Recently in different parts of the country including Alabama and California, there has been an outbreak of Hand, Foot, and Mouth Disease (HFMD).  Typically this condition affects children but also has the potential to affect adults as well.  Commonly the disease is seen affect classes of preschools or daycares.  HFMD can be caused by several viruses, commonly coxsackievirus A16.

Once the disease has been contracted it will take about three to seven days to see symptoms.  Signs and symptoms usually begin with fever and malaise.  A day or two after the onset of the fever, small red spots that will become blisters and then sores or ulcers will appear in the mouth.  Often with these lesions there can be associated sore throat and decreased appetite.  A rash will then appear on the skin on the palms of hands and soles of feet which may as well turn into blisters and sores.  The rash may also be present around the calf.

The disease spreads by direct contact often through oral secretions or stools and can even be spread weeks after the disease seems to have resolved.  Thorough washing of hands as well as avoiding close contact and sharing food or utensils with someone affected can help to prevent the spread of the disease or at least decrease the chances of contracting the disease.  

There is no certain treatment for the disease since it will commonly resolve on its own in about seven days.  However to alleviate pain and fever NSAIDs or Tylenol can be used.   Over the counter medicines and sprays can also be used to alleviate any pain of the throat.    As far as complications, one of the more common complications of the disease mostly in younger children is fingernail and toenail loss.  However the nails do grow back with time.

The physicians at Atlantic Foot and Ankle Associates treatpatients of all ages, ranging from pediatric to geriatric.  Please contact our office if you are suffering from any of the following:

• Persistent pain in your feet or ankles
• Severe cracking, scaling, or peeling on the heel or foot
• Blisters on your feet
• Changes in the nails or skin on your foot
• Heel Pain
• Toenail Fungus

With offices conveniently located in Palm Coast, Daytona Beach, Port Orange, and Orange City, our physicians will get you healthy and back on your feet again!

By Dr. Dennis McBroom

Although Adele won six Grammy Awards, celebrity fashion on the Red Carpet is still a hot topic in the news.  A key feature of fashion is of course shoes, particularly high heels.  High heels, as fashionable as they are, often contribute to many foot pathologies. 

Wearing high heels which often have a narrow toe box can encourage the formation of a bunion, a swelling at the big toe joint.  Bunions may not be aesthetically pleasing and may also cause pain and difficulty in finding appropriately fitting shoewear.   To avoid the formation of bunions, the American Podiatric Medical Association (APMA) recommends not wearing shoes with heels taller than 2 inches.  However, of course high heels are not the sole cause of bunions, genetics and biomechanics are also contributing factors.

High heels may also exacerbate the symptoms of a neuroma, a benign nerve tumor that often brings feelings of pain, numbness, or tingling.  The APMA again recommends shoes with heels no higher than 2 inches due to the stress placed on the forefoot where the neuroma is often located.

Wearing high heels constantly may also shorten the Achilles tendon which may lead to pain and tendonitis.  High heels may also alter the direction and pull of the Achilles tendon causing a deformity known as the “pump bump” (Haglund’s deformity) which may become painful.

Last but not least, high heels are infamous for the foot pain associated with them.  With the heel lifted, more pressure and body weight is placed on the ball of the foot.  This can change the position of the foot during gait (or movement).

Certain steps may be taken to prevent serious complications from high heels.  At Atlantic Foot and Ankle Associates, we recommend that you limit the amount of time wearing heels.  When wearing heels, chose a pair with a wider toe box and a smaller heel.  Also, stretch your calves to avoid any complications with your Achilles tendon.

If you’ve suffered from the pain that wearing high heels cause, come in and see us at Atlantic Foot and Ankle Associates.  We have four offices conveniently located in Palm Coast, Daytona Beach, Port Orange, and Orange City, Florida.  You don’t need to suffer any longer!

By Dr. Dennis McBroom

“Matt Schaub — who guided the Texans to a four-game winning streak, a 11/2-game lead in the AFC South and a 7-3 record that's tied with Pittsburgh for the best in the AFC — will be lost for the season if he elects to undergo surgery to repair the injury to the Lisfranc joint in his right foot. Before making a decision on season-ending surgery, Schaub will consult foot specialists in Indianapolis and Charlotte, N.C., next week.”

John McClain, EXPRESS-NEWS STAFF

A Lisfranc injury can be in the form of a fracture, joint dislocation or ligament tear combination. The Lisfranc joint is located on the top middle of the foot straight back from the second toe. This injury is usually associated with a tremendous force loaded to the foot while the foot is in a fixed position or planted firmly. The large majority of non-athletic Lisfranc injuries occur from car accidents when the foot is violently forced into the floor board of the car or a fall from a height. These injuries mostly can be diagnosed by x-rays and clinical examination. The foot is swollen and pain elicited with near every step. The x-rays usually consist of comparison of the injured and uninjured foot. The Lisfranc injury can be a very subtle fracture or gapping necessitating an MRI to allow visualization of the bone and soft tissue in much finer detail.

Simple treatment may involve supportive wrapping, ice, elevation, non-steroidal anti-inflammatories and a walking boot for 2-4 weeks. More complex injuries may need anatomic realignment of the disrupted joint by means of surgery involving screws and surgical hardware. A history of a Lisfranc injury may predispose a patient to early arthritis of the Lisfranc joint necessitating the need for good supportive shoes and arch supports with most activities. Severe joint pain associated with a neglected or old Lisfranc injury may need fusion of the painful joint.

Many different approaches to Lisfranc injuries are available at Atlantic Foot and Ankle Associates in Port Orange, FL. If you feel you are suffering from a new or old Lisfranc injury, let us know and we will immediately start treatment helping you recover.

By Dr. Dennis McBroom, DPM

Flatfeet, or Pes Planovalgus, is a term with a very vague description of decreased arch height as someone stands down on the ground.  Kelly Osborne of Dancing with the Stars has suffered from shooting pains as a result of flat feet.  It is well known that this foot condition is a precursor to foot problems ranging from general foot pain/fatigue, bunions, hammertoes, ball-of-foot pain, arch pain, and ankle pain.

There are four basic stages of flatfeet that are directly related to the degree of pain and correlating treatment, ranging from non-surgical to surgical:

1. The first stage usually is associated with general foot pain with mild to aggressive activity and long periods of standing. Initial X-rays are usually taken to determine if there are any signs of arthritis. At Atlantic Podiatry Associates, we typically recommend arch supports, good supportive shoes and anti-inflammatory medications, which are a great start and usually reduce pain significantly.
2. The second stage is associated with more pain and possible changes seen as a slight drop in the arch with more swelling. At this stage the treatment is typically a special walking boot and a possible MRI to visualize the tendons to see if there is any tear within the tendon.
3. The third stage typically is quite severe. There may be pain with every step and the foot has turned outwards; it is hard to move the joints in the arch. Treatment at this stage typically needs aggressive custom ankle-foot braces or orthotics (arch supports) for shoes. If pain is not controlled, surgery may be indicated.
4. The final stage is a painful foot and ankle that is debilitating. This is the “end stage” with a large majority needing foot and ankle fusion-type procedures aimed at moving the foot back underneath the ankle. Surgery is reserved for patients who fail conservative treatments.

A large majority of our patients ranging from Port Orange to Palm Coast find great relief with a custom arch support made from a mold of their foot. The custom inserts fit in athletic shoes and can ease the pressure on the fallen arch, decreasing pain and allowing for more activity.

It is important to address flatfeet to prevent “arch breakdown”. The idea is keep a person from progressing through any of the above stages. This can only be accomplished by supporting the weakened flat arch.

By, Dr. Dennis McBroom

“Doctor, my heel hurts and I can’t understand why?  It is definitely worse in the morning or after I sit and try to stand up.  It is a sharp pain that is causing me to limp.  I’ve tired different shoes and pads from the foot care isle and nothing is working.”  This is a daily complaint we treat at Atlantic Podiatry Associates in Palm Coast, and is without a doubt one of my favorite things to treat as a podiatrist.  

Our approach to heel pain is simple and effective.  After listening to our patients describe their pain, a thorough lower extremity physical examination is done.  A radiograph allows us to visualize the foot bones to see how the bones and joints interact with the ground.  Radiographs should always be weight bearing.  If there is pain while the toes are bent up and simultaneous pressure of the inner heel, an ultrasound will be performed.  If the ultrasound reveals a thickened plantar fascia, the patient is diagnosed with plantar fasciitis.

To start treatment, our doctors prefer to decrease inflammation of the plantar fascia with an oral anti-inflammatory (Advil or Motrin) or an injectable anti-inflammatory (cortisone) when pain is moderate to severe.  By using an ultrasound, we are certain to inject precisely where the fascia is inflamed using an ultrasound guided technique.  

Stretching the foot after periods of rest is crucial.  A night splint may be worn during leisure times or while sleeping to assist with stretching the foot.  Wearing arch supports, or orthotics, can help stabilize the foot and relieves the pressure of the plantar fascia.  It is very important to be sure the arch supports are somewhat hard or made from a plastic material that may be covered with a softer material.

It is common for athletes with sports injuries to be diagnosed with plantar fasciitis, including pros like Kobe Bryant and Eli Manning.  Sometimes patients need more than one injection, aggressive physical therapy, orthotics, and sometimes surgery.  

As the summer months continue, we love to kick off our running shoes and throw on our sandals.  However, prolonged sandal wearing is a major cause of plantar fasciitis and we encourage everyone to evaluate your shoes of choice.  Match them appropriately to your activity of the day and you may be able to avoid the “summertime” heel pain also known as plantar fasciitis.

By Dr. Dennis McBroom