A Step Ahead - Sole Foot and Ankle Specialists Blog

Are you a diabetic who is currently suffering pain due to neuropathy or recent amputation? If so, you probably already know it can be a difficult journey to find proper pain relief. Often, patients who suffer from diabetic neuropathy have an intense, sharp, stabbing, and burning pain that they cannot seem to relieve. They try every type of pain reliever or remedy, but have little success in treating their pain. An unfortunate truth is sometimes patients only find relief in strong, addictive painkillers such as opioids (morphine, Vicodin, Oxycontin, etc.), become dependent upon them for pain relief, and end up needing stronger doses due to their body becoming tolerant of the drug; this can become expensive and detrimental to the patient’s health. If this is your situation and are interested in a possible alternative, there have been tremendous successes in treating diabetic neuropathy pain with certain medications as Neurontin® (Gabapentin) and Lyrica® (Pregabalin).

What are Neurontin® and Lyrica®

There are countless medications on the market that have been repurposed to treat other conditions. Neurontin® (also known as Gabapentin) and Lyrica® (known as Pregabalin) are two medications originally made to help treat people with seizures. However, Neurontin® and Lyrica® have shown to provide pain relief in patients who suffer from diabetic neuropathy and provide an alternative to addicting painkillers. Neurontin® has been a beneficial treatment option for patients who have had amputations or complaints of phantom limb pains after an amputation. Lyrica® has also been shown to provide pain relief in patients who suffer from diabetic neuropathy.

What are the Possible Side Effects? Can I take these if I am on other Meds?

Every medication you take will come with the possibility of side effects. With these two medications, the most common side effects tend to be sedation, dysphoria, or the inability to concentrate. It is for this reason, if you begin taking these medications, they should be taken at night, rather than during the day. The good news is these medications do not get metabolized too quickly and this allows you to take them with other medications. Also, these provide the patient with a safer way to manage their pain without the concern of becoming addicted to the medications (as seen with opioid painkillers).

If you are experiencing severe pain due to diabetic neuropathy and have yet to find a way to manage your pain, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona, and see if Lyrica® or Neurontin® are suitable medications to help you manage your pain.

About Syndactyly

Just as newborns can be born with extra fingers or toes, they can be born with toes appearing webbed, or fused; when this happens, it is known as syndactyly. Syndactyly simply means “fingers or toes together” and a child can be born with it, or acquire it in an injury. During pregnancy, when a child’s arms and legs begin to form, they initially look like little paddles. During weeks 6th-8th of pregnancy, the fingers and toes start to appear separately, and eventually are divided into individual fingers, and toes. Syndactyly occurs when the tissue between the toes and/or fingers do not separate completely, result in the webbed appearance. Syndactyly can also be acquired at any age due to burn injuries.  

Types of Syndactyly

The appearance of syndactyly can be varied and classified accordingly. The following is a commonly used classification system:

  • Incomplete – The webbing does not extend the ends of the toes - This is the most commonly seen form and typically appears between the 2nd and 3rd toes
  • Complete – The webbing extends to the ends of the toes
  • Simple – Only soft tissue connects the toes or fingers
  • Fenestrated – There is skin inbetween the toes, but there is a gap between the webbing, and the start of the toes
  • Complicated – The bones in the toes are involved and are fused or abnormal in their size, shape, number, and arrangement
  • Complicated-Complex – There are 3 or more toes with interrupted, incomplete structures

How Will This Affect My Child or Myself?

This condition occurs in approximately 1 in 2000 births. Often, babies born with syndactyly do not have any major health problems, but the syndactyly can occur with other foot conditions such as polydactyly (extra toes or fingers). If the syndactyly only affects the toes, treatment is not usually necessary since it does not drastically alter the function of the foot. If the parent or guardian desires treatment for their child, surgery can be done to separate the toes, and restore any lost function. Surgery is typically performed when the child is younger to decrease the risk of issues that might occur as the child continues to grow.

If your child was born with webbed toes or you know someone who has syndactyly, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona, and have all your treatment options presented to you and learn more about your child’s condition to ensure you and your child continue to maintain healthy feet.

About High Blood Pressure and Circulation

High blood pressure is not an uncommon condition, especially in the United States, and can be seen in about 1 out of every 3 adults over the age of 20. High blood pressure (also known as hypertension) occurs when the force of blood coursing through your vessels is too high. High blood pressure is often associated with plaque buildup in arteries, and increased levels of bad cholesterol (LDL cholesterol) in the body. When plaque builds up in the walls of blood vessels, it limits the blood flow in that region due to a smaller space for flow. As a result, decreased circulation in your feet and legs can occur and result in a condition known as peripheral arterial disease (PAD). This poses a serious health problem for the areas affected and needs to be addressed.

How Does This Affect My Feet?

The foot is the farthest part of the body from the heart and is a concern for people with high blood pressure or decreased circulation. When a part of the body does not receive adequate blood, it does not receive the nutrients it needs to stay alive, and starts to die as a result. In the legs and feet, a lack of proper blood supply can lead to the formation of open wounds (ulcers), cause death of the tissues in your foot (necrosis), and potentially lead to amputation of the affected toes or limb.

What Should I Look Out For?

There are several things to be on the lookout for if you have high blood pressure and are concerned about poor circulation. The following are a list of some signs and symptoms of poor circulation in your feet and legs:

  • Loss of hair on the toes and top of the foot
  • Changes in the temperature and/or color of your feet (are they cold? warm? red-pink? blue?)
  • An open sore on your leg or foot (ulcer)
  • Leg and foot cramping
  • Burning feet, feelings of tingling or numbness in your feet
  • Swollen feet
  • Thin and shiny appearance of the skin on your feet

 

When You Should See a Podiatrist

If you were diagnosed with high blood pressure or are experiencing any of the previously mentioned issues, you should schedule an appointment to see a podiatrist. Having high blood pressure and/or decreased circulation can lead to additional problems in the foot and ankle, and may show up in the foot first before other parts of the body. When visiting your podiatrist, it is essential to tell them any blood pressure medications you are currently taking.

If you or someone you know is currently being treated for high blood pressure, and are concerned about your foot health, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona and have all of your treatment options explained to you.

“Doctor, the ball of my foot really hurts when I walk…it is like I am stepping on a pebble.” Does this sound like something you have experienced recently? Do you sometimes feel as if you have pain in between your toes and they go numb or tingle? If so, you could have a condition known as Morton’s Neuroma.

What is Morton’s Neuroma?

Neuromas are nerve thickenings and can develop in different parts of the body. This thickening is often painful and can potentially interrupt daily living or make simple tasks difficult. Morton’s Neuroma is a typical foot neuroma occurring between the toes, most commonly between the 3rd and 4th toes, but can also occur between other toes. With Morton’s neuroma, the thickened tissue around the nerve causes much discomfort around the ball of your foot, and may sometimes feel numb. This condition is also sometimes referred to as an “entrapment neuropathy” due to the possibility of the nerve becoming compressed with daily activities.

What Causes the Neuroma to Form? Who is at Risk?

Although the exact cause remains unclear, one of the most common causes of neuroma formation is due to continually irritation, compression, or entrapment of the nerves between your toes. Individuals who wear narrow shoes, high heels, or any shoe that causes the toes to squeeze together can lead to neuroma formation. Repeated trauma or stress from certain occupations or activities can potentially lead to neuroma formation (i.e. working with ladders, running, or standing for long periods of time).

Morton’s neuroma can occur in both genders and at nearly any age. However, women  are much more at risk for developing Morton’s neuroma than men. People with certain foot types and/or deformities are also more susceptible to neuroma formation. Pre-existing conditions such as bunions, hammertoes, or flat feet tend to be more at risk for developing a neuroma; this is due mainly to the changes in stability around the toe joints.

Typical Signs and Symptoms

Symptoms vary from patient to patient and can be unpredictable. However, the most common complaint given by patients with neuromas is pain in the ball of the foot and between the toes. However, the following are additional signs to watch for if you suspect Morton’s neuroma:

  • Tingling and/or numbness in the ball of your foot
  • Swelling in between the toes
  • Feelings of stepping on a marble or pebble when walking (may or may not be painful)
  • Pain when squeezing your foot and pressing in between your toes (Known as a Mulder’s sign)

 

When to See Your Podiatrist

If you suspect a neuroma in your feet, then it is important you see your podiatrist to get a definitive diagnosis, and begin treatment as soon as possible. Finding the correct treatment can sometimes be difficult due to the possibility of recurrence. There are several treatment options available to you depending on the severity of your pain and overall goals. The following are recommendations to help minimize or alleviate the pain felt from the neuroma:

  • Make sure to wear shoes with adequate room for your toes to move – this will help minimize compression of the space between the toes and decrease entrapment of the nerves
  • Wear shoes with shock-absorbing soles to help decrease the amount of pressure applied to the ball of your foot
  • Rest your foot when you can to take the pressure off your foot and ice it to help dull the pain
  • Non-steroidal anti-inflammatory medications may also help provide temporary relief.

 

If the above treatments have not been successful, more aggressive treatment may be needed to help provide pain relief and may include: orthotics, cortisone or  alcohol injection therapy or surgical excision.

If you are experiencing pain between your toes and suspect a neuroma, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona, and have all your treatment options presented to you to ensure you continue to maintain healthy feet.

About Polydactyly

It can be shocking news for parents when their newborn child is born with more toes than normal. When a child is born with more than 10 fingers or toes, it is known as polydactyly. Polydactyly literally means having many digits. This condition is not very common and it occurs in roughly 2 out of 1000 lives along with many patients having a positive family history of others with polydactyly. Polydactyly has been linked to having a genetic cause and has a dominant inheritance pattern, and can be recessive when associated with other conditions.

Types of Polydactyly

This condition can present in different forms ranging from a fully-functional toe (bones, nerves, and blood supply) or be a non-functioning skin tag type of toe (no bones). A classification system has been established for the different types of polydactyly based on where they are located and/or the shape of the underlying bones. The two main types of polydactyly are: preaxial and postaxial.

  • Preaxial  – with this type of polydactyly, there is an extra toe on the side of the big toe. Additionally, there are different types of polydactyly that involve the medial ray and include the following:
    • A duplicate of the 1st digit/toe
    • The big toe having three phalange bones rather than two (known as polydactyly of a triphalangeal first digit)
    • Polydactyly of the 2nd digit/toe
    • Polysyndactyly – this is an extra toe that is fused with another toe by skin
  • Postaxial – this type is the most common and refers to the extra toe being on the side next to the little toe (or 5th digit). This type of polydactyly has additional types that include:
    • Duplicated 5th metatarsal
    • Having a T- or Y-shaped metatarsal bone
    • Vestigial digit – this is an extra digit that does not have any bones and acts as a skin tag

 

How will this affect my child’s life?

In many cases, having polydactyly does not cause health problems, and many people with the extra toe can live their lives with it. However, depending on the type of polydactyly, it can be difficult to find appropriately sized shoes to fit your child, and some shoes may cause pain. There are several conservative treatment options available and include: padding, wider shoe types, and wearing shoes with extra depth. If the extra toe needs to be removed surgery can be done early in childhood.

If your child was born with an extra toe or you know someone with an extra toe that has been causing them pain, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona, and have all your treatment options presented to you and learn more about your child’s condition to ensure you and your child continue to maintain healthy feet.





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