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Posts for tag: Arthritis

By Dr. Jeffrey N. Bowman
February 13, 2014
Category: Foot Problems
Tags: Arthritis   Foot   Rheumatoid   Deformities  

Arthritis is that diagnosis that no one wants to hear from their physician.  It’s like going to Chick-Fil-A and finding out they have no more chicken sandwiches.  I think it’s because there is no true cure except to replace or fuse the joint that is affected, which obviously require surgery.  There are many types of arthritis, but the two most commonly mentioned are Osteoarthritis (OA) AND Rheumatoid arthritis (RA).

When you think of arthritis, you think of it effecting shoulders, hands, hips, and knees, but how often have you thought of it effecting the joints of the foot? Arthritis is actually very common in the foot and ankle.  Osteoarthritis and yes, even rheumatoid arthritis, are common in the foot.

So what might you expect to find with RA in the foot?

  • Rheumatoid Nodules – these are typically a sign a more progressive process and occur in 20-35% of all patients with RA.  These nodules often form in areas of subject to pressure (i.e. Plantar forefoot and heel).  These are typically asymptomatic unless they impinge a nerve or other structure that is highly innervated.  These can be treated with padding and shoe modifications OR surgical excision.
     
  • Joint Inflammation – the joint tissue becomes inflamed with the tissue becoming unstable with eventual destruction of the very valuable cartilage.  If tendons are involved, rupture may be an inevitable event.  Clinically you will notice swelling and pain of the involved joints.
     
  • Digital Deformities – with destruction of the stabilizing structures of your joints, you may begin to notice alterations in the form of your foot.  The most commonly seen deformity is dislocation of your digits.  Like your fingers, your toes begin to move in an abnormal direction.  To be exact, the big toe moves towards the little ones AND the little ones toward the big toe.  Eventually your foot may look like the head of a fluke.  Such a misshapen foot makes wearing shoes very difficult, if not impossible NOT to mention walking.
     
  • Other Deformities – although forefoot changes are more commonly seen, RA can affect the rearfoot and ankle.  Erosions may occur on the calcaneus (heel bone) leading to plantar heel pain that may initially mimic plantar fasciitis if a careful work-up is not performed.  Collapse of the midfoot joints may occur with weakness of the Tibialis Posterior tendon.  The foot may subsequently take on a more valgus (flatfoot) type of appearance. 

NOTE:  with deformities, conservative care may be used to manage the progressiveness of the disease OR surgical correction.  With surgery, it is recommended that you be in a more dormant stage of the disease.

If you or someone you know is suffering from any form of arthritis and needs the skillful mind and hands of a Podiatrist, please contact Dr. Bowman at 713-467-8886 or visit www.houstonfootspecialists.com.

Knee scopes are one of the most common procedures offered from Orthopedic Surgeons for a multitude of knee complaints. The use of a "scope" or "arthroscopic" surgeries has made an increase in the foot and ankle. Arthroscopic literally means to look inside of a joint. This is done with the use of a very small, lighted tube, roughly the size of a lollipop stick, to look inside of the ankle. This is done through a very small, 5mm stab incision. Another small stab incision allows the entrance of other surgical instrumentation.

Interestingly, from a historical perspective, the lighting to view the joint has grown from reflected sunlight, candles, burning filaments, gas and electric lamps to today's fiber-optic lights. These powerful fiber-optic lights illuminate inside of the joint while fitting inside of the small camera. To view the joint began with the naked eye and then employed lenses and has developed today into high-definition camera lenses. These cameras project the small area onto larger high definition screens. Technology today allows the use of smaller arthroscopic instrumentation with more and more procedures.

Ankle scopes are used today for a variety of ankle issues. Simple entrance into the ankle joint allows diagnosis of ankle pathology. The surgeon can visualize directly what an MRI or X-Ray may possibly miss. Many ankle complaints can be from previous ankle injuries that result in inflammatory or arthritic changes to the ankle joint. These injuries are easy to treat by simply entering the joint and smoothing the ankle joint defects and any excessive soft tissue linings. Any spurring on the bones of the ankle joint can be smoothed as well, while avoiding a large open incision.

Unfortunately, true ankle arthritis cannot be cured by any procedures, scopes or otherwise. Arthritis is an irreversible problem with treatments aimed mainly at symptoms. Steroid injections can help reduce inflammation to the joint, but scopes actually enter and clean up some of the painful tissue associated with arthritis. Eventually, painful arthritic ankles that fail conservative treatment are destined for either ankle joint fusions or total replacements.

Patients are permitted to bear weight immediately after surgery, however some recommend partial weight bearing for the first 2 weeks. Range of motion ankle therapy exercises are encouraged as soon as tolerable. Sutures are to remain in place for 10-14 days.

Ankle arthroscopy has improved by leaps and bounds over the last 50 years and will continue with an increase in surgeon competency and education and with improvements in technology. Ankle arthroscopy can provide a minimally invasive answer to ankle pain and avoid ankle fusion or replacement for chronic ankle arthritis.

For more information on ankle scopes and ankle pain please contact Dr. Aleisha Allen DPM by calling (713) 467-8886 or visit our website for online appointments at www.houstonfootspecialists.com.

Photo Credit: nuchylee via FreeDigitalPhotos.net

Living with osteoarthritis in your feet can be both painful and exhausting. Although the symptoms of osteoarthritis vary from case to case, the most common symptoms include painful joint damage, swelling, trouble walking, stiffness, and even deformity.

Because we rely on our feet to get around each day, having osteoarthritis in your feet can affect every single aspect of your life—especially your ability to work and support yourself. Immobility, unemployment, and severe pain have all been known to cause additional depression and anxiety.

If you have osteoarthritis in your feet and can no longer work, you may be eligible for financial assistance through the Social Security Disability program. The following information will help you determine whether or not you are eligible for disability benefits and will give you a better understanding of how the application process works.

Osteoarthritis of the Feet and Qualifying Criteria

To initiate the Social Security Disability application process, you will be required to fill out an application online or in person at your local Social Security office.

The Social Security Administration (SSA) provides specific medical criteria for each disabling condition—including osteoarthritis. The SSA uses these criteria to determine whether or not an individual is truly disabled. If your osteoarthritis has caused severe bone or joint deformity it is likely that you will meet the medical qualifications to receive disability benefits.

Simply put, the Social Security Administration will evaluate your initial application to determine whether or not your osteoarthritis keeps you from working.

Necessary Medical Evidence

Along with your initial application paperwork, the Social Security Administration will require that you provide medical evidence to support your claim. Medical evidence may include documentation of the following:

  • Your medical history
  • Each of your diagnoses
  • Your treatment history
  • Your past hospitalizations
  • Any lab results such as X-rays and CT scans

If your osteoarthritis has caused you to develop other conditions such as anxiety or depression, it is important that you mention this on your application as well. This is important because the SSA will evaluate the combined effects of each of your medical conditions, not just your osteoarthritis.

Other Requirements

In addition to the medical requirements for Social Security Disability benefits, there are additional financial and work-related requirements. You can learn about the different programs and their requirements here: http://www.disability-benefits-help.org/faq/apply-social-security-disability-insurance-or-supplemental-security-income

The Services of a Social Security Disability Attorney

Applying for Social Security Disability Benefits can be complicated and overwhelming for new applicants. If you are feeling stressed or unsure about the process, it may be in your best interest to consult with a Social Security Disability attorney. While hiring an attorney isn’t required, it can often be helpful for those who don’t have the time or energy to navigate the Social Security Disability application alone.

Social Security Disability benefits are a necessary life line for those who can no longer work due to osteoarthritis and other foot conditions. They can help relieve the financial burden of specialty medical treatment, assistive technologies, and supportive care. If you are interested in learning more about Social Security Disability visit the Social Security Disability Help page: http://www.disability-benefits-help.org/disabling-conditions/osteoarthritis-and-social-security-disability.

This is a guest blog written by Molly Clarke from Social Security Disability Help.

©2013 Jeff Bowman., All Rights Reserved

By Dr. Jeffrey N Bowman
April 15, 2013
Category: Foot Problems

If you have been diagnosed with arthritis, or joint inflammation, you know all too well the pain associated with the disease. There are several types of arthritis, but the most common form is osteoarthritis, or “wear-and-tear” arthritis. It’s also referred as degenerative joint disease; it’s the breakdown of cartilage that cushions the ends of the bones where they meet to form joints. This breakdown causes the bones to rub against each other, causing pain, stiffness, and loss of movement in the joint.

In the foot, osteoarthritis affects any joint in the foot. Symptoms associated with osteoarthritis are tenderness or pain, stiffness in the joint, swelling in the joint and reduced ability to move, walk, or bear weight. Proper diagnosis, early treatment, and pain management are all key factors in preventing joint deformity and disability.

Treatment entails taking medications for arthritis management. These medications include analgesics and NSAIDs (non-steriodal anti-inflammatory drugs and to provide pain relief and reduce inflammation. Analgesic medications are commonly sold over-the-counter as Tylenol or acetaminophen. Acetaminophen is most effective for mild to moderate pain. NSAIDs have anti-inflammatory, painkilling, and fever-reducing properties. Some common NSAIDs include aspirin, ibuprofen (e.g., Motrin and Advil), naproxen, and prescription medications such as Celebrex.

Experts are divided over the role of acetaminophen versus NSAIDs. Both are commonly prescribed for osteoarthritis and both are equally effective for pain relief. Factors to consider when choosing either analgesics or NSAIDs include cost, risks, and personal preference.

Other treatment options include steroid medications, pads or arch supports, inserts that support the ankle and foot, physical therapy, custom orthotics, and surgery.

Here are a few foot care tips to consider for arthritis management:

  • Wear shoes that fit properly and feel comfortable
  • Wear shoes with more cushioning and rubber soles
  • Perform exercises to help keep your feet pain-free, flexible, and strong:
    • Achilles stretch–With your palms flat on a wall, lean against the wall and place one foot forward and one foot back. Lean forward, leaving your heels on the floor. Repeat 3 times, holding for 10 seconds on each side.
    • Toe pull–Place a thick rubber band around the toes of each foot, and then spread your toes. Hold this position for five seconds and repeat 10 more times.
    • Toe curl– Pick up marbles or any small objects with your toes.

Topical pain medications and warm-water with Epsom salts work really well for osteoarthritis as well.

Consult Dr. Jeffrey N. Bowman to determine the best course of treatment for foot and ankle osteoarthritis. Dr. Bowman can be reached by calling 713-467-8886 or online at www.houstonfootspecialists.com.

©2013 Jeff Bowman., All Rights Reserved

By Dr. Jeffrey N Bowman
January 24, 2013
Category: Foot Health

Plutarch's Life of Caius Marius- "I see the cure is not worth the pain." In the health care industry, many patients agree. For this reason, many simple treatments are withheld due to the patients' fear of undergoing any pain.  What is even more remarkable is the patient with multiple tattoos and/or piercings who expresses a "fear of needles". Alleviation of many pains and problems is achieved with medical injections. All respect to my inked-up friends, they obviously know that the quick stick of a needle can lead to satisfying results.

When confronted with the offer to receive an injection, there is no need to turn and run. The foot can often times be a tricky place to inject as there are areas with highly sensitive nerves (soles and toes). Whether a steroid, anesthetic or Botox, there are merciful options available to patients that help minimize the pain of receiving an injection.

Some of the simplest techniques involve things like using smaller needles and syringes or warming the solution to be more consistent with body temperature. If you happen to smell Old Spice during the injection don't worry, as it isn't uncommon to see your physician carrying the syringes in their armpit!

Some techniques for improving comfort while administering injections involves pinching the skin or rubbing the area to be injected. This is known as counter-stimulation. While there is minimal scientific evidence as to it's effectiveness, you are exciting the nerve endings before the injection so that they will already be firing when the injection takes place.

The main focus to reduce painful injections is to anesthetize the skin before a needle stick. This is the more common practice involved today. Applying cooling sprays like ethyl-chloride, cold air, ice, ice packs or cold gels are easy ways to freeze the skin, acting to anesthetize the sensitivity.

Many topical anesthetics, including EMLA™, Elamax™, liposome-encapsulated lidocaine cream, amethocaine, cetacaine, and benzocaine products can be applied to numb the skin prior to injection. Local anesthetics act directly on nerve endings, blocking their ability to sense pain. This is the most effective way to anesthetize skin.

A newer tool is commonly used in practice today. Use of vibration on the skin to confuse the brain into not feeling local injections has gained popularity as a way to reduce pain from injections. Blaine Labs has a Vibration Anesthesia Device that can be used for reducing pain from injections, suture removals or inserting IV's. There is argument that this device simply works as a placebo-tricking the patient into thinking it will hurt less. Many patient fears of receiving an injection is a psychological over-thought. The injections themselves, when appropriately performed, are relatively painless anyway.

                   

For more information regarding injections for fasciitis, bursitis, arthritis or general aches and pains of the foot and ankle contact Dr. Jeffrey N. Bowman for information at 713-467-8886 or see all the great information on his website www.houstonfootspecialists.com.

©2013 Jeff Bowman., All Rights Reserved



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