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15/Dec/2017

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 !


15/Dec/2017

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!


15/Dec/2017

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 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 the Atlanta Area!


15/Dec/2017

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!


15/Dec/2017

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!

 


15/Dec/2017

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!

 


15/Dec/2017

What is the Pain in the Ball of Your Foot?Stabbing Pain in Ball of Foot

One area that we hear patients complain about often is discomfort in the ball of their foot.  This is where the toes join the rest of the foot and it is composed of muscles, ligaments, tendons, bones and nerves. Your forefoot endures a great amount of stress and impact, particularly if you are active in sports. This structure is used for balance, weight distribution, and pushing off during movement. Pain in this area can have several different causes, including weight gain, overuse in an activity, nerve damage, or even poor footwear. Two of the most common causes for pain in the ball of your foot are metatarsalgia and sesamoiditis. If you have forefoot pain, it may be one of these two injuries, and we have the treatments to get you back on your feet.

  1. The Burning Pain of Metatarsalgia

Pain in the Ball of the FootMetatarsalgia is actually a group of symptoms that involve localized pain in the area behind your toes, and there can be many factors involved. Pain is felt where the metatarsal heads connect to your toes. Sharp, shooting and/or burning pain are telling signs that this area is under too much pressure. You may also feel tingling or numbness and a sensation as if you have a bruise in the bottom of your foot.

Wearing shoes with tight, narrow toe boxes is a common cause for added pressure on the metatarsals as well as being involved in a high-impact sport such as gymnastics, football, basketball, and soccer. Other causes include being overweight, bunions or hammertoes, having a high arched foot, and arthritis. It is common for symptoms to come on slowly over time and to dissipate during periods of rest. Even if the discomfort is minor and comes and goes, it is likely to get worse without treatment.

  1. Chronic Inflammation of Sesamoiditis

Sesamoiditis is a very common forefoot problem. It stems from irritation to the sesamoid bones, which are two pea-sized bones beneath the big toe joint in the ball of your foot. These two small but very important bones act like pulleys for the surrounding tendons, allowing the big toe to move normally. They also play a large role in the absorbing the weight put on the forefoot and big toe. An injury in this area can involve the bones themselves and/or the surrounding tendons and tissues. Frequent impact and stress through sports, wearing high-heeled shoes and having high arches are common contributors for this injury. Chronic, dull pain beneath the toe joint is the most common symptom for sesamoiditis. 

How To Relieving the Pain

If you are experiencing pain in the ball of your foot, the good news is that we can help. The cause determines the treatment, so our first step will be to determine the reason behind your discomfort.

  • Relieving the pressure is usually the first goal, so you will need a period of rest, eliminating any activities that would cause further stress.
  • Icing can help with inflammation and switching to more supportive shoes is often very helpful.
  • Orthotic inserts can add extra cushioning and stabilization, and there is also the option for injectable fillers as a treatment for metatarsalgia.
  • Taping and strapping the big toe joint to immobilize it may be necessary with sesamoiditis, as well as rest from activity while the bones heal, and icing for inflammation.

 Seeking Treatment

If you’ve been searching for podiatric  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!


15/Dec/2017

What is Pain in the Ball of Your Foot?

Foot Pain Radiating Up Leg

One area that we hear patients complain about often is discomfort in the ball of their foot.  This is where the toes join the rest of the foot and it is composed of muscles, ligaments, tendons, bones and nerves. Your forefoot endures a great amount of stress and impact, particularly if you are active in sports. This structure is used for balance, weight distribution, and pushing off during movement. Pain in this area can have several different causes, including weight gain, overuse in an activity, nerve damage, or even poor footwear. Two of the most common causes for pain in the ball of your foot are metatarsalgia and sesamoiditis. If you have forefoot pain, it may be one of these two injuries, and we have the treatments to get you back on your feet.

The Burning Pain of Metatarsalgia

Pain in the Ball of the Foot Metatarsalgia is actually a group of symptoms that involve localized pain in the area behind your toes, and there can be many factors involved. Pain is felt where the metatarsal heads connect to your toes. Sharp, shooting or burning pain are telling signs that this area is under too much pressure. You may also feel tingling or numbness and a sensation as if you have a bruise in the bottom of your foot.

Wearing shoes with tight, narrow toe boxes is a common cause for added pressure on the metatarsals as well as being involved in a high-impact sport such as gymnastics, football, basketball, and soccer. Other causes include being overweight, bunions or hammertoes, having a high arched foot, and arthritis. It is common for symptoms to come on slowly over time and to dissipate during periods of rest. Even if the discomfort is minor and comes and goes, it is likely to get worse without treatment.

What is Chronic Inflammation of Sesamoiditis?

Sesamoiditis is a very common forefoot problem. It stems from irritation to the sesamoid bones, which are two pea-sized bones beneath the big toe joint in the ball of your foot. These two small but very important bones act like pulleys for the surrounding tendons, allowing the big toe to move normally. They also play a large role in the absorbing the weight put on the forefoot and big toe. An injury in this area can involve the bones themselves and/or the surrounding tendons and tissues. Frequent impact and stress through sports, wearing high-heeled shoes and having high arches are common contributors for this injury. Chronic, dull pain beneath the toe joint is the most common symptom for sesamoiditis.

How to Relieving the Pain

Should you be experiencing pain in the ball of your foot, the good news is that we can help. The cause determines the treatment, so our first step will be to determine the reason behind your discomfort.

  • Relieving the pressure is usually the first goal, so you will need a period of rest, eliminating any activities that would cause further stress.
  • Icing can help with inflammation and switching to more supportive shoes is often very helpful.
  • Orthotic inserts can add extra cushioning and stabilization, and there is also the option for injectable fillers as a treatment for metatarsalgia.
  • Taping and strapping the big toe joint to immobilize it may be necessary with sesamoiditis, as well as rest from activity while the bones heal, and icing for inflammation.

    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!


15/Dec/2017

What is Metatarsal Surgery?Metatarsal surgery

There are five metatarsal bones in each foot. These bones are the long bones behind each toe. The metatarsal bone behind the big toe is called the first metatarsal. The metatarsal bone behind the little toe is called the fifth metatarsal. The most common metatarsal surgery is performed on the first metatarsal for the correction of bunion deformity. The second most common metatarsal surgery is on the fifth metatarsal for the correction of tailor’s bunion deformity. This article will address metatarsal surgery of the other metatarsals.

Surgery on the remaining metatarsal bones is performed infrequently. When surgery is performed on the second, third, or fourth metatarsal bones, it is generally for the treatment of painful callouses on the bottom of the foot or for the treatment of non-healing ulcerations on the ball of the foot. Patients with rheumatoid arthritis may require surgery of the metatarsals, which is discussed in another section. Also, surgery of the metatarsals may be necessary in instances of trauma of the foot where the metatarsal bones may have been fractured. This article will discuss elective metatarsal surgery.

Painful callouses on the ball of the foot are due to an abnormal alignment of the metatarsal bones. If a metatarsal bone is lower than the others, excessive weight is placed on this area of the foot, and a painful callous may form. In people with diabetes, these areas of excessive pressure may break down and form open sores or ulcerations. Initial treatment generally consists of using a functional or accommodative orthotic to reduce the pressure to these areas. If this is not successful, metatarsal surgery may be considered.

The Surgery

The surgery consists of cutting the metatarsal bone just behind the toe. Generally, the bone is cut all the way through, and then manually elevated and held in its corrected position with a metal pin or screw. Following the surgery, the patient may be placed in a cast, or may be required to use crutches for several weeks. If a pin is used to hold the bone in place, it is generally removed in three to four weeks. Removal of the pin can be done in the doctor’s office without the need for anesthesia. While the pin is in place, the patient should keep the foot dry to prevent infection. Generally, it takes a total of six to eight weeks, or longer, for the bone to heal. During this healing period, the foot should be protected from excessive weight bearing. Walking prematurely on the foot can cause the bone to shift and heal in an incorrect position. This is the most common cause of failure with this surgery. Some studies indicate a failure rate as great as 60%. If the bone shifts downward, or is not elevated enough at the time of surgery, the painful callous may return. If the bone is elevated too much, a painful callous may form under the metatarsal next to the one which was operated on.

Some surgeons will also cut out the painful callous on the bottom of the foot when they perform the metatarsal surgery. Rarely will a foot surgeon remove the painful callous without also performing the metatarsal surgery. Without correcting the metatarsal alignment, the painful callous is almost certain to return.

Most surgeons prefer to do the surgery in an outpatient surgery center or hospital. In this setting, intra-venous sedation or general anesthesia can be used for the patient’s comfort.

After the surgery, the surgeon places a gauze bandage on the foot. Generally, the bandage stays in place until the patient‚ first follow up visit with the doctor. The skin stitches are removed in ten to fourteen days. If there are stitches in the bottom of the foot, they may remain in place for three weeks. The foot should be kept dry while the stitches and/or pin are in place to help prevent infection. May surgeons will have the patients wear a below the knee cast and/or use crutches for six to eight weeks. Other surgeons will allow the patient to wear a stiff-sole post-operative shoe, and allow limited walking on the foot.

Recovery Time

The time required to be off work will vary with the demands of the person job. A minimum of one week off work would be advisable with the patient staying at home with the foot elevated above the heart.

Possible Complications

Complications associated with this surgery are: infection, failure of the bone to heal in its correct position resulting in the return of the painful callous or transfer of the callous to a new location, delays or failure of bone healing, stress fractures of adjacent metatarsals, or excessive swelling. A common occurrence following the surgery is elevation of the toe associated with the elevated metatarsal bone that was operated on.

Metatarsal Surgery to Treat Diabetic Ulcerations

Diabetic patients with non-healing ulcerations on the ball of the foot may undergo a different type of metatarsal surgery. In this instance, the section of the metatarsal bone associated with the excessive pressure, called the metatarsal head, may be removed entirely. This is a relatively common and successful surgery that aids in the healing of the ulceration on the bottom of the foot. Possible complications with this surgery include infection, failure of the procedure to heal the ulceration, or the development of new ulcerations in adjacent areas on the ball of the foot. If the patient has poor circulation, further complications may be failure of the surgical sight to heal, or gangrene with partial loss of the foot or leg.

In most instances of metatarsal surgery, the patient should use an orthotic in their shoe after the surgery has healed. This is especially important for the diabetic patient. The orthotic will reduce the risk of reoccurrence or the development of new areas of callous formation or tissue break down. Cited PodiatryNetwork.com.

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!

 


15/Dec/2017

Our Podiatric ServicesPodiatric Services

Podiatry Group of Georgia is your foot and ankle specialist, offering a full array of podiatric services to help you treat and maintain healthy feet. Our Podiatrist that practices in our office is ready and willing to get to know you and ensure you receive the best treatment for your feet.As a foot and ankle specialist, Podiatry Group of Georgia is qualified to treat a variety of foot problems – whether you’re dealing with an irritating ongoing condition or an injury you’ve had for years.

Our Services Include:

Foot and Ankle Surgery

When you need foot surgery, you want to find the right doctor of podiatry for the job. Look at the medical team at the Podiatry Group of Georgia. Led by Dr. Tammy Gephart, our clinic has becoming the leading podiatry clinic in Georgia for a reason. We’ve worked hard to establish our office as a place where patients can come to get top of the line care.

Toenail Fungus Treatment

At Podiatry Group of Georgia, we offer toenail fungus laser treatment, an innovative outpatient procedure that zaps fungus by shining a laser light beam onto the nail, penetrating through the surface of the nail, and killing the pathogens that are causing the fungal infection.

Common Foot Problems

A foot and ankle specialist at Podiatry Group of Georgia is ready and willing to help treat your common foot problems. Each Podiatrist in our office will work with you to make sure you feel well taken care of. We know how easy it is to take your feet for granted, which is why we are committed to getting your feet treated as soon as possible.

Pain Management

Foot pain can be caused by a variety of factors, including the type of shoes you wear, the kind of activities you participate in, genetics, injuries or health problems. A foot and ankle specialist at Podiatry Group of Georgia can tell you about the variety of pain management options we have available to help you get back on your feet again.

Ingrown Nail Treatment

Most of the time, an ingrown toenail can be easily treated by a Podiatrist here at Podiatry, either by providing proper recommendations for at home treatment, or surgery in extreme cases. Either way, we can help you find out what is causing your ingrown toenails.

Custom Orthotics

Orthotics are shoe inserts that come in a variety of shapes and sizes. Podiatry Group of Georgia offers three different varieties of custom orthotics that are made to fit your individual foot structure. This orthotics are used to correct an irregular or abnormal walking pattern caused by the foot not bearing weight properly, and will help you stand, walk, run and generally just move more comfortably and efficiently.

Medical Foot Spa

Our Marietta foot doctor knows the importance of treating your feet right. You spend all day on your feet, moving around from one task to another. Keeping your feet happy will help keep the rest of your body happy. That’s why we offer spa services for your feet right in our office. We offer three different levels of service so you can choose the treatment that’s right for your feet and your budget.

 Call For 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!


Contact Us

Phone: 404.806.3731
Fax: 404.506.9444
3901 Roswell Road
Suite 340
Marietta GA 30062

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