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Podiatrist - Houston
1140 Business Center Drive Suite 510
Houston, TX 77043
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By Dr. Jeffrey N. Bowman
July 31, 2014
Category: Footwear
Tags: sandals   flip flops  

Have you ever wondered why and how sandals came to be?  My thought is that someone was tired of wearing occlusive and restraining shoe gear.  Freedom and breathability were a must and so the first sandal was designed.  Since that time, the sandal craze has taken off and a countless variety have overwhelmed the retail market.  Now, being a Podiatrist, not all sandals are created equal.  When it comes to sandals that I would call “Podiatric approved”, one at the top of the list would be Birkenstocks.  So what makes a Birkenstock a good fit for the foot?

Birkenstock Quality:


Upper made of:

  • High-grade leather
  • Suede
  • Nubuck

Contoured foot bed made of cork:

  • Ensure proper weight distribution
  • Elevated arch for support
  • Toe bar helping with toe grip and flexion
  • Over time this foot bed conforms to that individuals foot             

Shock absorbing soles


Deep heel cup that helps provide stability to the foot


These qualities aren’t found in your everyday sandal/flip flop.  Most of the sandals you find in stores have no arch support OR enough sole to provide good shock absorption.  As discussed in prior blogs concerning proper shoe gear, arch support and shock absorption are two key factors that all GOOD shoes must contain.

If you are in need of any foot/ankle care, please contact Dr. Bowman at 713-467-8886 or visit www.houstonfootspecialists.com.

Photo Credit: Hans VIA pixabay.com

By Dr. Jeffrey N. Bowman
July 30, 2014
Category: Diabetes
Tags: Infection   Foot  

The most exciting Jazz artists from around the world are about to converge in Houston, TX for the 24th Houston International Jazz Festival. Happening August 1-3, 2014, this is a summer highlight not to be missed. If you live a distance away and will be “road-tripping” your way there, you’ll probably make a list of all you need to get and do before you go. Lists are very helpful, even with regard to your health. If you have diabetes, foot care is of utmost importance, and going through a checklist each and every day can keep you free of injury, infection, and serious complications.

Poor circulation and neuropathy (nerve damage) are the two main reasons that you need to be checking your feet daily if you have diabetes. These two complications can mean that an injury could happen without you knowing, and the healing process could be compromised if something does occur. Print out this checklist and stick it on your bathroom mirror, or somewhere where you will be reminded to get it done.

  • Check your feet for any redness or signs of irritation. Look for areas that may look blue or black and could indicate bruising or blood flow problems.
  • Look for bald patches where hair is missing.
  • Look for hot spots or blisters and any breaks in the skin.
  • Take note of any calluses forming and any red, peeling or cracking skin, especially between your toes, which could indicate a fungal infection.
  • Have any new feelings of numbness or tingling checked out.
  • Check for sores or ulcers.
  • Inspect your toenails for signs of ingrown nails and any discoloration and thickening, which could mean a toenail fungal infection.

This is a quick inspection that only takes a few minutes but if could save your foot and even your life. Call Dr. Jeff Bowman at Houston Foot Specialists if you notice anything at all. You can reach our Houston, TX office by calling (713) 467-8886 or make an appointment online.

Photo Credit: nenovbrothers via FreeDigitalPhotos.net

By Dr. Jeffrey N. Bowman
July 28, 2014
Category: Foot Problems

Mountain climbing sometimes causes tendon dislocationsWhen you hear the word dislocation the majority of people will think of some joint; shoulder, hip, etc.  They would not be inaccurate in their thinking, but did you know that it is possible to dislocate a tendon?  Some are more easily dislocated than others.  In the foot and ankle there is one, actually two because they are so closely connected, that can become dislocated:  the Peroneus longus and Peroneus brevis. 

First, let’s define what it means to be dislocated.

Dislocation – disruption of an established order.  NOTE:  this is one of several that you will find in the dictionary.  The main medical definition refers to one or more bones of joint, but this does not fit our topic.  The best definition then is the one mentioned because the established order of the tendons is altered.

You may now be wondering what the Peroneal tendons are?

                The peroneal tendons believe it or not belong to the peroneal muscles which are located on the outside of each of your legs. 

  • The peroneus longus courses behind fibula towards the base of your 5th metatarsal before making a quick turn and continuing through the plantar central portion of your foot.  It inserts on to the lateral side of the 1st metatarsal base.  It functions to stabilize the 1st metatarsal to the 2nd and also plantarflexes the 1st metatarsal.
  • The peroneus brevis follows the same course as the longus but instead of turning at the base of the 5th metatarsal, it actually inserts on to the base.  Its main function is to be the major evertor of your foot, but it also causes some dorsiflexion.
  • NOTE:  these tendons course beneath a retinaculum which is designed to help keep them in their natural anatomical position.

The next question that should be racing around in your mind is how do these tendons become dislocated?

Acute trauma

  • Tendon dislocation may occur from a myriad of athletic activities.  Snow skiing being the more common cause; 1 in every 200.1  Other athletic activities include:  football, rugby, basketball, water skiing, dance, gymnastics, mountain climbing, and combat training.  Golf isn’t looking like too bad a sport now is it?1

o   Indirect causes is much more common than direct; direct being rare.

o   Chronic subluxation may often be found in those with recurrent ankle sprains.  For you Disney fans, Meg could have peroneal tendon subluxation/dislocation.  If you already know which Disney movie Meg is from then Kudos to you.  For those who need a little more help I’ll drop a hint.  HINT:  He made Arnold Schwarzenegger look like a “girly man”.2

o   Finally, dislocation may stem from neuromuscular abnormalities such as paralysis and polio.2

  • MOI (Mechanism of Injury)

o   Results from a sudden and “rapid dorsiflexory force across the ankle with subsequent simultaneous, violent, reflex contraction of the peroneal tendons and ankle joint plantarflexors.”1,3

o   Violent contracture of the peroneal tendons with the foot in a supinated position.  The ankle also being dorsiflexed.1,2,3

o   Retinacular rupture rarely occurs.  In fact, the retinaculum is typically “stripped off the fibular insertion or avulsed with a small fleck of fibular cortex.”2

Eckert and Davis developed a classification scheme to determine severity of injury as well as incidence of occurrence; based off observations that were noted during surgical repair.1,2,3

  1. The retinaculum is elevated off the lateral malleolus with the tendons now located between the fibula and retinaculum; Occurrence rate of 51%.
  2. The fibrocartilaginous ridge is elevated with retinaculum attached and the tendons displaced beneath this ridge; Occurrence rate of 33%.
  3. A small portion of the lateral malleolus is avulsed off and the tendons now located beneath this fragment of bone; Occurrence rate of 16%.
  4. NOTE:  as you can see, the more severe stage 3 is much less common.

On physical exam pain is more localized to the posterior aspect of the fibula which is opposite of that if this were an injury to the ATFL (anterofibular ligament).  Patients may complain of a snapping sensation over the lateral malleolus.4The tendons can be actively subluxed/dislocated in the office with:

  • Resisted dorsiflexion and eversion of the foot
  • Circumduction of the ankle and foot in a clockwise and counterclockwise fashion.
  • NOTE:  it is always important for your practitioner to examine the opposite foot.

The peroneus brevis can develop partial tears due to continued dislocation over the lateral malleolus.4

X-ray, CT, and MRI may all be used as adjunct to clinical evaluation in the diagnosis.  MRI may help diagnose any underlying injury to the tendon substance itself.

Treatment:

  • Conservative:  below knee cast for 5-6 weeks.  Literature reports a 50% success rate with conservative treatment.1,2  Some studies report a 14-56% success rate.3
  • Surgical:  often times this is determined by the severity of the injury.1,2,3

o   Direct repair of the retinaculum to the periosteum of the fibula is the treatment of choice for acute injuries.

o   Chronic injuries may require a little more ingenuity.

-  Reattachment of the retinaculum with reinforcement using tendon transfers

-  Rerouting the peroneal tendons

-  Fibular groove deepening.  What’s the fibular groove?  The fibular groove is a groove in the posterior aspect of the fibula that the peroneal tendons sit in.  If this groove is too shallow, it may aid in the dislocation process.5  By deepening this groove, you alter and increase the stability of the peroneal tendons.2

-  Bone block procedures:  these are osteotomies (cuts in the bone) that are meant to reform and deepen the fibular groove.

 

References:

  1. McGlamry et al.  Foot and Ankle Surgery.  3rd Edition.  Volume 2.
  2. Coughlin and Mann.  Surgery of the Foot and Ankle.  8th Edition.  Volume 2.
  3. Easley et al.  Operative Techniques in Foot and Ankle Surgery. 
  4. Ogawa et al.  Peroneal Tendon Subluxation Repair with an Indirect Fibular Groove Deepening Technique.  Foot & Ankle International/Vol. 28, No. 11/November 2007.
  5. Adachi et al.  Morphologic Variations of the Fibular Malleolar Groove with Recurrent Dislocation of the Peroneal Tendons.  Foot & Ankle International/Vol. 30, No. 6/June 2009.

Photo Credit: sebadelval via pixabay.com

By Dr. Jeffrey N. Bowman
July 24, 2014
Category: General
Tags: Foot   bone grafting  

Grafting is not uncommon terminology.  It is used in horticulture where you take a cutting of one plant and either insert it into a portion of the same plant OR of another type of plant.  Grafting is also used in the medical field.  We have all heard of skin grafting which can be from taken from the same individual OR from another.  What you may not have known is that bone can also be grafted. 

Why would you need to graft bone?

  • Bone lengthening
  • Filling in the void from bone tumor excision
  • Restore length following an osteotomy (bone cut) during a surgical procedure
  • Fill in gaps following a major fracture

Basics of bone grafting:

  • Autograft – comes from you
  • Allograft – from another individual of the same species
  • Synthetic grafts – carry properties of bone
  • Osteoconduction – physical structure to act as a lattice
  • Osteoinduction – growth factors for bone growth stimulation
  • Osteogenesis–bone producing cells

Are there different types?  YES!

  • Tricortical wedges
  • Bone chips
  • Injectable bone graft – YES, injectable.  Crazy I know. 

Your physician will already have an idea of what type of graft is needed based off of necessity.  For restoring length OR maintaining length, a block/wedge of tricortical graft is the best because you will be able to place fixation across it.  For void fillers bone chips work great.  Your podiatric physician will always keep these amazing grafts in mind for any procedure and will request them when needed.

If you are in need of any foot/ankle care, please contact Dr. Bowman at 713-467-8886 or visit www.houstonfootspecialists.com.

Photo Credit: How Soon Ngu via unsplash.com

By Dr. Jeffrey N. Bowman
July 23, 2014
Category: Nail Problems

Have the perfect toes for poolside funSunglasses, sunscreen, bathing suit, beach towel, IPod, water bottle and snacks – check off the list if you are getting ready for a fun summer vacation! If you have a hot spot destination in your future and the pool will be calling your name, make sure your nails and your toes are ready to be shown off. It’s not rocket science to take good care of your feet, but the following easy tips will keep them looking great, feeling healthy, and ready for vacation.

It is a great practice to regularly check your feet in order to avoid common foot woes such as ingrown toenails and fungal infections. These kinds of problems start out small and sneaky, but can take root quickly and become problems that are difficult to get rid of.

First, tend to your toenails properly. Before applying that spunky new, bright-colored toenail polish, make sure you trim your toenails straight across. Keep them just below the end of your toe—too short or curved and you could wind up with the start of an ingrown toenail, which is a painful problem you don’t want hindering your summer fun.

Second, it is best to leave your cuticles alone. Don’t cut them or push them back as they actually have the purpose of protecting against fungus and bacteria. Keep them moisturized and they will look healthy.

If you are taking off an old layer or two of polish, avoid using removers with an acetone base as it can strip the nail and cause it to become brittle. Use a smooth, fine nail file and file slowly in one direction. If you prefer to go to a salon, watch that the pedicurist is following these tips and is using completely sterilized instruments and footbath.

If you have any concerns before you go, or you notice a foot or toenail problem while you are looking at your feet on the pool lounge chair, don’t hesitate to contact Houston Foot Specialists. Dr. Bowman will get any problem solved quickly. Call our Houston, TX office at (713) 467-8886 or request an appointment online

Photo Credit: CapeJT via Pixabay.com





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Call Today 713-467-8886

1140 Business Center Drive
Houston, TX 77043

Podiatrist - Houston, Houston Foot Specialists, 1140 Business Center Drive, Houston TX, 77043 713-467-8886