Red Hot Chili Peppers' singer Anthony Kiedis knows first hand. He sustained a fracture to a small bone in his foot, called a sesamoid, while jumping off a drum while on tour last fall. It initially went untreated and was slowly improving until he injured it again running around on the beach. I'm sure some of you Red Hot Chili Peppers fans may have seen him on winter tour dates clomping around the stage with a walking brace. However, The show must go on!

The sesamoid bones are 2 small bones that are at the bottom of the big toe joint. They are a small version of the knee cap bone. They function to increase the pull of one of the muscles that flex the big toe. Sesamoid fractures can occur as a result of direct trauma, such as a fall from a height of from a forced hyper extension of the great toe. A stress fracture of the sesamoid can occur as well, usually due to repetitive trauma. Like all fractures, treatment options are based on the severity of the injury and the amount of space between the pieces of the bone, called displacement. With minimal amounts of displacement, protected weight bearing in a surgical shoe or walking brace for 4-6 weeks is usually adequate to allow healing.

Occasionally a period of crutch walking may be needed. Sesamoid fractures with significant displacement or multiple pieces (a comminuted fracture), can also be treated with immobilization, usually for longer periods and with longer time on crutches. A competitive athlete may consider initial surgical treatment to shorten recovery time. Should the fracture fail to heal in the usual time frame, electromagnetic or ultrasound bone stimulators can be employed to hasten bone healing.

Even with a non-healed sesamoid fracture, most people will become asymptomatic and will require no further treatment. Localized pain in the area of the sesamoid can be treated by off-loading with a dancer's pad or custom orthotic. Should pain from a non-healing sesamoid fracture be persistent, surgical intervention may be necessary. Repair of the fracture with bone graft, removal of one of the pieces or removal of the entire sesamoid are the typical options. Good results have been reported with all of these methods.

Should you or a loved one have pain in the ball of the foot, book an appointment online. The podiatrists at Midtown Podiatry will quickly diagnose your problem and get you on the road to recover fast (even if you are not going out on the road with your rock band)

By: Paul J. Betschart

No, it is not caused by hitting your foot with your golf club.  It is a congenital deformity of the foot that is usually recognized at birth or shortly thereafter. It occurs approximately 1 in every 1,000 births.  The position of the foot is turned inward toward the center of the body. If untreated and left to adulthood, the foot will resemble a club when walked on, hence the name. The cause of this condition is unknown. It may be due to abnormal intrauterine position or abnormal development of soft tissue or bone. The position can be flexible, rigid or a combination.

Fortunately, in the developed world, this condition can be successfully treated. The earlier this condition is recognized and treated, the better the outcome. It is treated with serial casting, surgery or a combination of both. Most often, serial casting is employed first. This involves manipulation of the foot in a certain way to reduce the contractures of the joints and tendons. The foot is then placed in a plaster cast to maintain the correction. This manipulation and casting is done at weekly intervals for several months to achieve correction. Following casting, if there is residual deformity, surgical correction may be performed.  Good results can be achieved with these treatments, allowing children to function fairly normally. Bracing is sometimes needed after correction to prevent recurrence. 

Neglected clubfoot seen later in life usually requires more complicated surgical approaches, usually involving the fusing of multiple foot joints. Neglected clubfoot is rarely seen in this country due to the early recognition and treatment mentioned above. Other areas of the world do not have access to the treatments we take for granted in this country. Generous doctors and nurses from our country regularly participate in medical missions throughout the world bringing advanced medical care to those in need. Several of our doctors have participated in such missions. To get involved, check with the United Way, Doctor's Without Borders, The Baja Crippled Children Project, or Google “Medical Missions”.

Should you or a loved one need advanced foot and ankle care, make an appointment  with Midtown Podiatry. We will give you the best care within our borders!

By: Paul J. Betschart

HOW TO PREPARE FOR FOOT SURGERY

Now that you and your doctor have decided on surgery as the treatment for your condition, there are some things you can do to get yourself ready for a comfortable and quick recovery.

Get your mind ready: It has been shown that attitude can effect the outcome of medical care and the perception of pain. Have confidence in the course of treatment and your doctor. If you are unsure, get a second opinion before proceeding. Learn some relaxation techniques such as deep breathing or meditation. Know that pain is expected after surgery. Relaxation techniques have been shown to reduce the need for pain medication. Have a positive attitude and focus on the intended outcome of the surgery. After the recovery, you will be glad of your choice.

Get your body ready: Proper nutrition is essential for recovery following surgery. If your diet is not the best, consider consulting a nutritionist for dietary advice. Supplements to consider include calcium and vitamin D for bone health, vitamin C and zinc for skin and soft tissue and extra protein for muscle support are good starting points. Hydration is important. Be sure to drink plenty of water. Be aware that some post-operative medications can cause stomach upset or constipation. Make sure you take the medication as prescribed and eat and drink normally. Extra fiber should reduce the incidence of constipation. Should antibiotics be prescribed, a pro-biotic vitamin can reduce the incidence of diarrhea. Yogurt or Kefir can be used as an alternative. If you will need to be on crutches post-operatively, make sure your arms and non-operative leg are strong enough to support you. Simple arm and leg strengthening exercises should be performed to get you ready. You can consider a consultation with a physical therapist or personal trainer to help get you ready for crutch walking.

Get your life ready: Your mobility will be temporarily restricted after surgery. Make sure you take care of chores prior to the surgery. You will want to do as little as possible in the first few days after surgery.

Make sure you have what you need on hand, including food, water and post-operative medications. Consider having a friend or family member stay with you to help out.

Get your house ready: Much like child proofing, you will want to fall proof your house or apartment, especially if you are going to be on crutches. Take a look around for things that can impede walking or trip you up, such as furniture, rugs, cables, etc. You may not want to use stairs right away, so temporary one level living should be considered in homes with stairs. Make sure the bathroom is accessible. Some accessories that can make toileting and showering easier are: a commode that can be used as a toilet riser, a shower seat, suction grab bars and a cast/ bandage cover to keep the operated foot dry.

These items can be obtained at a surgical supply store or through catalogs. Some items may be covered by health insurance as well. Make the kitchen accessible as well. Make sure frequently used items are easily within reach. Consider preparing meals in advance for easy microwaving. Using disposable dinnerware temporarily will reduce clean up. If you will be on crutches, take a dry run around the house. You may be surprised at obstacles that you never thought of. You may want to consider crutch alternatives such as a knee walker or scooter if crutch walking is difficult for you.

Get ready to go: Depending on where your surgery is taking place, you may be required to have pre-operative testing and a medical exam done prior to the surgery. Make sure these are done at least 1 week before the surgery. Follow up with your doctors offices to make sure that the facility has all the results ahead of time. Follow pre-operative instructions to the letter. If you are having anesthesia other than local alone, make sure you don't have anything to eat or drink within 8 hours before surgery. You should continue to take prescribed medications unless otherwise directed by your doctor. Plan to arrive at the surgical facility in advance. Most hospitals and surgical centers require their patients to arrive 2 hours prior to their scheduled procedure time to allow for intake. For office procedures, 15 minutes is sufficient. Arrange for transportation home in advance. An escort is required for discharge by hospitals and surgical centers and is recommended for office surgery. Don't forget to arrange for transportation to your post-operative visits as well. Don't hesitate to call your doctor for any reason post-operatively. We are all here to make sure your recovery is safe and rapid.

If you have any questions prior to surgery, call the doctors of Midtown Podiatry.

Another New York team has been affected by a serious foot/ankle injury. New York Yankee pitcher Joba Chamberlain recently sustained a serious ankle injury while having fun with his young son. He has been on the disabled list this season after having elbow surgery. His rehab was progressing as planned before this latest incident in which Joba sustained an open dislocation of his ankle.

This is a very severe injury, where the bones become separated due to ligaments tearing. An open injury refers to the fact that the skin over the area was torn as well, exposing soft tissue and bone to the outside. These types of injuries are most commonly seen with motor vehicle accidents or falls from heights. These injuries require emergent care by a foot and ankle specialist. Most will require some form of surgical treatment to relocate the joint and clean and repair the wound. Fixation of the joint to allow for healing can be accomplished with a cast, but commonly pins, wires or external fixation devices are used, especially with open injuries, in order to tend to the wounds. Usually several months of non-weight bearing immobilization will be needed for healing. This puts Joba's return to the team this year doubtful. We wish him the best for a speedy and complete recovery.

If you or a family member ever suffers an injury to your ankle, make an appointment with the qualified professionals at Midtown Podiatry with locations in Midtown, Union Square, Gramercy Park, Wall Street and Glen Cove.

By: Paul J. Betschart 

Diabetes has become a prevalent disease in our society today. According to the American Diabetes Association, 8.3% of the population has been diagnosed with this disease. Diabetes does not limit itself to race, class or gender; affecting celebrities like Halle Berry, Bret Michaels, Nick Jonas, Paula Deen, Salma Hayek and Bears Quarterback Jay Cutler.

As podiatrists we see the impact that diabetes can have on a person's mobility. Many serious foot complications and other medical complications can be reduced or eliminated with control of blood glucose (sugar) levels. This control of blood glucose is not easy to accomplish as evidenced by the explosion of numbers of people with type 2 diabetes in this country and in the world. Type 2 Diabetes has become a major public health concern in the United States, as 26 million people in this country alone have type 2 diabetes. A large number of these cases are caused by or worsened by obesity.

Weight loss has been shown in research studies to reduce blood sugar levels and reduce need for medication and insulin for control. Weight loss is usually difficult to attain, especially for those significantly overweight, who have difficulty exercising. Two recent studies have garnered new hope for those with diabetes caused by obesity. These studies examined the surgical treatment of obesity and it's relationship to diabetes. The studies followed patients who underwent gastric bypass weight loss surgery. This type of surgery reduces the size of the stomach and redirects some of the intestine to cause weight loss. These studies showed that, not only did patients lose weight and keep it off, but their diabetes significantly improved! These studies showed over 80% of patients no longer need to take medication to control their diabetes.

Weight loss surgery has been shown to significantly improve other obesity related health problems as well, such as high blood pressure, cardiovascular disease and sleep apnea to name a few. Current NIH standards still only recommend weight loss surgery for those significantly overweight that have failed other approaches at weight loss. Recent advances in surgical techniques have made the procedure safer, with complication rates lower than other common abdominal surgery, such as gall bladder removal. Hopefully, the increased safety and the demonstrated effectiveness in managing disease will widen the NIH recommendations to give people better access to this life saving treatment.

Should you or a loved one need a recommendation for a weight loss surgeon, we can help you! Through our affiliation with Gramercy Surgery Center, we can refer you to some of the best Bariatric surgeons in New York. Give the office a call or mention it on your next visit to Midtown Podiatry, with locations in Midtown, Gramercy Park, Union Square, Wall Street or Glen Cove.

By: Paul J. Betschart, DPM