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.

New Office Renovation

People are hard at work completing the final touches on the new podiatry building on the campus of Absolute Healthcare.  I am very pleased with the new spacious office.  I find it very welcoming and am excited to start caring for my patients in this beautiful building.

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!

Osteomyelitis

Since it has been awhile since I have posted on this blog, I wanted to post on a topic that I have seen a lot of patients develop recently.  I decided to talk a little bit about osteomyelitis, or bacterial infection of bone.

Working at the wound care center, I have found that a great deal of patients with chronic ulcerations can develop infection in the bone under the ulcer.  I have also found that a doctor needs to suspect this whenever there is a chronic wound that is not healing.  To say it in simple terms, infected bone can "die" and needs to leave the body and this can often be why a wound will not heal.  If infected bone can not find a way to "exit" the body, this infection can lead to a localized infection or abscess.

Sometimes a simple x-ray is enough to suspect osteomyelitis but often more advanced studies such as a bone scan or MRI are necessary to form a diagnosis.  The only definitive test, however, is a biopsy of the bone.  In my experience, though, MRI / bone scan is pretty reliable and a bone biopsy is often deferred due to its invasive nature.

Treatment for osteomyelitis includes more than 6 weeks of IV antibiotics and / or resection of the infected bone (amputation).  Obviously, amputation is always a last resort.  Medicine has made great advances to treat osteomyelitis.  Hyperbaric oxygen therapy is one such treatment.  The clinician must also assess other issues such as a patient's circulation to heal the infected bone and the patient's nutrition.

If you have a chronic wound that will not heal, do not delay treatment.  See you podiatrist if it is a foot or ankle wound or wound care specialist for any chronic wounds.

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.

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.

My Weekend in San Antonio

This past weekend, I traveled to San Antonio, Texas for a wound care course.  Though I have visited Texas while in middle school, I have never been to San Antonio.  I enjoyed seeing the city including staying on the Riverwalk and visiting the Alamo.  However, my primary purpose for the trip was a 12 hour wound care course.

As a podiatrist, part of what we do is caring for diabetic foot ulcerations.  So, I have been doing wound care for over 10 years.  The 3 years I spent in Pittsburgh was heavy on surgical limb salvage of diabetic feet.  During my time in Winter Haven, I also was on staff at the wound center in Lake Wales, Florida.

I really think I could make a difference in this community of Hernando County in regards to wound care.  Therefore, I have been working closely with the Spring Hill Wound Care Center and the experts at this facility recommended this course.

Though I am experienced, I still learned quite a bit at the course and am eager to begin using these new ideas to help people here in this area.