.  This can lead to tendonitis as tendons work to support a foot that a shoe should be supporting.  I often hear, "going barefoot is natural."  I counter this argument by replying "what is natural about concrete?"  You do best in a man-made supportive shoe when walking on this man-made surface.

3) Wearing flip-flops:  In Florida, these shoes are a year round favorite.  In other parts of the country, they come out when the snow thaws.  However, these shoes, especially the really flat flimsy ones, are just as bad as going barefoot.  They offer little support or protection for the foot.  It is hard, as people love these shoes, but at least try to get one with a rigid sole and even an arch.  A small heeled wedge sandal is much better than a flimsy flip-flop.  However, a trip to Disney World is probably best enjoyed in a sneaker.

4) Using medicated pads or callus remover:  I am fine with padding that can be bought in the drug store, as this can be a good conservative treatment for some foot problems.  However, any padding that says "medicated" can be very harmful.  Medicated pads usually contain salicylic acid.  Yes, real acid that damages skin.  The acid can not select the "good" tissue from the "bad" callused tissue and I have seen infections from using these products.  Unfortunately, in a few diabetic patients, I have seen the use of these pads lead to bone infection and toe amputation.  A callus is more than just something that can be removed easily as there is often an underlying deformity leading to this hardened uncomfortable skin.

5) Doing "bathroom surgery":  We likely have all done this.  A toe can be a little sore and we "dig out" a toenail in our bathroom using a dirty pair of toenail clippers or whatever object available.  This can lead to a bacterial infection needing antibiotics.  Again, as with medicated padding, I have seen bathroom surgery lead to amputation.

This is my list of 5 things people do wrong for their feet.  Podiatrists are trained to treat almost all foot or ankle problems.  I welcome new patients who are experiencing any foot or ankle pain.

Something to Celebrate

As a podiatrist, I read with interest a recent study that shows a drastic increase in lower extremity diabetic amputations.  The study was published in this month's Foot and Ankle International.  The study pointed out when looking at Medicare claims from 2000-2010, lower extremity amputations decreased 28.8%.  I am wondering if this is related to the 143.3% increase in the treatment of foot ulcers in the same time period.  Also interesting is that amputations at the upper and lower leg level are down 47% while partial toe amputations increased 24%.  (Sometimes a toe amputation is needed to be done by a physician like myself to prevent the infection from getting worse).  To me this means podiatrists are saving feet and legs.

This is a big deal on many levels.  First, it saves money.  Lower extremity amputations cost our health care system a lot of money.  Second, it improves patients quality of life.  Obviously, having a limb amputation is a big deal and can lead to other problems.  Earlier studies have found that a lower extremity amputation has a mortality rate of 50% within 5 years.  So one can argue that saving some one's limb, saves some one's life.

I am proud to have a hand in all of this and excited to continue to help bring down the level of amputations in my community.

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.

Blame your parents for your bunions?

As a podiatrist, one of the procedures I perform most is correction of bunion deformities.  This is a deformity in which the great toe turns out and creates a bump on the inside of the foot just below the great toe.  If conservative treatment fails, surgery is an option for many patients.

A study came out last month that suggested this deformity is inherited.  In my opinion, however, it is more complex than this.  I believe your foot type can be inherited (ie, flat or high arch) and this foot type can lead to deformities.  For example, a young lady can have a foot type that she "inherited" from her father but she gets bunions unlike her father because she wears tight high heels that can lead to easy development of a deformity based on her inherited foot type.

I believe, the environment does come into play.  Another example would be a flat flimsy foot.  An individual with this foot type who wears flip flops all the time may develop a much more severe bunion than someone who wears a supportive shoe and insert most of the time.

Just like other medical risks such as heart disease it is likely that most bunions can be prevented with the proper decisions and care.  You should see a podiatrist if there are any concerns you have a bunion or believe you are developing one.

Exciting Annoucement

I am very excited to announce that effective April 24, 2013 I will be joining a new practice.  I will be the first podiatrist in a multi-specialty practice in Spring Hill, Florida.  I think my 8 years of experience will allow me to incorporate great podiatric care into this new practice.  I am thankful for the opportunity and am thrilled to continue to practice in the State of Florida.  Here is the information on the location with contact information:

ABSOLUTE HEALTHCARE LLC
3378 MARINER BLVD
SPRING HILL, FL 34608
352-678-3033

Kobe Bryant's "Bone Spur"

Thursday night after the Lakers game against the Bucks, the Lakers revealed that Bryant has a "bone spur" in his left foot.  This could mean many things as there are several places that an individual could have a bone spur in the foot.  However, there are really only two places where a bone spur is common.  The most common is at the bottom of the heel bone.  This is also called the "plantar" part of the heel and a band of tissue that attaches there called the plantar fascia can often get inflamed.  Not always, but usually heel spur syndrome and plantar fasciitis are the same thing and treated the same way.

The other common area for spurring is at the back of the heel where the largest tendon, the achilles, attaches.  This can be more difficult to treat and when conservative measures fail surgery to remove the spur and reattach the achilles tendon is often necessary.

It is difficult to say exactly were Bryant's spur is, but Laker fans should hope it is at the bottom of the heel instead of the back.  Either way, however, both conditions can be very painful.  Fortunately, though, both conditions can be treated and in most instances successfully resolved.

Kris Letang's Broken Toe

I have been enjoying my NHL Center Ice subscription down here in Florida as of late.  It allows me to watch every Pittsburgh Penguins game that I can.  (I am happy as a fan that most of them have been wins).  Along with all the great trades the team has made, there is news that Kris Letang, the Pens all-star defenseman, suffered a "lower body injury."  Hockey does not have to say much about a player's injury but most sources said he is suffering from a broken toe.

It is not just athletes who suffer from broken toes.  Anyone can injure his or her toe to lead to fracture.   The most common way I see it happen is from bumping the toe against a piece of furniture.

Many people don't seek treatment because they believe there is "nothing that can be done."  Often times not much treatment is required but the condition can be painful.  Compensation can occur from trying to walk on a painful foot and this can lead to other problems.  Additionally, if an injury is significant enough to cause a broken toe it is not uncommon for another part of the foot to be injured as well.  Therefore, if you do injure your toe (or foot) a trip to the podiatrist is always a good idea.

Kristen Stewart at The Oscars

I am a little late blogging this but I wanted to chime in.  The details are not know but Kristen Stewart walked the red carpet last week on crutches after apparently cutting her foot on a piece of glass while "partying."  Certainly, this can be a serious issue.  A laceration on the bottom of the foot can lead to painful scarring.  Also infection is a very real concern and often antibiotics are needed.

Of course, the best course of action is to prevent injury in the first place.  Protective shoes are important, especially in a diabetic patient that may not have full feeling in his or her feet.  Going barefoot can be dangerous anywhere, even inside the home.  I have had a few patients require surgery to remove a sewing needle that they stepped on at home.

If you step on a piece of glass or any foreign body, you should not wait but should see a podiatrist right away.

Erik Karlsson's Achilles Laceration

Erik Karlsson suffered a 70 percent laceration of his Achilles' tendon on Wednesday night.  The Senators were playing my favorite hockey team, The Pittsburgh Penguins.  Hockey skates are razor sharp and Matt Cooke's skate caused the laceration.  Matt Cooke has been a subject on controversy but has cleaned up his act recently.  The NHL has determined that the injury was accidental (unlike some of Cooke's actions of the past).  As a podiatrist, I deal with achilles injuries on a regular basis.  Karlsson will likely require surgery or at a bare minimum immobilization and extensive therapy.  Hockey players are not the only ones to suffer injury to the achilles tendon which is the largest tendon (muscle to bone connection) in the body.  However, the Ottawa Senators certainly will miss the services of last year's Norris Trophy winner who was voted the best defenseman in the league.

Pau Gasol's Plantar Fascia Tear

Last week, a doctor confirmed that Pau Gasol tore his plantar fascia and will be out for 6-8 weeks from playing with the Lakers.  Apparently it is also unknown if surgery will be required.  As a podiatrist, this is of course interesting to me.  I see plantar fascia problems several times a day.  What confuses me is the issue of surgery as I have never seen a torn fascia repaired.  Usually, the opposite is true as I have seen chronic inflamed fascia "released" surgically.  In fact, I often perform this procedure myself.

Anyone can suffer from problems with plantar fascia but usually a tear or rupture on a traumatic level is much less common.  The plantar fascia is a band of tissue (or fascia) on the bottom (or plantar) surface of the foot.  It attaches at the bottom of the heel and extends out towards the toes widening before attaching in the ball of the foot.

We commonly see inflammation of the fascia or plantar fasciitis.  This is when the fascia tears on a very small scale repeatedly.  This can be caused by wearing the wrong shoes for two long, going barefoot for to long, or sometimes, but not as common, from trauma (as in Pau Gasol's case).  It is important that if you experience chronic or severe heel pain you are seen by a podiatrist.  We will work to 1) reduce the inflammation and 2) try to prevent the fascia from becoming inflamed again.