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18/Jun/2018

Stretches for the Feet and Ankles

Ankle and Foot Stretches

The next time you watch an exercise program, pay special attention to the time spent on stretching the feet and ankles.  It’s likely that your favorite exercise guru completely ignores these areas of the body.  This seems counterintuitive when you consider that your feet are bearing up to four times or more the body’s weight when you do jumping jacks.  While the research varies on the benefits of stretching, one of the primary goals of this activity is injury prevention.

Note that the calves are also an important piece to the stretching puzzle and good foot health.  These muscles are connected to the feet by the Achilles tendon, and they play a role in conditions such as plantar fasciitis and Achilles tendonitis.

Stretching not only aids in the prevention of injury, but it also helps during recovery.  Whether you’ve experienced an ankle fracture or foot surgery, home exercises or physical therapy are often a part of the after-care plan.  Restoring strength and flexibility to the affected area is the primary goal.  Focused stretching also brings the body’s natural healing process to the area through increased blood flow.

What do I need to know about stretching?

Stretches for the Feet and Ankles Many people see stretching as the beginning of their workout routine, but it should really be phase two.  First, take a quick walk, or even jog in place to get your body warmed up prior to completing your regimen of stretches.  Remember that stretching should not cause pain.  If you experience discomfort, you should pull back to a more comfortable point.

This process could take up a large period if every muscle of the body was addressed.  Instead, break the body down into areas of focus, and spend more time on the muscles that you will use during your regular workout.  To prevent tearing, keep the targeted muscle still during the stretch.  It’s always best to speak with your doctor before beginning any type of exercise plan.

What are some common stretches for the feet, ankles, and calf muscles?

Dr. Gephart prescribe stretching exercises for various conditions after an evaluation.  However, there are some general stretching exercises that can benefit anyone.

Stretch the toes–While sitting, place your feet flat on the floor and move your toes apart.  Hold and repeat.  Next, grab a towel and lay it on the floor.  Use your toes to gather it up, and then lift it.  Finally, loop the towel around your toes and gently pull toward your body.

Work out arch pain—Spend ten to fifteen seconds walking on your toes and complete eight reps.  Using a golf ball or tennis ball, give yourself a foot massage by rolling the item back and forth underneath your foot. For additional benefits, try a frozen water bottle.

Don’t avoid the ankles—Sit in your favorite chair and flex your feet slowly.  After ten reps, point the toes and hold.  Do these ten times as well.  You can also stretch the ankles by going downward and inward and holding that position.  Now, try going upward and outward.

Focus on the forgettable calves—The calves are often forgotten, but they are an important part of the overall health of your feet.  Use a step for one of the most popular stretching exercises.  Stand with your heels over the edge, and let the heels drop.  Now, stand in front of a chair back with your feet apart.  Rise up on one foot and lift the heel as far as possible. Lower and repeat ten times.

Foot and ankle pain can be a thing of the past with the right care.  Foot and ankle stretching is just one way that you can strengthen your foundation and help in the prevention of injury.

Seeking Treatment

If you’ve been searching for Foot Doctor for all your foot and ankle needs, take time to meet with the Podiatry Group of Georgia. Our doctor has the experience and knowledge you need to help your feet and ankles feel their best. Give us a call today and set up an appointment for your initial consultation. Call us today!

Call Our Marietta, Georgia Office Today at 404-806-3731 or Book your appointment online now!

Serving Marietta And Atlanta Area!


18/Jun/2018

Marietta Podiatrist Foot Care

Marietta Podiatrist Brings Foot Care For You!

Many people struggling with problems in their feet and ankles. In fact, the American Podiatric Medical association reports that nearly three quarters of Americans currently live with some kind of foot pain. They might not know the treatment options available to them, and decide to try to put up with the pain instead. But our podiatry services in Marietta can help you overcome painful foot and ankle issues so you can get back to enjoying your life–pain free. We offer comprehensive treatment options including laser treatments, surgery options, and therapeutic spa treatments. Our doctor will create a treatment plan that addresses your health concerns and moves you towards a pain free life. Our mission is to passionately pursue the health and well-being of our patients!

If you need assistance with any of these services, call our office today for an appointment:

We have the only medical spa in North Georgia solely dedicated to the treatment of hands and feet at our clinic. Our hand and foot spa was founded by Dr. Gephart, a licensed podiatric surgeon. We offer custom-formulated products that are used to treat your hands and feet and help them recover from harsh everyday use. Our spa offers a variety of services, so your feet and hands can look and feel their best. We recommend using our spa services as part of your treatment plan.

Combine our spa with our personalized medical care to ensure you get the best solutions to address the issues you are experiencing with your feet and ankles. Foot pain isn’t normal, and it isn’t something you have to live with. Allow our podiatry services in Marietta to detect issues and care for your feet. Your feet are an important part of your body and deserve the best care possible. Quit living with pain and make your appointment today!

Call Our Marietta, Georgia Office Today at 404-806-3731 or Book your appointment online now!

Serving Marietta and Atlanta Area


18/Jun/2018

Marietta Podiatry Services For You !

Marietta Podiatry Services

Many people struggling with problems in their feet and ankles. In fact, the American Podiatric Medical association reports that nearly three quarters of Americans currently live with some kind of foot pain. They might not know the treatment options available to them, and decide to try to put up with the pain instead. But our podiatry services in Marietta can help you overcome painful foot and ankle issues so you can get back to enjoying your life–pain free. We offer comprehensive treatment options including laser treatments, surgery options, and therapeutic spa treatments. Our doctor will create a treatment plan that addresses your health concerns and moves you towards a pain free life. Our mission is to passionately pursue the health and well-being of our patients!

If you need assistance with any of these services, call our office today for an appointment:

We have the only medical spa in North Georgia solely dedicated to the treatment of hands and feet at our clinic. Our hand and foot spa was founded by Dr. Gephart, a licensed podiatric surgeon. We offer custom-formulated products that are used to treat your hands and feet and help them recover from harsh everyday use. Our spa offers a variety of services, so your feet and hands can look and feel their best. We recommend using our spa services as part of your treatment plan.

Combine our spa with our personalized medical care to ensure you get the best solutions to address the issues you are experiencing with your feet and ankles. Foot pain isn’t normal, and it isn’t something you have to live with. Allow our podiatry services in Marietta to detect issues and care for your feet. Your feet are an important part of your body and deserve the best care possible. Quit living with pain and make your appointment today!

Call Our Marietta, Georgia Office Today at 404-806-3731 or Book your appointment online now!

Serving Marietta and Atlanta Area


18/Jun/2018

Marietta & Atlanta Best Podiatrist Are Here!

Marietta & Atlanta Best Podiatrist have spent years learning about feet! Your feet are an amazing area of your body, and one of the most complicated mechanically. There are over 26 bones in your feet, along with 33 joints and over 100 muscles,tendons, and ligaments. With so many parts and pieces working together to make your feet function properly, there is plenty of room for error. One small bone, joint, or ligament getting out of place can cause you endless pain in your feet. In fact, 77 percent of adults said they have had a foot ailment and half say they experience foot pain, according to the a 2010 survey from the American Podiatric Medical Association.Marietta & Atlanta Best Podiatrist

There are things you can do to keep your feet performing their important function of keeping you moving and balanced. Wearing supportive shoes is one of the most important. The next most important is visiting our Podiatry Group in Georgia at the first sign of foot pain. Because the mechanics of your foot are so complicated, you want to be sure you are seeing someone who thoroughly understands how your foot works and how to correct any problems you might be experiencing with them. Our doctor who has been working with patient’s feet for years, and she knows how to accurately diagnose and resolve your foot and ankle pain.

Your feet shouldn’t hurt, and foot pain isn’t something you have to live with. Our podiatrist is happy to serve the people of Marietta and Atlanta in anyway possible. Get in touch with our office today and make an appointment to find solutions to your foot pain issues. Learn more about our office, your feet, and the different conditions we treat by browsing through our website before your visit. We’re looking forward to seeing you soon , so call us today!

Call Our Marietta, Georgia Office Today at 404-806-3731 or Book your appointment online now!

Serving Marietta and Atlanta Area


18/Jun/2018

My Shoe AnatoShoe Anatomymy

Familiarizing yourself with the parts of a shoe is helpful when choosing footwear that accommodates your foot shape and size, as well as your activities.
Here are the basic parts of a shoe:

  • Counter: The counter is the stiff part of the heel area of the shoe that strengthens the back part of the shoe; it adds support and helps the footwear keep its shape.
  • Heel: The heel is positioned at the heel of the foot. It elevates the back part of the foot so it sits higher than the front. The degree of heel elevation varies, and higher heels place more pressure on the forefoot.
  • Sole: The sole is the bottom of the shoe that runs the entire length of the foot, from the toes to the heel. The insole is the layer of material that lines the inside of the shoe’s bottom, providing comfort and support. The outsole is the outside of the shoe’s sole that comes in contact with the ground when standing, walking, or running. It should be made of a material that is durable and waterproof and provides a good grip.
  • Toe Box or Toe Cap: The toe box or toe cap is the front upper portion of the shoe where the toes are positioned. There are different types of toe boxes, depending upon the activity at hand, ranging from open or decorative to solid or steel for extra protection. The toe box should have enough space to comfortably fit the toes without pressure or restriction. The shape of a toe box can be pointy, round, or square.
  • Upper: The upper is the top of the shoe area that covers the entire foot. It is attached to the sole.
  • Vamp: The vamp is the part of the shoe where the laces are placed. It covers the upper middle part of the foot below the toe box.
  • Waist: The waist covers the arch of the foot, as well as the instep. It curves in a way that accommodates most foot shapes. This curve distinguishes between a shoe for the left foot versus a shoe for the right foot.

Footwear can be made of a variety of materials for breathability, support, shock absorption, and protection.

If you’ve been searching for Foot Doctor for your foot and ankle needs, take time to meet with the Podiatry Group of Georgia. Our doctor has the experience and knowledge you need to help your feet and ankles feel their best. Give us a call today and set up an appointment for your initial consultation. Call us today

Call Our Marietta, Georgia Office Today at 404-806-3731 or Book your appointment online now!

Serving Marietta and Atlanta Area !


18/Jun/2018

What is Acrocyanosis?

Acrocyanosis

Acrocyanosis is a disorder that causes spasms in the arteries responsible for blood flow to the skin on the hands and feet. When the skin is deprived of necessary oxygen due to the constricted blood flow, it takes on a blue color, known as cyanosis. Acrocyanosis is not a common condition, although it afflicts women more than men. In addition to blue-colored skin, the hands and feet may feel moist and cold. Swelling may also be present, but the condition usually does not cause pain.

Since acrocyanosis can worsen with exposure to cold, acrocyanosis of the feet is treated by keeping the feet warm and dry so that the blood circulates as best as possible. Insulated boots and insulated socks can help with this. The condition does not worsen over time. Since acrocyanosis can be present alongside a serious medical condition affecting the cardiovascular system or connective tissue.

Acrocyanosis  is often seen in healthy newborns and refers to the peripheral cyanosis around the mouth and the extremities (hands and feet) . It is caused by benign vasomotor changes that result in peripheral vasoconstriction and increased tissue oxygen extraction and is a benign condition

Where to Seek Treatment

If you’ve been searching for podiatric surgeons for your foot and ankle needs, take time to meet with the Podiatry Group of Georgia. Our doctor has the experience and knowledge you need to help your feet and ankles feel their best. Give us a call today and set up an appointment for your initial consultation. Call us today

Call Our Marietta, Georgia Office Today at 404-806-3731 or Book your appointment online now!

Serving Marietta and Atlanta Area!


18/Jun/2018

Orthotics SolutionOrthotics Make My Feet Hurt

There Ready! Your custom orthotic shoe inserts are ready for you to pick up. Who knew you could get so excited about orthotic shoe inserts. You’ve been looking forward to them for weeks because you’ll finally be able to manage your foot pain and get back to enjoying daily activities – like taking long walks through the park or just standing and watching your child’s soccer game without being distracted by your feet.

You arrive home with your orthotics, slip them into your shoes, and try them on. Hm. Something doesn’t feel quite right. You wiggle your toes inside your shoes, walk around a bit, and then decide you just need time to get used to them. You can’t wait to try them out in the morning.

It’s 7a.m. and you’re welcoming the sound of your alarm because it’s time to go for a morning run in your new custom orthotics! You quickly get dressed, tie your shoes, and hit the pavement.

But something feels off. Your orthotics are not helping your foot pain at all. So, you make excuses – maybe it’s the running surface. Maybe it takes a few runs to break them in.

After the third mile you think no way are these orthotic inserts made custom for my feet! Your custom orthotics hurts. In your disappointment you wonder why and what should you do now?

Reasons Your Orthotics Are Hurting Your Feet

The purpose of orthotic shoe inserts it to correct an abnormal or irregular walking pattern caused by your foot not bearing weight properly, and to help your foot function better in general. As your foot rests on the orthotic insert it’s directed into the correct position for walking, running and standing.

SORE MUSCLES

Changing the alignment in your feet changes the way the muscles in your feet are being used. Muscles protest when doing something unfamiliar to them – think about how you feel after a new workout routine at the gym – so your feet may be sore because they are being supported in an area that hasn’t had support in a while, causing them to be tired and achy until they get used to your new orthotics.

THEY WEREN’T MADE CORRECTLY FOR YOUR FEET

Custom orthotics are made a couple of different ways: by casting your feet and making a mold or by using the F-Scan, a computerized system that works by slipping an arch with computer chips built in, into the shoe.

As you begin to walk and run the device makes a mini-movie that gathers data and scans showing how pressure is going through your foot. These computer scans are used to create a multi-layered custom orthotics device made for your unique foot shape and to target your specific problem.

It’s possible the orthotics were poorly casted, there was an error during the scan, bad materials were used, or they just need adjustment.

IMPROPER FOOTWEAR

Another reason your orthotics aren’t working out may be because you aren’t wearing the right shoes for your feet in the first place. Make sure your shoes aren’t too tight, or worn down and have strong soles that offer some support.

Everyone has their own break-in time to get used to their orthotics, but don’t force yourself to push through the pain. If after a few weeks your custom orthotics are still hurting your feet, you should talk to your podiatrist. If you’re visiting or living in the Atlanta area, consider scheduling an assessment with a podiatrist in Marietta Georgia.

Seeking Treatment

If you’ve been searching for podiatric  for your foot and ankle needs, take time to meet with the Podiatry Group of Georgia. Our doctor has the experience and knowledge you need to help your feet and ankles feel their best. Give us a call today and set up an appointment for your initial consultation. Call us today
Call Our Marietta, Georgia Office Today at 404-806-3731 or Book your appointment online now.

Serving Marietta and the Atlanta Area!


18/Jun/2018

Whats  is a Neuroma?Neuroma

What is a Morton’s Neuroma? A neuroma is a pinched nerve or a nerve tumor—a benign, though usually uncomfortable, thickening or growth in the nervous tissue. There are several ways it can form, but often it is related to irritation or trauma to the nerve. Rubbing, pinching, and sudden injuries can lead to painful swelling and inflammation. Since the nerve is then enlarged, using your foot also causes the damaged tissue to rub against other structures, aggravating the condition. While this can develop in almost any of the nerves in your feet, the one most commonly affected sits between the third and fourth toes. This is called Morton’s neuroma, and it can cause pain in the ball of the foot, tingling, burning, numbness in the toes, or even the sensation that you’re standing on a pebble. Since continued use tends to make the problem worse, neuromas generally do not get better without intentional intervention.

Can a Neuroma Be Fixed?

The good news is that you have no reason to continue to suffer with your ball of the foot pain. Dr. Gephart can offer you real relief from your discomfort and help you regain any mobility you may have lost from the discomfort. The doctors will perform a thorough examination of your feet and ankles to be sure you don’t have a stress fracture, metatarsalgia, or arthritis, which can have similar symptoms. They may request different diagnostic images, like digital X-rays, to be sure. Once they’ve properly diagnosed a neuroma, they can begin looking for the cause and for the best solution to eliminate your foot distress.

You’ll need to relieve pressure on the damaged nerve and reduce the swelling in the area. In most cases, this can be done conservatively, or without surgical intervention. You may need to change your shoes or add orthotics to provide extra padding under the injured structure or correct any preexisting conditions that are adding pressure to the balls of the feet. Resting the foot, icing the painful area, and massaging out the ball of the foot can all help as well.

Seeking Treatment

If you’ve been searching for Foot Doctor for your foot and ankle needs, take time to meet with the Podiatry Group of Georgia. Our doctor has the experience and knowledge you need to help your feet and ankles feel their best. Give us a call today and set up an appointment for your initial consultation. Call us today
Call Our Marietta, Georgia Office Today at 404-806-3731 or Book your appointment online now!

                               Serving Marietta and the Atlanta Area!


18/Jun/2018

What Can Cause Purple Feet Circulation?Purple Feet Circulation

Purple Feet Circulation or CIRCULATION DISORDERS, Here are a Few Causes!Acrocyanosis

Acrocyanosis is a vasospastic disorder affecting the arteries supplying blood to the skin of the hands and feet. Vasospasm refers to the arteries going into spasm and blocking the flow of blood. These small arteries carry oxygen and nutrients through the blood to the skin of the hands and feet. When the blood cannot flow through, the skin will lack the necessary oxygen required, and turn a dark blue to purple color. This characteristic color is called cyanosis, hence the name acrocyanosis. It is not a common condition. It is seen more frequently in woman than in men.

Unlike the vasospasm seen in Raynaud’s disease which may last several minutes to several hours, the vasospasm in acrocyanosis is more persistent. In addition, the vasospasm in Raynaud’s disease affects the small arteries supplying blood to the fingers and toes. In acrocyanosis the vasospasm affects the arteries supplying blood flow to the skin of the hands and/or feet. Therefore, the skin damage and ulcerations seen in Raynaud’s disease are not present in acrocyanosis. Lastly, Raynaud’s disease goes through a typical triphasic or biphasic color change. In contrast, acrocyanosis maintains its characteristic blue skin coloration.

Diagnosis

Typical symptoms and signs of acrocyanosis of the hands or feet, are a persistently cold temperature and blue discoloration. They often feel sweaty or moist, and swelling may be present. The blue cyanosis usually appears worse upon exposure to cold, and improves upon warming. Rarely is there any pain associated. Normal arterial pulses are always present in the hands and feet since there is no blockage of the larger arteries of the arms or legs.

Treatment

Generally, the treatment is a common-sense approach to preventing cold exposure and keeping the feet dry. This may involve the use of insulated boots, thin polypropylene liner socks to wick the moisture away from the skin, and an insulated sock to maintain normal skin temperature. Generally, no other treatment is necessary. Vasodilators have been tried with limited success. In extreme cases a surgical procedure called a sympathectomy has been performed to relax the persistent vasospasm. This surgery is rarely necessary, and seldom recommended.

Blood Clots in the Legs – Phlebitis

There are two sets of veins which carry blood from the feet back to the heart and lungs. The superficial veins are located just beneath the skin, and are often visible as enlarged or varicose veins. The second network of veins are the deep veins which are located close to the bone of the leg and thigh, and are not visible. Each of these sets of veins has the potential to develop a blood clot.

A blood clot is referred to as a thrombosis. When a blood clot forms there is usually an inflammatory reaction. An inflamed vein is called phlebitis. The inflammation causes swelling, pain, redness, and warmth along the course of the vein. Because these two events (blood clot and inflammation) almost always occur together, the terms venous thrombosis and thrombophlebitis are both used to refer to a blood clot in a vein.

Under normal circumstances blood does not form a clot in the vein. There are certain things, which will make a clot more likely to occur. For example, some families have an unusual trait, which causes their blood to clot more than normal. This is a hereditary abnormality. More common causes of blood clots would include a direct injury to the vein, oral birth control pills, long hours of sitting (for example truck drivers), a recent surgery, prolonged periods of bed rest, a recent pregnancy, or the presence of some types of cancers. Everyone with a blood clot should be evaluated for the underlying cause.

Superficial Phlebitis

Diagnosis

When a thrombosis (blood clot) forms in a superficial vein in the foot or leg it is recognizable as a linear, firm cord. That is because these veins are inflamed and swollen, and because they are located just beneath the skin. They may appear red and feel warm from the inflammation. They are usually painful and very tender to pressure. Classically in the legs, these occur along the course of the greater or lesser saphenous veins. A blood test to evaluate white blood cells may be necessary to differentiate superficial phlebitis from cellulitus (an infection under the skin which can also lead to pain, swelling, and redness of the foot or leg).

Treatment

Superficial phlebitis, although painful, is not a serious condition. This condition should be evaluated by your doctor to rule out other more serious problems. Treatment usually involves the use of anti-inflammatory medication, elevation of the foot and leg, and warm compresses applied over the area of inflammation. Diabetic patients should not use heating pads or warm compresses unless they are supervised by their treating doctor.

Deep Vein Thrombosis

Diagnosis

Although occasionally asympotomatic, most people with deep vein clots complain of pain, swelling, and warmth of the leg. There may be swollen superficial veins as well. The leg pain and soreness is worse with standing or walking, and feels better with rest and elevation. When the area is examined there is often severe tenderness with deep pressure, although this could also be found with muscular problems in the same location.

Confirmation of a suspected deep vein thrombosis can be made by ultrasound testing or by venogram. These tests are important because it is sometimes difficult to establish the diagnosis without them. A proper diagnosis is essential with deep vein clots because failure to properly treat these can result in chronic venous insufficiency or a life threatening pulmonary embolus.

Treatment

Most patients with deep vein thrombosis require hospitalization. In this setting the patient will be given a blood thinner to prevent blood clots from spreading in the leg veins, and to prevent pieces of the clot (emboli) from traveling up to the lungs. Traditionally, heparin has been the blood thinner used in this situation. Other clot dissolving medications are now sometimes added to this treatment to prevent long term damage to the veins, thereby helping to preventing chronic venous insufficiency. Care must be taken with all these medications because they can result in serious undesirable bleeding. An additional treatment, which may be recommended, is a filter, which is surgically placed into the large vein returning blood to the heart. This filter is to prevent pieces of clots from traveling from the leg veins up to the heart and lungs. Clots in the lungs can cause death.

 

Once the patient has been stabilized, the heparin is discontinued and an oral blood thinner called warfarin(Coumadin) is used. This is usually continued for several months depending upon the severity of the episode, and the patient. Periodic blood tests are required to monitor the bleeding and clotting ability of the patient. The dose of the Coumadin is then adjusted as necessary.

 

Following an episode of deep vein thrombosis, it is wise to wear a firm below knee elastic stocking (30 – 40 mm compression) to control swelling. Failure to wear an elastic stocking can lead to chronic venous insufficiency and its associated problems including pain, swelling, dermatitis, skin discoloration, and ulcerations.

Erythromelalgia

Erythromelalgia is a rare disorder manifested by vasodilatation of the blood vessels in the feet. Normally blood flow through the feet and hands is regulated by nerves and muscles in the walls of the blood vessels that either tighten and shrink the vessel’s diameter to restrict flow or to open the blood vessels diameter to allow for more flow. This is all controlled automatically by the body and is necessary to preserve or give up body heat so that we maintain a constant body temperature.

For instance, when we are subjected to cold temperatures the blood vessels will constrict and shunt blood back to the heart and body cavity. This is an example of how our body responds to cold and is a survival mechanism to keep us alive if we were exposed to prolonged or severely cold temperatures. The heat of the blood is not allowed to escape in the fingers and toes into the air or water around us and is sent back to the heart to keep the core body temperature warm so your heart will continue to beat. Certainly, you have heard “Cold hands, warm heart”. When we are hot just the opposite happens and the blood vessels enlarge or dilate allowing for more blood to go to the fingers and toes thereby ‘giving up heat’ to the surrounding air. The ‘cooler blood then goes back to the heart where it helps lower core temperature.

The vasoconstriction (tightening of the blood vessels) and the vasodilatation (opening of the blood vessels) is always changing and adjusting to maintain blood pressure, control body heat, regulate heart rate, among other functions you don’t even think about. Part of the controls for this are partially understood and maintained by the primitive part of our nervous system called the autonomic nervous system. It is this part of our nervous system that is responsible for out heart to beat and for us to breath regularly without having to think about it.

When these controls fail to operate normally we see the pathologic disease patterns of erythromelalgia or Raynaud’s disease or phenomenon. Raynaud’s disease or phenomenon is a vasoconstriction of the blood vessels in the feet and hands. We notice it when our fingers and toes get icy cold and turn blue or even white. This can be a very painful condition depending on how long we are subjected to the cold and the vasoconstriction since the tissues of the hands or feet are deprived of blood and therefore oxygen. In many individuals it may be very mild and not be a problem. All of us experience vasoconstriction to some degree when we are in cold weather. In the disease state however, the vasoconstriction does not entirely reverse when subjected to warmer temperatures and a chronic painful situation ensues.

Erythromelalgia on the other hand is just the opposite. The blood vessels are open or dilated and the oxygen and heat of the blood is discharged into the tissues making them turn red and feel hot all the time. Likewise, this can be a very painful condition. It is a rarer disorder and less understood than Raynaud’s.

Diagnosis

Before treatment, the diagnosis should be confirmed. This can be accomplished by a variety of different medical specialties. Internal medicine or an internist is a good place to start to make sure there are no disease factors or other medications causing the Raynaud’s or erythromelalgia. In many instances the internist will treat the disorder so he may help you monitor medications that have undeliverable side effects or react with other medications.

Treatment

These disease states can be treated with varying degrees of success using drugs that induce vasodilatation or vasoconstriction. Unfortunately, the side effects of vasodilators or vasoconstrictors are often worse than the disease. Obviously, avoiding temperatures or situations that can trigger the responses are also useful. For instance, people with vasoconstrictive problems should wear socks and well insulated shoes to maintain heat. Patients with vasodilatation problems may be more comfortable in sandals, going barefoot, or certainly using a light shoe that can ‘breath’ to allow heat to escape. In severe conditions pain medications can be a useful adjunct. Hypnosis and biofeedback may have some degree of success in certain individuals if administered by appropriately trained individuals.

Gangrene

Gangrene of the skin is associated with the loss of blood supply of an area. In some instances, it is caused by bacterial infection of an open sore or ulceration. The most common form of gangrene develops in the feet of people with diabetes who also have associated loss of circulation in the feet and toes. Any person with poor circulation can develop gangrene. A sudden onset of pain in the feet or legs associated with a decrease in skin temperature, and color changes to the skin of the feet is a strong indication that there has been a sudden blockage of blood flow to the legs. This condition needs immediate medical attention. People who have diabetes may not experience pain associated with such an event because of a condition called diabetic neuropathy. Diabetic neuropathy affects the nerves of the feet and legs causing a diminished ability to perceive pain, excessive heat, cold, vibration, or excessive pressure. This condition places people who have diabetes at greater risk of injury from any source without their being aware of it. For instance, a patient with diabetes can develop an ingrown toenail, and if they also have diabetic neuropathy, they may not experience the same level of pain as someone without the neuropathy. Therefore, the ingrown toenail can worsen, and become infected without providing the warning signs of pain. If the person with diabetes also has poor circulation, the infection can lead to gangrene of the toe. This situation can ultimately lead to the amputation of the toe, foot, or leg, depending upon how bad the circulation is in the leg.

Treatment

Treatment consists of surgical removal of the gangrene, surgery to improve the circulation (by-pass surgery), hyperbaric oxygen treatment and IV antibiotics.

Severe infections can also cause gangrene. The flesh-eating bacterium called Hemolytic Streptococcus is a rapidly spreading infection. Intense local heat, redness, swelling, fever, and weakness characterize this rapidly developing infection. The infection can start with a small abrasion or injury. This condition requires immediate medical treatment. It can result in amputation and/or death. Treatment consists of surgical removal of the infected tissue and IV antibiotics and supportive care as needed for any failing body functions.

Peripheral Vascular Disease

Circulation disorders includes many different problems with one thing in common, they result in poor blood flow. Specifically, the term peripheral vascular disease refers to blood flow impairment into the feet and legs (although it could include the arms and hands as well).

 

Blood is circulated throughout the human body by the strong, muscular pump called the heart. With each heartbeat, blood is pushed along through blood vessels called arteries that carry the oxygen and nutrient rich blood to all parts of the body including the legs and the feet. The individual cells in the body take up the oxygen and nutrients. Then a second set of blood vessels known as veins carry the oxygen depleted blood back to the heart and lungs to get more oxygen, and again be pumped throughout the body. Peripheral vascular disease may refer to arterial inflow disorders, (arterial insufficiency) or venous outflow disorders (venous insufficiency).

Arterial Insufficiency

Arterial inflow disorders are categorized by the size of the artery involved. If a large artery in the thigh or behind the knee becomes blocked by cholesterol deposits this is referred to as large vessel disease or atherosclerosis. The result may be a painful ischemic foot, which means there is a severe lack of arterial blood flow from the heart into the foot. If smaller arteries like those in the lower leg or foot is blocked, this is referred to as small vessel disease, or arteriosclerosis. This too can result in ischemia of the foot. Small vessel disease is seen more often in diabetics, but can affect non-diabetics as well. If the skin of the feet or legs lacks adequate blood flow a sore will develop which may be difficult to heal. These sores are known as ischemic ulcers. Any blockage to arterial inflow will result in a circulation problem to the body tissues downstream. Occasionally a small blockage will occur in the small arteries that supply blood to a toe. This is known as a “Blue Toe Syndrome.” Another arterial inflow problem may result when the smooth muscles that control the size of the arteries go into spasm. The arterial muscle spasm can block the blood from circulating into the foot. One common vasospastic disorder is called Raynaud’s Syndrome. A second vasospastic disorder is called acrocyanosis.

Venous Insufficiency

Venous outflow disorders refer to problems getting blood from the foot back to the heart. There are two sets of veins in the feet and legs to help bring the blood back toward the heart. The superficial venous network refers to veins located just beneath the skin. The deep venous networks are veins located closer to the bones and are not visible when looking at the foot or legs.

Varicose veins refer to an enlargement of the veins and a loss in the ability of the vein to properly maintain blood flow back toward the heart. When this occurs, blood can collect in the feet and legs. Superficial varicose veins may appear as unsightly cords or a small bunch of grapes, which usually appear on the tops of the feet, around the ankles and may extend upward to the knees and thighs. Deep varicose veins while usually not visible will result in chronic swelling of the feet, ankles and legs. When the blood is not circulated from the feet back to the heart gravity will cause the fluid to collect in the feet and ankles. This results in swelling, called edema. Chronic edema over a long period of time may cause a discoloration of the skin around the ankles. The skin can become inflamed, and is known as venous stasis dermatitis. If left untreated the skin will become weakened and a weeping sore will develop, usually on the inside of the ankle called a venous stasis ulcer.

 

A potentially serious consequence of blood collecting in the feet and legs is the formation of blood clots in the veins. A superficial vein blood clot will result in a painful, inflamed superficial vein called superficial phlebitis. When a blood clot forms in a deep vein, it is called deep venous thrombosis, or deep phlebitis. This is a serious condition that causes painful swelling of the leg and may result in part of the clot breaking free. If the clot should travel back up to the heart and get caught in the lungs, it is referred to as a pulmonary embolism which can be life threatening and requires emergency treatment.

 

Raynaud’s Disease

Raynaud’s Disease is a vasospastic disorder most commonly affecting the hands and feet. A vasospasm occurs when the smooth muscles controlling the small arteries supplying circulation into the hands and feet contract. This smooth muscle contraction, or spasm, makes the arteries so small that blood has difficulty passing through. The most common event causing the vasospasm is exposure to cold temperature. Raynaud’s disease must be differentiated from Raynaud’s phenomenon. Raynaud’s disease is a disease that is not associated with any other specific disease entity. Raynaud’s phenomenon has the same findings, as Raynaud’s disease except there is an underlying disease associated with the vasospasm. Raynaud’s phenomenon may be seen with rheumatoid arthritis, scleroderma, lupus, and other diseases. The condition is aggravated by smoking. A single cigarette may decrease the circulation by one half for more than an hour. Raynaud’s disease is most common in young women, and has no known cause. It typically is found in both feet and both hands. It appears that the threshold for vasospasm is lowered in these individuals, and may occur following exposure to cold, or during times of stress.

Diagnosis

The diagnosis of Raynaud’s disease is a clinical diagnosis based upon the patients’ symptoms and the findings on examination. Patients with Raynaud’s disease will often hear the expression, “” Cold hands, warm heart”” when shaking hands with others. This is because the arterial vasospasm decreases blood flow into the hands and feet. In addition to the cold skin temperature, there is a pattern of color changes seen in the fingers and toes. Initially after exposure to cold, the toes and fingers will turn white, then as the oxygen is depleted they become cyanotic which is a blue color, finally the spasm relaxes and there is an excess of blood flow which turns the toes red and warm (reactive hyperemia). This pattern of triphasic color change, white to blue to red, is a hallmark of Raynaud’s disease. However, not all individuals will have the triphasic (three-color) change. Some will have a biphasic (two color) change going directly from white to red.

The length of vasospasm may last from several minutes to several hours. This may be accompanied by pain, or more commonly by numbness. In severe cases there may damage to the skin on the tips of the toes and fingers with an appearance like frostbite. These areas may develop into ulcers (sores) which can be very painful.

Treatment

In mild forms of Raynaud’s disease, the simplest treatment is to protect the hands, and feet from cold exposure. Since cold is the cause of the vasospasm, preventing exposure to cold will prevent the spasm from occurring. This may require insulated boots and thick warm socks in colder climates. Dressing in layers, with new polyester liners and new insulating materials may be helpful. Most sporting goods stores that stock hiking or camping equipment will be able to help in this regard. Cigarette smoking contains nicotine, which is known to cause vasospasm. Discontinuation of cigarette smoking will be a definite benefit for the individual with Raynaud’s disease. In more severe cases, or in those with recurrent episodes, medications are available to help relax the arterial smooth muscle. Medications that have been used successfully in some individuals include phenoxybenzamine, prazosin, nifedipine, pentoxifylline, and guanethidine. These medications are only available by prescription, and patients must be monitored for potential side effects.

The Ischemic Foot

The term “ischemic foot” refers to a lack of adequate arterial blood flow from the heart to the foot. There are a wide variety of possible causes for poor arterial circulation into the foot including arterial blockage from cholesterol deposits, arterial blood clots, arterial spasm, or arterial injury. The ischemic foot is also referred to as having arterial insufficiency, meaning there is not enough blood reaching the foot to provide the oxygen and nutrient needs required for the cells to continue to function.

Diagnosis

The result of insufficient blood supply to the foot can manifest itself in a variety of ways depending upon how severe the impairment to circulation. Early symptoms may include cold feet, purple or red discoloration of the toes, or muscle cramping after walking short distances (intermittent claudication). Later findings may include a sore that won’t heal (ischemic ulcer), pain at night while resting in bed, or tissue death to part of the foot (gangrene).

The diagnosis of ischemia is made by reviewing the patient’s symptoms, examination of the foot, and special testing to evaluate the circulation. The examination should reveal cold skin temperature, and skin atrophy that causes the skin to appear shiny or paper thin with loss of normal hair on tops of the toes and on the lower leg. There is often a color change associated with ischemic feet. This may show as a purple discoloration of the toes, white blanching of the toes when the foot is elevated, and red discoloration when the foot is hanging down. Additionally, the two arterial pulses in the foot will not be as strong as normal, or may be entirely absent. Certainly, the presence of a pale looking ulcer, or black gangrenous toes would be an ominous sign of poor circulation.

When these findings are present further testing is usually required. This will often include arterial Doppler testing. This test uses sound waves to listen to the blood flow through the arteries and can record the quality of the blood flow and the blood pressure. If the quality of blood flow is poor and the pressure is greatly diminished, this would indicate a lack of adequate blood flow. A second test may be required to further determine where the arterial blockage is located and how much blood is able to squeeze past the blockage. This test is known as an arteriogram. The arteriogram requires the injection of a special dye into the artery so that the artery will be visible when an x-ray is taken. This x-ray can then show where the artery is blocked and how much blood can flow past the blockage.

Treatment

In the early stages of ischemia of the foot, the doctor will often recommend a program of walking exercises to increase blood flow, protective shoes and insoles if necessary, to protect the skin from rubbing producing irritations which may lead to ulcerations. Medications are also available to help improve the blood flow into the feet.

In more advanced stages of ischemia, a referral to a vascular specialist is appropriate for further evaluation. Oftentimes, if the patient is in otherwise good general health, a surgery may be recommended to bypass the blocked artery or to clean out the area of blockage. This can be major surgery, however in these cases, failure to improve the circulation into the foot may result in gangrene, which may ultimately require amputation of part of the foot or leg. The surgery is an attempt to save the foot and leg from the impending amputation. The surgery has improved over the years and the chances for success are now greater than ever before. However, each individual needs to be evaluated as to the potential risks and possible benefits from this type of surgery.

Venous Stasis

Venous stasis refers to loss of proper function of the veins in the legs that would normally carry blood back toward the heart. This may occur following injury to the veins, which can result in blood clots in the superficial veins known as superficial phlebitis, or following blood clots in the deep veins known as deep venous thrombosis. Swelling in the lower legs and ankle can also occur because of heart disease called Chronic Congestive Heart Failure and due to kidney disease. In some instances, the cause of the swelling may not be easily identified.

Diagnosis

Individuals with this condition usually exhibit edema, which means swelling, of the legs and ankles. The superficial veins in the legs may be varicosed, causing the veins to be enlarged and appear as a cord or a bunch of grapes. Patients often complain of a feeling of fullness, aching, or tiredness in their legs. These symptoms are worse with standing, and are relieved when the legs are elevated.

As the condition progresses the blood continues to collect in the feet, ankles, and legs. The pigmentation from the red blood cells stains the skin from the inside, and a reddish-brown discoloration develops on the skin. This is called venous stasis dermatitis.

In severe cases of long-standing venous stasis, the skin begins to lose its elasticity, and a sore may develop on the inside of the ankle. This is known as venous stasis ulceration. This ulcer often will drain large amount of fluid and will have a red base. Secondary infection can complicate the ulcer and will require antibiotic treatment.

Further testing may be requested by your doctor to further evaluate the condition of your veins. This may include venous Doppler testing, which uses sound waves to listen to the blood flow through the veins. If there is a suspicion of an acute thrombosis (blood clots), a venogram may be requested. This enables the veins to be visible on x-rays, and the blood clot can be identified with greater certainty. Identification of deep vein thrombosis is important, because failure to properly treat may result in a blood clot breaking loose in the leg and traveling to the lungs called pulmonary embolus, which can be fatal.

Treatment

The most common treatments for venous stasis are rest, elevation, and compression stockings. When elevating your feet, the ideal position is to have your feet above the level of your heart. This permits greater return of blood back toward the heart. This usually means you are lying down with your legs raised with pillows.

The compressive stockings come in different lengths. A knee-high stocking may be sufficient if the swelling is confined to the lower legs and ankles. However, if the swelling extends up to the knee, then a thigh high or panty hose style elastic stocking may be required. The compression stockings are also available in a variety of compression strengths. The greater the compression the more squeeze the stocking will apply to the leg. Generally, over-the-counter elastic stockings are available (without prescription) in most pharmacies or surgical supply stores. These have a compression range of 10 to 20 mm compression. If these do not provide enough compression to control the edema, then a prescription compression stocking may be necessary. These begin at 30 to 40 mm compression, and are often referred to as T.E.D. stockings. In more severe cases a higher level of compression may be necessary. These stockings often need to be custom sized to each individual leg, otherwise they are difficult to put on and may not provide even compression throughout the extremity. Your doctor may also use medications to reduce the swelling called Diuretics. Diuretics increase the output of urine and your doctor should closely monitor the use of this medication. If the cause of the swelling is due to heart problems or kidney problems your doctor will evaluate the need to adequately treat these conditions. Cited www.apma.org

Who to call for Treatment?

If you’ve been searching for podiatric surgeons for your foot and ankle needs and have Purple Feet Circulation Problems, take time to meet with the Podiatry Group of Georgia. Our doctor has the experience and knowledge you need to help your feet and ankles feel their best. Give us a call today and set up an appointment for your initial consultation. Call us today

Call Our Marietta, Georgia Office Today at 404-806-3731 or Book your appointment online now!

Serving Marietta and Atlanta Area!

 


18/Jun/2018

What’s the Difference Between Breaks, Sprains, or Fractures?Difference Between Broken and Fractured Bone

Broken Bones, Sprains, and Fractures

If you’re running when you stumble over a large crack in the pavement You may feel a sudden, sharp pain in your foot. Whenever you try to move your lower limb, it hurts, and you must limp to keep walking. What did you injure—a bone, or the supporting connective tissues? When a problem occurs inside your body, out of sight, it can be hard to tell exactly what it is. Symptoms like these can be indicative of several different foot and ankle injuries, including a broken bone or a sprain.

Break vs. Fracture vs. Sprain

Trauma to your foot or ankle can cause serious damage to the bones and connective tissues that hold them together. The specific damage that results is what determines the type of injury. The painful overstretching or tearing of a ligament is called a sprain. This is different from the same type of damage to a tendon or a muscle—that is called a strain. When the injury is a disruption of the bone, it’s a called a break or a fracture.

There is a common misconception that breaks and fractures are different. Some assume that a fracture isn’t as serious as a broken bone, but that isn’t the case. Though you can certainly injure bones to varying degrees—small, aligned cracks are easier to treat than misaligned bones or ones with multiple breaks—the names “fracture” and “broken bone” mean the exact same thing: a break in the hard tissue.

Although broken bones and sprains affect different structures within the lower limb, it can be hard for you to tell which injury has taken place until you have it diagnosed by a doctor, like those here at Podiatry Group of Georgia. Both kinds of damage can be extremely painful. The discomfort is immediate and can make it very difficult, and sometimes impossible, to put weight on the affected foot, depending on the severity of the problem. The injured area swells and often bruises. Both conditions can result in chronic pain and weakness, as well as lead to additional injuries, if they are not addressed and remedied.

How To Repairing the Damage

How your foot is treated does depend both on the specific diagnosis and the severity of the damage. The professional staff of Podiatry Group of Georgia will evaluate your foot with tests and diagnostic images to get a clear picture of what structures are injured. Dr. Gephart know whether you have a fracture or a sprain, they can move forward with accurate treatment.

Both conditions can usually be treated conservatively. A sprain will need to have the irritation and swelling decreased. This means resting and icing the affected area. You may need to have your foot immobilized in a wrap or brace to keep from stressing the injured ligaments. More serious sprains may require a no weight-bearing period to allow the connective tissues to recover. A broken bone will need a period in a cast or special boot to hold it still so the body can repair the crack. Usually this means no weight on the foot until the break has healed.

Ruptured ligaments or displaced broken bones may need surgery to repair the damage. Neither will heal correctly on its own unless the ends of the torn or misaligned tissues are brought back together. The edges must be surgically realigned—and sometimes pinned in place for them to reattach.

Seeking Treatment

If you’ve been searching for podiatric surgeons for your foot and ankle needs, take time to meet with the Podiatry Group of Georgia. Our doctor has the experience and knowledge you need to help your feet and ankles feel their best. Give us a call today and set up an appointment for your initial consultation. Call us today

Call Our Marietta, Georgia Office Today at 404-806-3731 or Book your appointment online now!

Serving Marietta and Atlanta area!

 


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