For most Americans that complain that their bones ache, it is due to their muscles, ligaments or joints — not their bones. Occasionally, when someone says that their bones ache, it can be a sign that something more sinister is behind the pain. This is especially true if they notice that the ache is localized to a specific bone, if it is felt deep inside the bone, if the pain wakes them up at night, causes loss of function, or is associated with night sweats, weight loss, and/or fatigue.

Causes that may be considered by your doctor or podiatrist:

• Both benign and malignant tumors that may need to removed or treated with chemotherapy or radiation
• Infection inside the bone marrow
• Systemic cancers such as multiple myeloma
• Auto immune syndromes
• Occult fractures such as stress fractures
• Systemic metabolic derangements such as gout (although there is a noticeable effect on the soft tissues as well)
• Bone density loss

Many of the recommendations from your doctor may mirror those used to assess unexplained masses in the body: imaging, blood tests, biopsy and special clinical tests. Most causes of bone pain are treatable but see your doctor early to have them assess the site of pain to provide an early diagnosis and treatment.

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Disorders of the lesser digits are extremely common and are seen by podiatrists daily. Although there could be many causes of pain, one of the most devastating is the dislocation of the second digit joint where the toe meets the foot, often named predislocation syndrome if not fully dislocated.

Often this deformity occurs due to pressure from other foot deformities: bunions in which the first toe under rides the second, a short first or third long bone in the foot which places pressure on the joint of the second, and trauma in which the joint capsule is injured. This injury can result in displacement of the toe or even dislocation and often the tendons and ligaments can elongate or shorten with chronic deformity leading to an extremely rigid second toe that lies over the great toe.

Actions that may be considered by your doctor or podiatrist:

• The location of pain and position and flexibility of the toe will determine treatment options
• Imaging may be ordered including xrays, ultrasound or magnetic resonance imaging (MRI)
• Strapping and taping may improve symptoms if the deformity is mild
• Larger, wider, deeper footwear may take pressure off the second toe
• Orthotics may take pressure off of the joint itself and allow for minimal pain with walking
• If the toe can be reduced to its original position, the doctor may suggest tendon releases or joint capsule sutures if the joint surface has not been damaged
• If the toe is not reducible, the doctor may suggest surgery that includes cutting bone to restore alignment

Predisclocation syndrome is one of the more difficult deformities to treat. You may be limited to accommodating for the dislocated toe with proper footwear or orthotics. Communicate clearly with your podiatrist and they will be able to better serve you and improve your pain.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

Over 23,000 ankle sprains occur daily in the United States. Many recover without pain or long-term consequences but nearly half do not seek treatment and many will reinjure the ankle leading to long term pain or instability in over half of those affected. While ankle mechanics can be affected due to increased ligament laxity on the outside of the ankle, some patients report nerve pain and changes in sensations around their ankle, even the ability to perceive where their ankle is in space. Damage may have occurred to the joint surfaces, nearby tendons and the bone underneath the joint. It is important that you see your doctor or podiatrist if painful or instability symptoms persist beyond a few days as failure to treat major ankle sprains contribute to arthritis.

Actions that may be considered by your doctor or podiatrist:

• It is important that you are specific regarding the nature and location of your pain so that your doctor can better diagnose what has been damaged; your doctor may perform special tests or use local anesthetic to diagnose the site of injury
• Imaging may be ordered including x-rays, computed tomography (CT) or magnetic resonance imaging (MRI)
• A non-weight bearing period or partial weight bearing with bracing may be recommended
• Pain control with ice, rest, elevation, and medication; most ankle sprains do not require any medication more potent than ibuprofen
• Long term use of bracing may be appropriate to help ligaments and tendons heal
• Tendon or ligament tears, joint damage or bone damage will most likely require surgery sooner rather than later
• More and more surgical treatments are arthroscopic, providing quicker recovery and smaller incision sites
• Treating old/chronic injuries may only result in improvement rather than full resolution of symptoms; be patient with your body while you heal

As half or more of ankle injuries result in long term symptoms when left untreated, it is important to treat all ankle sprains seriously and seek medical advice. These injuries take anywhere from 6 weeks to 18 months to heal and re-injury is common. Remember to follow your doctor’s advice closely and protect your ankle from further damage.

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A portion of the population will develop a mass or nodule on the foot that may worry them. However, many masses are benign and should not be treated with surgery unless symptomatic. Examples include fibromas, which are hard rubbery mobile masses often on the bottom of the foot; cysts which are fluid filled sacks, often near joints; lipomas which are fat accumulations; and exostoses which are bony outgrowths. If you notice a mass on your foot, look for change in size, especially rapid change, pain, itching, redness, swelling and any color changes to the skin. Changes, especially rapid growth and system symptoms like night sweats and rapid weight loss mean that you should see your doctor right away.

Actions that may be considered by your doctor or podiatrist:

• Imaging including x-rays, computed tomography (CT) or magnetic resonance imaging (MRI)
• If a cyst is identified, they may try draining it or use steroids to reduce it
• If symptomatic but not growing, they may try to offload the mass and prevent pain from bearing weight on the mass
• If bone, joints, or tendons are affected, they may remove the mass even if it is not growing because of mass effects on these structures or location of the mass
• Any mass that is rapidly growing may warrant a referral to oncology
• Oncology may also recommend radiation and/or chemotherapy
• If melanoma is discovered, your doctor may have to perform a more extensive surgery because of the nature of this cancer

Most masses are benign and it is rare for a large number of them to become cancerous. However, early detection and monitoring can prevent invasive growth and metastasis that could threaten life or limb. See your doctor or podiatrist early and often if you notice these important changes.

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Venous disease is common among the elderly. As we age, the valves in the veins that maintain the movement of blood back to the heart weaken and are insufficient to prevent backflow of blood. The blood pools to some extent, allowing fluids to diffuse from the capillaries to the tissue external to the vascular system. This accumulation leads to swelling of the legs and feet, darkening of the skin, and weeping wounds. The darkening of the skin is due to hemosiderin from the blood depositing in the skin. The wounds occur due to increased pressure and erosions. Although surgical treatment of this condition is limited, there are conservative treatments that are extremely effective in preventing wounds.

Treatments that may be considered by your doctor or podiatrist:

• Compression stockings during the day, but NOT at night
• Elevation of the legs above the heart
• If wounds form, an Unna boot may be used to treat and heal the ulcers
• Myofascial release therapy and kinesiotherapy may help women in menopause dealing with venous disease
• While standing exacerbates swelling, exercise including walking, biking, and swimming can improve symptoms
• Swelling may also be controlled with medications, including diuretics
• Venoblation is a surgical option that is reserved for patients that have venous disease that is refractory to more conservative therapy

Venous disease is a condition that, once acquired, requires life-long treatment and management. Working closely with your doctor, you should be able to prevent complications and control symptoms.

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The most common cause of nail complaints is nail fungal infection, a rather benign condition in which the nails become thickened, oddly shaped, with debris under the nail fold. If there is no pain or the nail is not lifting from the nail bed, treatment is entirely aesthetic. But other nail defects can underlie more serious illnesses.

Examples of nail changes that you should bring to your doctor or podiatrist:

• Nail pitting – along with skin changes may indicate psoriasis or psoriatic arthritis
• Nail spooning – notably associated with iron deficiency anemia
• White lines across the nail – at least send a photograph to your doctor as it may be indicative of arsenic posioning
• A black or brown stripe from the end of the nail into the cuticle – SEE YOUR DOCTOR as this is a sign of melanoma
• Swelling of the tissue under the nail – indicative of lung disease
• Whitish nails with a pink end – can be a sign for liver disease, heart failure, kidney failure or diabetes
• Grooves across the nail – associated with zinc deficiency, diabetes, peripheral vascular disease, scarlet fever, measles, mumps and pneumonia
• Lifting of the nail from the nail bed – can be a sign of psoriasis or thyroid disease
• Yellow nails – respiratory diseases and lymphedema

Each of these signs of disease can be confirmed by additional symptoms. See your doctor to identify any underlying problems if you notice any changes in your body or energy level. Many of these signs are early changes and can help prevent disease progression.

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Do you notice that your child complains of heel pain especially after running, jumping, or playing sports? Is the pain on the back of the heel? No parent likes to see their child in pain. Often the first causes that come to mind are the scariest: tears, breaks, and perhaps…cancer. Although these fears are occasionally legitimate, most often the pain is not a threat to the health and well-being of your child. In fact, the pain may be easily treated at times. One of the major causes of heel pain in children, especially in boys, is a condition called Sever’s Disease. The Achilles tendon on the back of the lower leg is pulling on a secondary ossification center (that allows bones to keep growing as the child grows) and causing inflammation and pain from overuse. Another way to describe the condition is growth plate swelling. Children usually first notice it around 8 or 9 years old with high impact activities and notice that rest improves the symptoms. When you see the podiatrist, they may recommend radiographs to confirm the diagnosis and rule out any other problems.

Your podiatrist may recommend the following for pain relief:

• Activity modification including avoidance of running and jumping
• They may recommend that the child put sports on hold if possible until the symptoms full subside
• Daily stretching to reduce equinus (contracture of calf muscles) can help reduce the pull of the tendon
• Heel lifts in the child’s shoes to allow relaxation of the Achilles and reduce pull on the heel bone – bring in your child’s shoes that they wear (all of them) to ensure fit of heel lifts
• Ice at the heel or behind the knee may be recommended with a simple warning to keep the cold exposure to no more than 20 minutes at a time
• Ibuprofen or naproxen may be taken orally to reduce symptoms, but they do not “cure” the problem, but rest may
• They may recommend a CAM walker and crutches during the first two to three weeks of symptoms if it is caught early
• While in the CAM boot, the child may still use a stationary bike or swim to stay active and limber
• Physical therapy may be used to increase the strength of the athlete and improve control of motion around the ankle

If the symptoms do not resolve, an MRI can be ordered to determine a separate cause the child’s pain. Sever’s apophysitis is not a condition to worry about but it is a condition that should be treated early to reduce pain and return the child to sports and daily activities. If instructions from the podiatrist are followed, most cases resolved within a few months.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

Pain is one of the most common reasons that a person visits the doctor. Often kidney disease, a fear of addiction, side effects, etc. may prevent a person from taking oral medications. What is left for the person to control the pain and go about their daily lives and special occasions?

The following topical medications can be used for pain relief:

• Diclofenac (Voltaren gel) – a proven anti-inflammatory that may be applied directly to the site of pain, especially effective in tendonitis, synovitis, soft tissue injuries and chronic joint conditions such as osteoarthritis
• Topical ibuprofen – similar to diclofenac
• Topical lidocaine – extremely useful for post-herpetic neuralgia and diabetic neuropathy. Evidence based medicine supports its use.
• Topical capsaicin – used anecdotally in diabetic neuropathy and neuritis but not supported by scientific literature
• Topical amitryptiline and ketamine – both have shown to be successful for treating peripheral neuropathy in small cohort studies
• Topical opioids – also provides relief from pain associated with injury or inflammation for most patients in small studies
• Topical menthol – shown to better for pain control than application of ice in small studies

The advantages of topical analgesics include no systemic effects, low side effect profile, and avoidance of addiction/withdrawal. If you are able to take oral medications, topical medications may be used as adjuncts as long as contraindications are avoided. Talk to your doctor today if your pain is poorly controlled.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

Although rare, juvenile arthritis (JA) affects over 200,000 children in the US each year. It can cause a constellation of symptoms or be localized to one joint.

Examples of JA include:

• Oligoarticular – pain in four or less joints for at least six weeks
• Polyarticular – pain in five or more joints for at least six weeks and is rheumatoid factor negative or is rheumatoid factor positive
• Systemic – joint pain plus:
  • Enlargement of the lymph nodes.
  • Enlargement of the liver or spleen.
  • Inflammation of the lining of the heart or the lungs.
  • The characteristic rheumatoid rash, which is flat, pale, pink, and generally not itchy.
• Enthesitis JA – pain at muscle, ligament and capsule attachments and 2 of the following:
  • Inflammation of the back
  • A positive blood test for the human leukocyte antigen (HLA) B27 gene
  • Onset of arthritis in males after age 6
  • A first-degree relative diagnosed with ankylosing spondylitis, enthesitis-related arthritis, or inflammation of the sacroiliac joint in association with inflammatory bowel disease or acute inflammation of the eye.

Your podiatrist and/or dermatologist may recommend:

• Blood test for markers that identify types of arthritis (rheumatoid factor, human leukocyte antigen, etc.)
• Radiographs of the affected joints
• A team of specialists to coordinate treatment
• Non-steroidal anti-inflammatory drugs, disease modifying drugs or steroids
• Physical therapy, orthotics and/or splints
• In extreme cases or later in life, fusion of the joints may be recommended

Half of children who experience JA find it resolved within months to years. However, the remainder still have symptoms of arthritis into adulthood. Early recognition and early treatment can alleviate many of the symptoms and help the child to have a full life.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office

Although rare, juvenile arthritis (JA) affects over 200,000 children in the US each year. It can cause a constellation of symptoms or be localized to one joint.

Examples of JA include:

• Oligoarticular – pain in four or less joints for at least six weeks
• Polyarticular – pain in five or more joints for at least six weeks and is rheumatoid factor negative or is rheumatoid factor positive
• Systemic – joint pain plus:
  • Enlargement of the lymph nodes.
  • Enlargement of the liver or spleen.
  • Inflammation of the lining of the heart or the lungs.
  • The characteristic rheumatoid rash, which is flat, pale, pink, and generally not itchy.
• Enthesitis JA – pain at muscle, ligament and capsule attachments and 2 of the following:
  • Inflammation of the back
  • A positive blood test for the human leukocyte antigen (HLA) B27 gene
  • Onset of arthritis in males after age 6
  • A first-degree relative diagnosed with ankylosing spondylitis, enthesitis-related arthritis, or inflammation of the sacroiliac joint in association with inflammatory bowel disease or acute inflammation of the eye.

Your podiatrist and/or dermatologist may recommend:

• Blood test for markers that identify types of arthritis (rheumatoid factor, human leukocyte antigen, etc.)
• Radiographs of the affected joints
• A team of specialists to coordinate treatment
• Non-steroidal anti-inflammatory drugs, disease modifying drugs or steroids
• Physical therapy, orthotics and/or splints
• In extreme cases or later in life, fusion of the joints may be recommended

Half of children who experience JA find it resolved within months to years. However, the remainder still have symptoms of arthritis into adulthood. Early recognition and early treatment can alleviate many of the symptoms and help the child to have a full life.

Please visit our website for more information or call 614-885-3338 (FEET) to schedule an appointment with us at our Columbus or Gahanna office