Today I got a question from a patient who is thinking about surgery for bunions and hammertoes. She explained that a friend of hers had a similar surgery. She said that her doctor pinned the hammertoes. In addition, he put a plaster cast around the front half of the foot. Her friend was wearing a surgical shoe, but that the pins and cast would have to stay in place for at least 5 weeks!
So the question is… is it necessary to have pans sticking out of the end of the toes after you have hammertoe surgery. The other question is how long does it take for someone to really recover.
There are many ways to fix hammertoes. In the cases described here, the patients also had bunions and decided to have surgery to fix both of those problems at the same time. Many times as a bunion forms, the big toe will move over against the second toe and push the toe out of alignment. This causes the hammertoe deformity.
If this is the case, fixing the hammertoe alone is not a good idea. Without fixing the bunion that is pushing into the second toe, the hammertoe deformity is likely to develop again.
When the hammertoe is straightened, something has to be done to keep the toe in alignment while it heals. One way to do this is to drive a pin in the end of the toe through all of the bones in shish kebab fashion. I personally don’t like this method. Although it is simple and inexpensive, it does have additional risks.
A pin sticking out of the end of the toe is a portal for bacteria and can lead to an infection. Whenever you walk or move the foot, the skin moves back-and-forth across the pin. Over time, the bacteria that normally grows on the skin can work its way down the pin as it pistons relative to the skin.
Because the pin is driven into the bone, this can lead to bone infection. Bone infections, also known as osteomyelitis, are very difficult to treat and often lead to amputations. This is a very serious complication.
A better way to correct a hammertoe is to put an implant in the joint that is corrected when the foot surgeon out the toe. This implant is completely contained within the toe. There is no exposed tendon and no additional risk of contracting an infection. There are both absorbable and nonabsorbable implants available to surgical podiatrists for this procedure. The nonabsorbable implants are typically made of titanium or surgical stainless steel.
These implants do cost more than the pin that’s typically left sticking out of the end of the toe. Medicare will not pay for these types of implants. For my patients, this is no longer a problem is I have decided to opt out of Medicare. I believe it’s important to make sure the patient has the best treatment available, not just the cheapest treatment.
Regardless of which method you and your foot doctor choose, it does take about six weeks for the corrected hammertoe to heal. It is necessary to wear either a surgical shoe or a fracture walking boot while you recover. Most people can walk while they are recovering. It’s not always necessary to use crutches.
If the pin is sticking out of the end of the toe, it is typically necessary to leave in place anywhere from four to six weeks. Much of this depends on the patient’s age, how well the person is recovering, and whether or not an infection develops.
Although this can be an inconvenience, there are other methods. It’s important to discuss your expectations and desired activities with your foot surgeon before you have any foot surgery. Making sure that you understand what will be required for you to recover, to make sure that you can get back to activities you enjoy as quickly as possible.
Dr. Christopher Segler is an author, inventor and award winning foot doctor with a surgical podiatry practice in Chattanooga. He invented the patented surgical instrument that simplifies flatfoot surgery and bunion surgery. He publishes articles and teaches other surgeons about his unique methods to decrease pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.
Friday, December 26, 2008
Wednesday, December 24, 2008
Can I Drive After Bunion Surgery?
When anybody starts thinking about foot surgery, they start to realize her to have limitations after the procedure. Aside from having some limitations of walking, people next start to realize that they might not be able to drive a car.
For any kind of surgery, anesthesia can impair your ability to think and drive. That is why all hospitals and surgery centers require someone to come with you on your date of surgery to make sure that you can get home safely. He should never drive within 24 hours of having surgery under any circumstances.
In terms of foot surgery, many people feel confident enough to drive immediately after the procedure. However, what is a wise choice. If you have an immobilizing device such as a fracture walking boot, cam walker, cast, or posterior splint he should never drive an automobile. All of these immobilization devices make it very difficult for you to feel the pedals in the car. It is very easy for a fracture boot to become lodged between the gas pedal and the brake.
While I was in residency, I had one patient who had had bunion surgery and decided to drive her car. One morning when getting ready to come into the office to see me for her postoperative follow-up appointment, she got in her car, and proceeded to lose control and drive it straight through her garage. So be very difficult to explain to an insurance agent.
About a year ago, at another patient here in my office in Chattanooga, who had an ankle fracture. He was wearing a fracture walking boot in order to provide stability to the injured area. Although he had been instructed not to drive a car while wearing the boot, he thought he could handle it. Unfortunately, he lost control of his car and drove into the Hardees restaurant. Fortunately no one was injured.
One of my instructors and residency used to always tell patient that driving a car while wearing a fracture walker was a “personal legal decision.” The reality is that if you get into an automobile accident while wearing one of these immobilization devices, the investigating officers will almost always consider the accident to be your fault.
Even if you are only wearing a surgical shoe to provide stability after bunion surgery, a 2008 study published in the Journal of Bone and Joint Surgery investigated the motor skill ability of patients who had had bunion surgery.
In that study, the investigators took 28 patients who had undergone bunion surgery on the right foot and evaluated them. They used a custom-made driving simulator in order to compare the bunion surgery patient’s abilities regarding total brake response time, reaction time, and actual brake time. The bunion surgery patients were compared to a group of 28 subjects who had not had surgery. These two groups were matched for age, driving status, and sex.
What the investigation found was that two weeks after bunion surgery on the right foot, 75% of patients were unable to complete the test. This showed that two weeks after bunion surgery, most patients will be unable to safely operate a car. Interestingly, however. Six weeks after bunion surgery the patients' reaction, brake, and total brake response times were even better than they had been before the bunion was surgically corrected.
The study concluded that it is safe to operate a car six weeks after bunion surgery, but not before. It’s always important to use common sense. Although it may be a minor inconvenience, if you can make arrangements to have a family member help you with transportation while he recovered from your bunion surgery, it will be much safer. He will also likely to recover faster because you won’t have pressure applied to surgical repair while the area is healing.
It typically takes about six weeks for the bone to heal after bunion surgery. If you were forced to apply the brakes, or if you are involved in a collision, there would be a substantial risk that the bunion correction could be damaged. If you have had bunion surgery, it is always important to discuss your plans with your foot surgeon, before you drive a car, just to make sure that you won’t have any problems.
Dr. Christopher Segler is an author, inventor and award winning foot doctor with a surgical podiatry practice in Chattanooga. He invented the patented surgical instrument that simplifies flatfoot surgery and bunion surgery. He publishes articles and teaches other surgeons about his unique methods to decrease pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.
For any kind of surgery, anesthesia can impair your ability to think and drive. That is why all hospitals and surgery centers require someone to come with you on your date of surgery to make sure that you can get home safely. He should never drive within 24 hours of having surgery under any circumstances.
In terms of foot surgery, many people feel confident enough to drive immediately after the procedure. However, what is a wise choice. If you have an immobilizing device such as a fracture walking boot, cam walker, cast, or posterior splint he should never drive an automobile. All of these immobilization devices make it very difficult for you to feel the pedals in the car. It is very easy for a fracture boot to become lodged between the gas pedal and the brake.
While I was in residency, I had one patient who had had bunion surgery and decided to drive her car. One morning when getting ready to come into the office to see me for her postoperative follow-up appointment, she got in her car, and proceeded to lose control and drive it straight through her garage. So be very difficult to explain to an insurance agent.
About a year ago, at another patient here in my office in Chattanooga, who had an ankle fracture. He was wearing a fracture walking boot in order to provide stability to the injured area. Although he had been instructed not to drive a car while wearing the boot, he thought he could handle it. Unfortunately, he lost control of his car and drove into the Hardees restaurant. Fortunately no one was injured.
One of my instructors and residency used to always tell patient that driving a car while wearing a fracture walker was a “personal legal decision.” The reality is that if you get into an automobile accident while wearing one of these immobilization devices, the investigating officers will almost always consider the accident to be your fault.
Even if you are only wearing a surgical shoe to provide stability after bunion surgery, a 2008 study published in the Journal of Bone and Joint Surgery investigated the motor skill ability of patients who had had bunion surgery.
In that study, the investigators took 28 patients who had undergone bunion surgery on the right foot and evaluated them. They used a custom-made driving simulator in order to compare the bunion surgery patient’s abilities regarding total brake response time, reaction time, and actual brake time. The bunion surgery patients were compared to a group of 28 subjects who had not had surgery. These two groups were matched for age, driving status, and sex.
What the investigation found was that two weeks after bunion surgery on the right foot, 75% of patients were unable to complete the test. This showed that two weeks after bunion surgery, most patients will be unable to safely operate a car. Interestingly, however. Six weeks after bunion surgery the patients' reaction, brake, and total brake response times were even better than they had been before the bunion was surgically corrected.
The study concluded that it is safe to operate a car six weeks after bunion surgery, but not before. It’s always important to use common sense. Although it may be a minor inconvenience, if you can make arrangements to have a family member help you with transportation while he recovered from your bunion surgery, it will be much safer. He will also likely to recover faster because you won’t have pressure applied to surgical repair while the area is healing.
It typically takes about six weeks for the bone to heal after bunion surgery. If you were forced to apply the brakes, or if you are involved in a collision, there would be a substantial risk that the bunion correction could be damaged. If you have had bunion surgery, it is always important to discuss your plans with your foot surgeon, before you drive a car, just to make sure that you won’t have any problems.
Dr. Christopher Segler is an author, inventor and award winning foot doctor with a surgical podiatry practice in Chattanooga. He invented the patented surgical instrument that simplifies flatfoot surgery and bunion surgery. He publishes articles and teaches other surgeons about his unique methods to decrease pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.
Tuesday, December 16, 2008
Small Problems, Big Obstacles After Foot Surgery
Whenever planning for foot or ankle surgery, it is important to consider how extensive the surgery will be, and whether or not you will be able to walk. Many people underestimate the difficulties of not being able to walk while recovering after foot surgery. Although most people tend to worry about the pain that they have after foot or ankle surgery, this is not typically the biggest problem.
One patient explained that after having foot surgery, she can get around to be very difficult. She said that her doctor did explain that she would have to be non-weightbearing that she underestimated the difficulty and discovered that even minor tasks that could seem challenging.
She explained that even the simplest tasks take a LOT longer when you do it on crutches or in a wheelchair. Even though she has a ranch style home, which has no stairs, she still famished needed help.
Like most homes, some doorways are not quite big enough to get through with a wheelchair. This makes it difficult to move from room to room.
Other things that she previously took for granted like getting a bowl from a high cabinet like the one below is virtually impossible without help.
Because she has a stacked washer and dryer, she found the same is true of doing laundry. Getting anything out of the basement is impossible.
Moving from the kitchen to the dining room with a plate of food is a real challenge as well. . Fortunately, she has recruited the help of her husband without any difficulty. For anyone living alone, all of these tasks can prove to be very difficult.
Because of this it is important to make sure that you discuss what your living situation is like, prior to foot surgery. Many people don’t even think about one or two stairs in a split level home as much of an obstacle, until they have foot surgery.
As long issue plan ahead, even more extensive surgeries requiring crutches or a wheelchair can go smoothly. But it’s important to be realistic about your expectations in the amount of help, you will have while recovering.
Dr. Christopher Segler is an author, inventor and award winning foot doctor with a surgical podiatry practice in Chattanooga. He invented the patented surgical instrument that simplifies flatfoot surgery and bunion surgery. He publishes articles and teaches other surgeons about his unique methods to decrease pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http:www.anklecenter.com.
One patient explained that after having foot surgery, she can get around to be very difficult. She said that her doctor did explain that she would have to be non-weightbearing that she underestimated the difficulty and discovered that even minor tasks that could seem challenging.
She explained that even the simplest tasks take a LOT longer when you do it on crutches or in a wheelchair. Even though she has a ranch style home, which has no stairs, she still famished needed help.
Like most homes, some doorways are not quite big enough to get through with a wheelchair. This makes it difficult to move from room to room.
Other things that she previously took for granted like getting a bowl from a high cabinet like the one below is virtually impossible without help.
Because she has a stacked washer and dryer, she found the same is true of doing laundry. Getting anything out of the basement is impossible.
Moving from the kitchen to the dining room with a plate of food is a real challenge as well. . Fortunately, she has recruited the help of her husband without any difficulty. For anyone living alone, all of these tasks can prove to be very difficult.
Because of this it is important to make sure that you discuss what your living situation is like, prior to foot surgery. Many people don’t even think about one or two stairs in a split level home as much of an obstacle, until they have foot surgery.
As long issue plan ahead, even more extensive surgeries requiring crutches or a wheelchair can go smoothly. But it’s important to be realistic about your expectations in the amount of help, you will have while recovering.
Dr. Christopher Segler is an author, inventor and award winning foot doctor with a surgical podiatry practice in Chattanooga. He invented the patented surgical instrument that simplifies flatfoot surgery and bunion surgery. He publishes articles and teaches other surgeons about his unique methods to decrease pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http:www.anklecenter.com.
Thursday, December 11, 2008
What is a Bunion?
A bunion is a nothing more than a bump or enlargement of the bone and joint at the base of the big toe. This joint is called the first metatarsophalangealjoint (MPJ). A bunion forms when the joint becomes misaligned and the bone or soft tissues at the big toe joint start to move out of place. What happens is that the big toe starts to bend over toward the other toes. This causes the bone to stick out. The soft tissues that are covering that bone Denbigh come irritated red and inflamed. This causes a painful knot of bone. Because this joint carries the majority of the body´s weight while walking, bunions can become extremely painful. Eventually the big toe joint itself may become arthritic, stiff and sore. This can make walking and fitting into shoes extremely difficult.
Dr. Christopher Segler is an award winning foot and ankle surgeon with a podiatry practice in Chattanooga. He is the inventor of a patented surgical instrument designed to simplify bunion surgery and flatfoot surgery. He publishes articles teaching other surgeons about his techniques and how to decrease pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.
Dr. Christopher Segler is an award winning foot and ankle surgeon with a podiatry practice in Chattanooga. He is the inventor of a patented surgical instrument designed to simplify bunion surgery and flatfoot surgery. He publishes articles teaching other surgeons about his techniques and how to decrease pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.
Wednesday, December 10, 2008
Do I Need Surgery for Arthritis in my Big Toe Joint?
Today I had a question from an active 28 year-old named Jennifer. She has a very active 3 year old son she chases about, but she gets pain and stiffness in the big toe joint. She says its worse when she crawls around on the floor kneeling, squatting, and playing with her little boy. She says he's into everything, but she loves watching him learn.
She thought she had a bunion and went to see a foot doctor who told her it was arthritis. And she needed foot surgery right away. Although this assessment was close, it was wrong.
She came in to see me for a second opinion.
Now, I will admit that she does have a little arthritis in the big toe joints. I will admit that one is worse than the other. I will even admit that I (or any foot surgeon) could make it look different on xrays. Maybe even look better on xray. But no guarantee it would feel better. At least not by New Years.
Jennifer has a condition called hallux limitus or hallux rigidus. This happens when there is restricted motion and the big toe doesn't bend up as far as it should. Because of this, the joint starts jamming and develops arthritis. Eventually, bone spurs start to develop on top of the joint. With time it will get worse. The cartilage can even get worn away over time.
Someone recommended that she have joint replacement surgery to put an implant in to replace the worn joint. Good idea, but not when she is committed to taking care of a 3 year old. I recommended she get some super-stiff Dansko Clogs from ZUMFOOT. With these she can walk without pain because the big toe won't be forced to bend and thus it won't jam anymore.
For her this was a good solution. She can can now walk without pain and wait until the timing is better. It won't get worse fast, and she can wait until the little one starts school.
Eventually she will have surgery. But I truly believe that unless the condition is going to get significantly worse, you should have foot surgery when it fits your lifestyle best.
Foot surgery can help many conditions, but the amount of disruption to your daily routine is elective...just like the surgery.
Dr. Christopher Segler is an award winning foot and ankle surgeon with a podiatry practice in Chattanooga. He is the inventor of a patented surgical instrument designed to simplify bunion surgery and flatfoot surgery. He publishes articles teaching other surgeons about his techniques and how to decrease pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.
She thought she had a bunion and went to see a foot doctor who told her it was arthritis. And she needed foot surgery right away. Although this assessment was close, it was wrong.
She came in to see me for a second opinion.
Now, I will admit that she does have a little arthritis in the big toe joints. I will admit that one is worse than the other. I will even admit that I (or any foot surgeon) could make it look different on xrays. Maybe even look better on xray. But no guarantee it would feel better. At least not by New Years.
Jennifer has a condition called hallux limitus or hallux rigidus. This happens when there is restricted motion and the big toe doesn't bend up as far as it should. Because of this, the joint starts jamming and develops arthritis. Eventually, bone spurs start to develop on top of the joint. With time it will get worse. The cartilage can even get worn away over time.
Someone recommended that she have joint replacement surgery to put an implant in to replace the worn joint. Good idea, but not when she is committed to taking care of a 3 year old. I recommended she get some super-stiff Dansko Clogs from ZUMFOOT. With these she can walk without pain because the big toe won't be forced to bend and thus it won't jam anymore.
For her this was a good solution. She can can now walk without pain and wait until the timing is better. It won't get worse fast, and she can wait until the little one starts school.
Eventually she will have surgery. But I truly believe that unless the condition is going to get significantly worse, you should have foot surgery when it fits your lifestyle best.
Foot surgery can help many conditions, but the amount of disruption to your daily routine is elective...just like the surgery.
Dr. Christopher Segler is an award winning foot and ankle surgeon with a podiatry practice in Chattanooga. He is the inventor of a patented surgical instrument designed to simplify bunion surgery and flatfoot surgery. He publishes articles teaching other surgeons about his techniques and how to decrease pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.
Monday, December 8, 2008
Is it a Foot Sprain or will it need Foot Surgery?
49ers' receiver Arnaz Battle may have an undiagnosed foot injury.
This weekend's football injury report included San Francisco 49ers' receiver Arnaz Battle having a "foot sprain." Right now he is listed as questionable for next week’s game against the Miami Dolphins. The interesting part is that this is first time that Battle has returned to the gridiron action since sustaining a foot sprain back on Oct. 26. All he did was return some punts and he aggravated the injury in the second half.
This smells of a more serious injury.
The classic midfoot injury that needs surgery happens in either a high impact trauma or a lower impact twisting injury. The classic case is sustained in an a car accident. You have your foot on the brake, smack into the car in front of you and all of the force causes the midfoot joints to be dislocate or fracture. The area injured is a collection of joints called Lisfranc’s joint. For trivia buffs, Lisfranc was Napoleon’s surgeon. These injuries are very often misdiagnosed as a “midfoot sprain.”
In 2004, I began a research project to determine how accurately different doctors were able to diagnose Lisfranc’s injuries. The results of that study were quite scary. We found that primary care physicians and emergency room physicians were only able to recognize 1.6 % of all identifiable features of these injuries on x-ray. That means that more than 98% of these injuries could be missed, if not evaluated by a foot and ankle specialist. That may be the case with Battle.
As a result of this research, I won an award from the American College of Foot and Ankle Surgeons. Since that time I have seen many patients that came into the office having been misdiagnosed. In most cases they bring their x-rays from the emergency department. Unfortunately, in many of these cases, the injury is visible. It was just not noticed. In every case, the doctor told the patient that it was just a sprain and would get better. And they didn't. The difficulty is that we know in fact, these will not get better unless appropriately treated.
It can happen in car wrecks, motorcycle accidents, football, running, mountain biking or baseball. The big clue is pain in the mid-foot (above the arch) with swelling or bruising. Bruising on the top of the is a very bad sign. If it happens to you, get checked immediately. Whether you are a pro or a weekend warrior, you can;t afford to be listed as "questionable" for next week!
Dr. Christopher Segler is an author, inventor and award winning foot surgeon with a surgical podiatry practice in Chattanooga. He invented and a patented surgical instrument designed to simplify bunion surgery and midfoot surgery. He publishes articles teaching other foot doctors about his methods to prevent pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.
This weekend's football injury report included San Francisco 49ers' receiver Arnaz Battle having a "foot sprain." Right now he is listed as questionable for next week’s game against the Miami Dolphins. The interesting part is that this is first time that Battle has returned to the gridiron action since sustaining a foot sprain back on Oct. 26. All he did was return some punts and he aggravated the injury in the second half.
This smells of a more serious injury.
The classic midfoot injury that needs surgery happens in either a high impact trauma or a lower impact twisting injury. The classic case is sustained in an a car accident. You have your foot on the brake, smack into the car in front of you and all of the force causes the midfoot joints to be dislocate or fracture. The area injured is a collection of joints called Lisfranc’s joint. For trivia buffs, Lisfranc was Napoleon’s surgeon. These injuries are very often misdiagnosed as a “midfoot sprain.”
In 2004, I began a research project to determine how accurately different doctors were able to diagnose Lisfranc’s injuries. The results of that study were quite scary. We found that primary care physicians and emergency room physicians were only able to recognize 1.6 % of all identifiable features of these injuries on x-ray. That means that more than 98% of these injuries could be missed, if not evaluated by a foot and ankle specialist. That may be the case with Battle.
As a result of this research, I won an award from the American College of Foot and Ankle Surgeons. Since that time I have seen many patients that came into the office having been misdiagnosed. In most cases they bring their x-rays from the emergency department. Unfortunately, in many of these cases, the injury is visible. It was just not noticed. In every case, the doctor told the patient that it was just a sprain and would get better. And they didn't. The difficulty is that we know in fact, these will not get better unless appropriately treated.
It can happen in car wrecks, motorcycle accidents, football, running, mountain biking or baseball. The big clue is pain in the mid-foot (above the arch) with swelling or bruising. Bruising on the top of the is a very bad sign. If it happens to you, get checked immediately. Whether you are a pro or a weekend warrior, you can;t afford to be listed as "questionable" for next week!
Dr. Christopher Segler is an author, inventor and award winning foot surgeon with a surgical podiatry practice in Chattanooga. He invented and a patented surgical instrument designed to simplify bunion surgery and midfoot surgery. He publishes articles teaching other foot doctors about his methods to prevent pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.anklecenter.com.
Saturday, December 6, 2008
Mid-Foot Sprains, Pains, and Fractures
The midfoot is a complex area involving 10 different bones coming together to form more than a dozen separate joints. A sprain in this area can result in aching or throbbing midfoot pain, swelling and bruising. Sometimes the pain will start on the top of the foot and go deeper all the way through to the bottom of the arch. This type of injury can interfere with running and has the potential for serious problems if ignored.
The most common way for an injury of midfoot to occur, is trauma. But it doesn’t have to be the hit-the-foot-with-a-hammer sort of trauma. For a runner, this sort of injury happens when twisting the foot while stepping in a pothole, accidentally stepping off the shoulder, or tripping over a root on a trail run.
Fortunately, this sort of injury is rare from running. However it is common in other accidents. The classic midfoot injury is sustained in an automobile accident while braking. You have your foot on the brake, smack into the car in front of you and all of the force causes the midfoot joints to be dislocated or fractured. The area most often injured is actually a collection of joints called Lisfranc’s joint. For trivia buffs, Lisfranc was Napoleon’s surgeon. These injuries are often misdiagnosed as a “midfoot sprain.”
In 2004, I began a research project in order to determine how accurately different doctors are able to diagnose Lisfranc’s injuries. The results of that study were quite frightening. We found that primary care physicians and emergency room physicians were only able to recognize 1.6 % of the identifiable features of these injuries on x-ray. That means that more than 98% of these injuries could be missed if not evaluated by a foot and ankle specialist.
As a result of this research, I won an award from the American College of Foot and Ankle Surgeons. Since that time I have seen many patients that came into the office having been misdiagnosed. In most cases they bring their x-rays from the emergency department and the injury is visible. It was just not noticed. In every case, the doctor told the patient that it was just a sprain and would get better.
The difficulty is that we know in fact, these will not get better unless appropriately treated.
Pain and tenderness on the top of the foot is relatively common in runners, but this is more often related to irritation of the tendons on top of the foot. This common problem is not that serious, and is easily treated.
In contrast, pain that is worse when standing and twisting the foot, or when running, is worrisome. Any associated bruising is always a concern and may signal a much more significant injury. Without appropriate treatment, continued pain and rapid development of arthritis, with associated destruction of the joints in the midfoot, can occur. This can result in significant disability.
Anytime you have had an injury where you were involved in an accident, stepped off a curb of wrong or stepped into a pothole while running, you should be aware of this possibility. Do not run if you have continued pain. If you are a runner and suspect that you may have a midfoot sprain, it is critical to get evaluated by an expert in foot and ankle care. That way you can get back on the road as quickly and safely as possible.
Dr. Christopher Segler is an author, inventor and award winning foot surgeon with a surgical podiatry practice in Chattanooga. He invented and a patented surgical instrument designed to simplify midfoot fracture surgery and reconstructive flatfoot surgery. He also publishes articles teaching other foot doctors about his methods to prevent pain after foot surgery. You can order a FREE copy of his informative book about common causes of foot pain at http://www.AnkleCenter.com.
Thursday, December 4, 2008
What are the Best Shoes for Nurses?
In between cases I wandered into the doctor’s lounge adjacent to the O.R. I got something to eat and sat down. From over my shoulder I heard, “do you mind if I ask you a question?” It was Amy, the scrub nurse I had been working with all morning. “You see I have this heel pain…”
I listened to her story, about how her heels first hurt when she gets out of bed. About how they don’t usually bother her while she is standing during surgery, but how she gets this sharp pain after she sits down for a break and then gets up and starts walking again. She seemed somewhat frustrated because it had been going on for about two months.
I looked at her yellow Crocks, that likely used to be bright, long before being splattered with saline, blood and iodine. I paused and said, “So let me guess. You got your Crocs about six months ago.” And quick came the reply, “how did you know!”
Well I am not a psychic, palm reader, sole reader, nor any kind of magician, other than a podiatrist. The fact is, its just math. It seems that Crocs will only withstand about 3-4 months of being compressed between a nurse (working hard on his/her feet all day) and the hospital floor (hard as concrete, quite literally). Four months of use plus two months of abuse, past the life of the shoe, equals plantar fasciitis. This was also about the third or fourth time I had a similar exchange with a nurse complaining of heel pain in the hospital.
The fact is nurses work hard. Up, down, charting, giving meds, dressing wounds, hanging IV’s, putting Mr. Jones’s nasal cannula back in nose instead of his eyebrow, busy, busy all the time. The shoes that nurses wear must be prepared for a world class beating. And not all shoes are created equal.
The Croslite material (the only material in Crocs) is quite similar to the cushioning midsole of a running shoe. As a marathon runner and Ironman triathlete I can say that the stuff does not last forever. I am always advising patients (who are also runners) how to tell if the midsole is worn out. And when it is...time to donate them to a less fortunate recipient at the Chattanooga Community Kitchen.
Does that mean Crocs are bad? Nope. It just means they are soft and don’t last real long. I will however, say that if you are on the wards, walking fast all day, they are worse than if you are mostly standing (like in the O.R.). If you have any foot or ankle instability, such as flatfeet, bunions or tendinitis, you are at risk of aggravating those problems. If you have high arches you are safe.
One other potential concern is the little air vents in the toe box. There have been many incidences with sharps, so watch the toes around needles, scalpels and other falling pointed things. My understanding is that some facilities have actually instituted policies against Crocs, due to safety concerns.
So, if they take away my beloved Crocs, what will I wear? I would suggest something good for your feet. If you have flat feet, wear athletic shoes with stability or motion control features. If you have high arches, wear cushioning running shoes or something with a rocker sole that will decrease stress in the big toe joint. If I had to pick one shoe for nurses, I would pick Dansko clogs. To see more choices than you could ever want, click on our recommended running shoe list. Or visit the experts at ZUMFOOT, for something healthy and fashionable. Remember...you nurses deliver all of the care that actually happens. You need your feet to take of the rest of us. Treat your feet as well as you treat your patients.
Dr. Christopher Segler is a nationally recognized award winning foot and ankle surgeon practicing in Chattanooga Tennessee. He is the inventor of a patented surgical instrument designed to simplify bunion surgery. He has published articles teaching other surgeons about his techniques about how to decrease pain after bunion surgery. You can request a FREE copy of his new book about common causes of foot pain at http:www.anklecenter.com.
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