Foot & Ankle Health

A Picture Of Health

2009-11-21T04:42:00.000-08:00

If you had a microscope into your body, an x-ray of the structures, and a mirror into the innermost parts of your body, would you take a look? Maybe you would be even more interested if this picture could help limit future pain or prevent future disease.

As I continue to see patients day to day, many would love to find ways to prevent the foot and ankle problems that are now interfering with their lives. Some even look for options to ensure they can stay active. I feel this information is important and should be available to everyone that desires it.

For this reason, we have created a new free report that will let you not only stay active, but help you understand how careful foot and ankle care can prevent pain, keep you active and even give you a picture into your overall body health.

Request this report and Optimize What You Were Born With...

Dr Brandt R. Gibson
Mountain West Foot & Ankle Institute
American Fork, Utah
http://www.utahfootdoc.com/

What Is A Bunion?

2009-10-19T12:43:00.000-07:00

I often see patients with the complaint of "bunion" that really don't have this deformity. Often they come in with a bump on a toe, a corn or callus on the inside or outside of the foot or even curling of toes and think it might be a bunion. The truth is, a bunion is a very distinct problem that can easily be diagnosed at home. The presence of pain can then help you determine if it needs to be treated.

Bunion --> A bunion is a bony prominence to the inside of the foot, just behind the big toe, often accompanied by angling of the big toe towards teh second toe. This prominence grows over time and can lead to increased pressure in the shoes, redness and swelling to the area and even significant pain. If significant pain is seen, it is an indication that treatment is necessary including wider shoes, orthotics, toe spacers, bunion splints, bunion pads or even surgery. Surgical correction has improved significantly and often allows quicker return to activity that previously encountered.

Tailor's Bunion --> A tailor's bunion is a similar bony prominence to the outside of the foot, just behind the little toe. Another name for this is bunionette (or smaller bunion). This has similar treatment options and can also produce similar pain.

If both deformities are present, the problem is even exacerbated and may lead to more difficulties in finding good shoes or participation in activities.

The key to both these deformities is the amount of pain. Pain is never normal and can usually be significantly improved or resolved by surgical correction.

Dr Brandt R. Gibson
Mountain West Foot & Ankle Institute
American Fork, Utah
http://www.utahfootdoc.com

Don't Let PAD or Leg Pain Stop You

2009-09-17T08:48:00.001-07:00

September is National Peripheral Arterial Disease Awareness Month. As part of this month, I have felt it necessary to invite anyone with leg cramps or circulation problems to their legs or feet to be evaluated for PAD or Peripheral Arterial Disease. PAD is a well known entity that can interfere with an active lifestyle, and often indicates increased risk for other life-threatening conditions like heart attacks or strokes.

PAD is defined as disease to the peripheral arteries of the body. These arteries include any vessels away from the trunk of the body (primarily legs/feet and arms/hands). When this disease is present, circulation is less than ideal to the areas served by the arteries. The most common presentation in the legs is cramping to the calf with walking that improves after sitting or resting for a few minutes. Fatigue may also present and lead to inability to walk. If you have pain to the legs with walking, especially if it always presents after a given time or distance (10 minutes of walking, one block, etc.), then you should be evaluated for possible arterial disease.

Don't let PAD stop you from staying active. Don't risk the possible side-effects of additional arterial problems to the heart or brain. It is important that evaluation is done early to preclude any additional risks. Early treatment is important. Mountain West Foot & Ankle Institute can perform the vascular testing that is required to determine if PAD is a problem.

Dr Brandt R. Gibson
Mountain West Foot & Ankle Institute
American Fork, Utah
http://www.utahfootdoc.com

May Is World Foot Health Awareness Month

2009-05-05T13:27:00.001-07:00

Foot health is a new concern around the world, because even a slight decrease in foot or ankle health and other health will decrease. I have found over the years in medicine that heart health, or other physical signs of health are improved by simple activities like walking, biking or other forms of exercise. The opposite is also true: If someone stops activities, health deteriorates quicker. Thus the international community is striving to keep everyone active by protecting foot and ankle health.

As we start into the summer season, I want to include some simple recommendations to keep your feet healthy as you enjoy the warmer weather. Through these simple techniques, problems can be avoided and we can help you Optimize What You Were Born With:

1. Protect your feet with proper shoegear for the activity. Flip flops are not the shoe for running or walking, but work great around the pool or at the beach. Running shoes work great for walking or running. If you want a supportive "slip on" shoe, think Crocs or supportive sandals.

2. Feet can get sunburned too. As you apply sunscreen, don't forget the painful area of the feet.

3. Drink lots of water. As you overheat, drinking water will help overall health and reduce cramping or other symptoms in the feet and legs.

4. Enjoy the beauty around you. Sometimes just slowing down to smell the roses, taking time to talk with friends or family and taking in the beauty that we miss if we hurry by will increase your joy for life and your overall health.

Dr Brandt R. Gibson
Mountain West Foot & Ankle Institute
American Fork, Utah
http://www.utahfootdoc.com

Walk into health...

2009-04-08T14:25:00.000-07:00

National Public Health week is now in day 3. As a part of this health push, the APMA (American Podiatric Medical Association) has been promoting foot health awareness. One powerful instrument in staying healthy is exercise, which can be easily accomplished through walking. To faciliate walking and help people walk without problems, the APMA has released the 2009 Walking Guide. This guide will help each of us follow the recommendations that adults participate in moderate physical activity for at least 30 minutes on most days of the week. Let’s stay active and be healthy.

Dr Brandt R. Gibson
Mountain West Foot & Ankle Institute
American Fork, Utah
http://www.utahfootdoc.com

The Utah Run Doctor

2009-03-03T08:20:00.000-08:00

From an early age, I have always loved to run. Earlier in my life I used to run to relax, to think or just to get away. Rarely did I listen to music or other "distractions" because I just wanted to think while I was running. Since that time, I now run for similar reasons but also to get the exercise benefit. Since becomining a podiatrist (or foot & ankle specialist), I have a new perspective on running and learn more about running from the simple act of running.

With this information in my pocket, I have started a new blog, the Utah Running Doctor, to discuss aspects of running that comes up in my training for marathons this year. I feel it is important that in my running I provide the necessary information for runners as they run for exercise, run training for races or just run because they want to be more healthy. My goal is to keep people running.

Dr Brandt R. Gibson
Mountain West Foot & Ankle Institute
American Fork, Utah
http://www.utahfootdoc.com

Jazz Owner Larry H Miller Dies From Complications of Diabetes

2009-02-23T07:59:00.000-08:00

Utah and the Utah Jazz lost a great man with the death of Larry H Miller. Larry H Miller is well known as the owner of the Utah Jazz NBA team, but also has multiple business and personal accomplishments that have helped rocket him to notoriety. He became co-owner of the Utah Jazz with a 50% purchase of the team on 11 April 1985. In June 1986, he purchased the remaining 50% and became the sole owner. He has since made it one of the most stable teams in the NBA.

Although Larry H Miller has been in declining health for several years, diabetic complications seemed to play a greater role in his health problems and his death. In June 2008, he suffered a heart attack and was hospitalized for 59 days with bleeding problems and kidney failure. In October of the same year, he developed a bone infection (osteomyelitis) from diabetic ulcerations. He underwent foot surgery at that time, and later progressed to below knee amputations of both legs “as a result of complications of diabetes.”

Larry H Miller’s story is not that different from many diabetics. Diabetes is becoming better known throughout the world as patients and physicians alike study and learn more about this growing disease. The American diet has been implicated with increasing the rate of diagnosis of diabetes, and greater complications are being recognized, including many parts of the body. Many of these complications affected Larry H Miller, but may not be directly related to his death, as he had a rare condition called calciphylaxis that may have aggrevated some of the complications of diabetes.

For more information of the complications of diabetes, request our free CD on diabetes or request our free book on Foot & Ankle Health.

Dr Brandt R. Gibson
Mountain West Foot & Ankle Institute
American Fork, Utah
http://www.utahfootdoc.com

Rheumatoid Arthritis and The Foot

2009-01-08T04:59:00.000-08:00

Rheumatoid arthritis (RA) is a systemic disease that affects about 2.1 million Americans, mostly women and has been shown to attack multiple joints throughout the body. It is estimated that 1.5 million women and 600,000 men are victims of this debilitating disease. Of these affected, approximately 90% of the people with RA eventually develop foot or ankle symptoms and deformity. In fact, many of the early symptoms of RA often include foot problems. Foot problems are more common than symptoms to the hand and only second to knee problems. These symptoms can lead to serious disability.

After years of study, however, the exact cause of RA is still unknown. Some possible causes include inheritance from parents, and chemical or environmental “triggers” all leading to a malfunction of the immune system. In RA, the immune system of the body turns against itself and damages joints causing cartilage damage and inflammation.

Symptoms

Symptoms often begin with pain, swelling and stiffness, but can also involve deformities. Typically the first joints affected in the foot include the metatarsophalangeal joints (the joints at the ball of the foot) and can include significant pain with pressure from standing, motion of walking or tightness of shoes and the area may also be warm from the inflammation. In other words, even simple activities may causes pain to the foot.

The pain then can affect other areas of the forefoot (front of the foot) including the toes caused by contractures of ligaments and tendons leading to bunions (turning of the big toe towards the other toes) or your other toes may begin to curl and get stiff (often called hammertoes or claw toes). As this occurs, calluses become a larger problem and may build up under the ball of the foot, at the joints of the toes or even at the tips of the toes. Care must be exercised to limit damage to the skin that may occur as these calluses to become wounds.

Other areas that may be affected include the hindfoot (back of the foot) with heel pain from Plantar Fasciitis (inflammation of a ligament extending from the heel to the toes), tendonitis of the Achilles tendon or even bursitis (inflammation of a fluid filled sack at the back of the ankle).
RA, as an inflammatory disease, may also include neuropathy (loss of nerve functioning including numbness or muscle weakness), vasculitis (inflammation of the blood vessels), ulcerations (wounds), necrosis of the toes or even gangrene. Foot drop may also occur as part of an entrapment injury to the nerves.

RA is a systemic disease and will commonly produce generalized symptoms of fatigue, fever, loss of appetite and energy, and anemia (poor oxygen distribution to the body) adding to the symptoms of tiring easily.

Diagnosis

In arthritic conditions, especially rheumatoid arthritis, it is important to establish a correct diagnosis. Often the symptoms in the foot or ankle may be the first indications of this diagnosis.

A diagnosis is obtained through review of your medical history, your current occupation, and recreations activities you participate in and any previous history of problems to your feet or legs. One possible indication of RA is appearance of symptoms in the same joint on both feet or several joints in the feet. X-rays may also be obtained to clarify what joint damage is occurring. Blood test may show anemia or have an antibody called “the rheumatoid factor” which is often indicative of RA.

If you already have a diagnosis of RA, any symptom changes to your feet or ankles should be followed closely, as new swelling or foot pain may be the early signs of the foot or ankle being affected. There are usually treatments that can reduces the symptoms and possibly slow the progression.

Treatment

It is important to understand that RA is a progressive disease that currently has no cure. With this understanding it should also be understood that medications, exercises, conservative therapies and surgery can all be utilized to lessen the effects of the disease and may slow its progress.

Medications are usually designed for one of three reasons: 1) Control pain, 2) Reduce Inflammation or 3) Slow the Spread of the Disease. Aspirin and non-steroidal anti-inflammatories (NSAIDs) like ibuprofen and anesthetic injections to the joints principally help control pain. Local cortisone injections help reduce inflammation locally. Ice and some topical medications (like Biofreeze) may also help reduce inflammation and the associated pain. Medications like methotrexate, minocycline, azothioprine, prednisone, sulfasalazine, and gold compounds, help slow the spread of the disease itself

Exercises usually include physical and occupational therapy modalities. Range-of-motion exercises, exercise in whirlpool or warm swimming pool, remaining active all help decrease the immobility produced by the disease.

Conservative therapies include custom shoe inserts (orthotics), braces (especially for foot drop), specialized shoes to better accommodate the foot changes, and protective padding. The most common padding required is for pressure points on the toes where calluses (thick skin) form and cause pain. Some of the easiest padding can include:

Gel Toe Caps – A compressive sleeve completely lined with gel that is easily slipped onto the toes to pad the joints and the tip of the toe. Reduces the pressure and is protective from callus formation or progression.

Gel Corn Pads – A compressive sleeve with gel padding to be easily applied to the toes to protect prominent joints of the toes and reduce callus formation or even wounds to these areas. Again this will reduce pressure and is protective from callus formation or progression.

Gel Crest Pads – A pad to be placed under the toes to flatten and elevate the toes, reducing the pressure to the tips of the toes from hammertoes or claw toes. Protective from wound formation or callus formation to tips of toes.

Even with these or similar treatments, regular follow-up with a physician is important, because callus tissue should still be reduced on a regular basis (it just won’t get bad as fast with protective measures) to eliminate the possibility of wounds developing.

Surgical intervention can also be undergone, including tendon release or lengthening, correction of single or multiple hammertoes or other foot deformities, bunion correction, metatarsal surgery, ankle surgery, joint implants, or complex foot surgeries to reduce risk factors.

The role of a qualified foot and ankle specialist or podiatrist may include major contributions to the management of this disease, including relief of pain and restoration of function. This can add not only to a reduction of disability but an improvement of walking, increased independence and the regular ability to engage in activities of daily living. Increased joy and happiness in life may then occur, as the foot and ankle are optimized to function even with this difficult disease.Dr

Brandt R. Gibson, DPM
Mountain West Foot & Ankle Institute
American Fork, Utah
http://www.utahfootdoc.com

A Maggot Can Save Your Life

2008-12-08T23:05:00.000-08:00

In the diabetic foot, wounds quickly become a problem as they fail to heal and often can become a life-threatening infection. What methods would you be willing to undergo to prevent amputation or an infection that could put you in the hospital or even the grave? Many unconventional treatments are appearing to help save lives and heal wounds. Recent advances include silver dressings, honey and even maggots.

Would you be willing to undergo maggot therapy to heal your wound? In a recent article I found on Syracuse.com, Linda Franks talks about treating her wound with maggot therapy and saving her leg and her life. Although the process took two years, the heel wound has healed and the infected bone has healed and new skin has developed. She has even stopped her wheelchair and is walking on her own.

Let’s discuss this treatment. Maggot therapy has been around for many years. In ancient times they were utilized to clean wounds. Even before that time, the earth has utilized the maggot to remove dead, infected tissues. This is the basic technology utilized to help heal these wounds, as it ensures dead and infected tissues are removed without damage to healthy tissues. It was started as a technology in 1930s when maggots were produced commercially. Although it fell out of favor for years, it has returned as an option when all else fails and when doctor and patient are willing to give it a try.

What other treatments should be tried first? Antibiotics; Wound care treatments that include aggressive removal of dead tissue (debridement); Strict diabetic blood sugar control; Removal of habits such as smoking; Offweighting the area (i.e. no pressure to the wound); Advanced wound care modalities; Bypass surgeries; Hyperbaric oxygen. Any and all these can be utilized, but if they fail, would you be willing to try maggots?

Maggot therapy has been proven to be effective and improve wounds when other treatments fail. Now this isn’t your neighborhood fly maggot, nor can you place your own maggots on your wound. Commercial, “sterile” maggots have been developed for this purpose. They are applied with pain medication use and allowed to work on the wound. The maggots are then removed within a day or two and disposed of. This is not a single treatment, but often requires many cycles of treatment but provide an option for the stubborn, nonhealing wounds.

I have seen the work of maggots and have seen great improvements in wounds through their therapy. One patient even had her life protected after days of an infected wound treated with maggots kept the infectious spread from other areas and additional bone damage. Is maggot therapy the first treatment people should undergo? No. Should it be considered? Absolutely. As we continue to search out new treatments to speed the healing of diabetic wounds, no successful treatment should be discounted or ignored. If you can handle this therapy, it may save your foot and may even save your life.

We seek to provide the highest quality care for diabetic wounds and are trying tested and true techniques. Please visit our office if you need help with your wound. You can also access our website or request our FREE BOOK.

Stop Ingrown Nails in Children

2008-12-08T13:21:00.000-08:00

On a regular basis, I see ingrown toenails in both adults and children. Although the treatment is quite common, they can become a big problem and often can interfere in even normal activities and normal shoes.

Parents can help prevent this common and painful foot problem in children by following a few simple tips, and with a careful understanding of the common causes. First, ingrown toenails are a commonly caused by tight shoes, tight socks and incorrect nail trimming (nails should be trimmed strait across as opposed to curved like fingernails). More improtant, however, inheritance or genetic curving of the nails can lead to the problem. In fact many people without an inherited tendency for nails to curve, will never have ingrown toenails even with tight shoes, poor nail trimming and other causitive occurances.

In my experience, many kids hide their ingrown toenails from their parents, even though the condition can cause significant pain. Over time, the nail may break the skin and lead to dangerous infections. The following recommendations can help parents prevent ingrown toenails in their children:

1. Teach children how to trim their toenails properly. Trim toenails in a fairly straight line, and don't cut them too short. I commonly trim my toenails strait and then remove the corners.

2. Make sure children's shoes fit. Shoe width is more important than length. Make sure that the widest part of the shoe matches the widest part of your child's foot. This may mean that you are unable to pass shoes down from child to child.

3. If a child develops a painful ingrown toenail, parents can reduce the inflammation by soaking the child's foot in warm water (not hot) with epson salts. While in the water, the parent may also gently massaging the side of the nail fold.

4. The only proper way to treat a child's ingrown toenail is with a minor surgical procedure at a doctor's office. Parents should never try to dig the nail out or cut it off. These dangerous "bathroom surgeries" carry a high risk for infection. Doctors may prescribe antibiotics to children with infected ingrown toenails, but often an antibiotic is not necessary.

So if you see your child limping, notice a red swollen toe, see blood or dainage on a sock or see a child start to cry with a simple "bump" of the toe, you should be thinking ingrown toenail and seek to alleviate the infection and the pain by having it treated correctly. Until that time, follow the above steps to limit the presentation and recurrence of an ingrown nail. Like you, we want to keep your children active.

If you would like additional information on this condition, visit us at Mountain West Foot & Ankle Institute, or request our Free Book on foot health.

World Diabetes Day - The Diabetic Foot

2008-11-14T11:39:00.000-08:00

Today is World Diabetes Day. Since diabetes is growing at an unprecedented rate in 2008, the World Health Organization is trying to increase the understanding of people throughout the world on this increasing problem. Diabetes now affects approximately 24 million people in the United States, an increase of more than 3 million in approximately two years, according to new 2007 prevalence data estimates released recently by the Centers for Disease Control and Prevention (CDC). This means that nearly 8 percent of the US population has diabetes. This has also become increasingly problematic in thw world:

Recent data in India confirms this same growth (or increased growth) throughout the world. (According to the International Diabetes Federation (IDF), there were an estimated 40 million people with diabetes in India in 2007 and this number is predicted to rise to almost 70 million people by 2025. )

With this understanding, it is my recommendation that any diabetic do at least three things daily:

1. Check your feet twice a day -- Most people put shoes on and take them off. I recommend you take this opportunity to evaluate your feet for any changes during this period. If you take good care of your feet, you will be able to keep them.

2. Strictly control you blood sugars -- Often a diabetic will fail to see the importance of not just having an okay blood sugar, but a strictly controlled sugar. All the studies repeatedly confirm that blood sugar control is THE BEST way to limit the complications of diabetes.

3. Protect your feet -- Neuropathy (numbness, tingling or loss of feeling in feet) can often lead to injuries. Use good shoes, including in the home. Don't walk barefoot. Test water before stepping into the bath. Even little wounds should be treated aggressively.

If you practice these simple techniques, your feet will be able to carry your throughout the rest of your life. Now isn't that what we want?

Deron Williams Sprained His Ankle

2008-11-12T15:00:00.000-08:00

On October 19, 2008, Deron Williams (the allstar guard for the Utah Jazz) suffered a left ankle inversion sprain with 5:39 left in the first quarter. The inury occurred when Williams landed on the foot of Bulls guard Derrick Rose. X-rays were negative and it was later diagnosed as a "grade 2" ankle sprain.

The ankle is a very complex structure consisting of three bones (the fibula, tibia and talus) that function similar to the hinge on a door. Similar to a door, the ankle primarily moves in two directions (ie you can point your toes or flex your foot). Since the surfaces we walk on are often not completely flat, some side to side motion is also allowed. This motion is limited by a strong thick ligament on the inside of the ankle (the deltoid ligament) and three smaller ligaments on the outside of the ankle. Commonly it is these smaller ligaments that are easily injured in high impact sports such as basketball.

I, at Mountain West Foot & Ankle Institute, often see High School basketball players that have suffered multiple ankle sprains by landing on someones foot or even landing wrong after a jumpshot. For this reason, basketball players and volleyball players commonly either tape their ankles or wear ankle braces to limit injury.

Often athletes ask when they should be evaluated by a physician. Deron Williams was evaluated immediately, but mild sprains can often be self treated with rest, ice, compression and elevation (RICE). Moderate injuries will not improve without more aggressive bracing or taping and should be evaluated for fractures by x-ray. If you have a tendency to sprain your ankle easily, or your sprain is not getting better, it is always a good idea to visit a specialist in foot and ankle injuries.