Custom Orthotics Save Giraffe's Life

Humans aren't the only creatures that need care for their feet.

Hope, a baby giraffe born at the Topeka Zoo this July, has been given another chance at a full life, thanks to some clever work with some makeshift "custom orthotics". The giraffe was born with her fetlock joints bent at 90 degrees and dislocated.

Dr. Joseph P. Kamer, a local small animal practitioner, acted quickly at the time of the giraffe's birth and straightened the animal's joints. He put her rear hooves into hard casts within two hours of her birth. After consulting withe veterinarians at the zoo as well as some large animal specialists, Dr. Kamer decided to take the conservative approach and designed a corrective shoe of his own custom design for baby Hope.

The wooden shoes were glued to Hope's hooves using methylmethacrylate cement and polyethylene mesh reinforcement. Dr. Kramer fashioned artificial tendons out of nylon rope to resemble the flexor tendons and attached them to the shoe, then ran them along the leg in plastic tubing.

As the baby giraffe grew, the casts and shoes were changed to accommodate her size, and by late September she was out of the casts and no longer needed support for her left leg. "The animal can run - full bore - with these shoes on," said Dr. Kamer. "As long as I can keep the shoes on this animal for the next several months, then I think that's key." He is guardedly optimistic about Hope's chances of survival and adds that he hopes these podiatric techniques will help other giraffes that suffer from similar deformities.

Special thanks to a wonderful patient of ours for pointing out this article from JAVMA (Journal of the American Veterinary Medical Association) by R. Scott Nolen! Article is from Vol. 237, No.9 Page 1002 on November 1, 2010. Photo courtesy of Topeka Zoo.

Stasis Dermatitis

Stasis dermatitis is an inflammatory skin disease that occurs on the lower extremities and is chronic in nature.

This condition is commonly seen in patients with chronic venous insufficiency. Venous insufficiency occurs as a result of loss of valvular function. Stasis dermatitis typically affects middle-aged and elderly patients and may be a precursor to lower leg venous ulcers.


History/Physical:

• The appearance of reddish-brown skin may represent an early sign of stasis dermatitis
• Stasis dermatitis is associated with brown deposits in the skin called hemosiderin
• The inner ankle is frequently involved
• Lower extremity edema (swelling) is often present
• The patient with stasis dermatitis may experience mild itching, pain, or even cramping
• Stasis dermatitis may present as red, scaling plaques with drainage, crusting, and possible superficial ulceration
  

Differential diagnosis:

• Eczema - A skin condition that may include dryness, rash, and inflammation
• Dermatitis (various types)
• Cellulitis - A skin infection
• Necrobiosis Lipoidica - A necrotizing skin condition
• Tinea Pedis - An infection of the skin caused by a fungus
  

Work-up:

• Venous doppler study may be used to reveal a deep venous thrombosis or valve damage
• Skin biopsy of stasis dermatitis may be indicated in rare instances.

Treatment:

• Compression therapy - Specialized compression stockings that have a controlled gradient of pressure. Compression can also be accomplished by the use of elastic wraps and Unna boots.
• Elevation of lower extremities frequently
  

Topicals:

• Corticosteroids - To reduce inflammation and itching
• Wet to damp gauze dressings for weeping lesions
• Open lesions are treated with topical antibiotics
• Leg ulcerations or lesions with with coexisting skin infections may also be treated with oral or IV antibiotics by the physician
  

Winter Tips for Cold Feet

Brrr! Winter is in full force here in the valley and that means it’s COLD. During this time of the year we often pile on layers to protect our core but tend to forget about our extremities. If you’re looking for tips on how to keep your feet warm this winter, Shenandoah Podiatry can help.
Socks made from natural fibers – like wool – should be worn because they have moisture-wicking properties. This helps to prevent fungus which grows best in warm, damp places. Leather shoes can also keep your feet warm because leather has natural insulating properties. If you choose to wear insulated boots, be sure that they aren’t too tight as this can cause ingrown toenails. Avoid electric socks and other heated inserts because they can be dangerous especially if there’s an underlying reason for your cold feet.

Aside from winter weather, cold feet can be caused by a number of serious ailments that should be addressed right away. If our feet are cold year-round, we might be especially quick to write it off as normal during the winter. Unfortunately, cold feet can be indicative of a more serious problem and should never be ignored.

Peripheral vascular disease (PVD) or poor circulation is a common culprit. Blood helps to keep us warm and without proper circulation our bodies direct heat to our core and away from out feet. If you smoke or have diabetes, you have an increased risk of developing PVD which can make it harder for small cuts and ulcers to heal properly. This is why it’s so important to see a podiatrist right away if one of these sores develops.
Diabetes can also put you at risk for chilbains or ulcers of the toes and feet after cold exposure. If you experience redness and swelling in your toes after being outside and it doesn’t go away once they’ve warmed, make an appointment to see us right away.
We hope that you’ll follow these tips and be on the lookout for these possible conditions. If you do, you’ll find it easier to keep your feet warm this winter which is important because warm, dry, pain free feet are healthy feet.

Happy New Year!

Wanna break out those sassy high heels for your New Year's celebrations? Ring in the New Year the healthy way with some tips (an quick fixes, so you don't have to miss the fun!) for happy feet, courtesy of the APMA:

http://www.apma.org/new-years-foot-fixes

Happy New Year from all of us at Shenandoah Podiatry!

Corns

For more information visit our website http://www.roanokefoot.com/


Corns are hyperkeratotic papules of the skin. They are also known as clavi. These lesions can be painful.

They develop due to excess pressure on the bony prominences of the feet and toes.


Factors that contribute to the formation of corns include:

Abnormal foot mechanics

Foot Deformities

High Activity Levels

Peripheral Neuropathy


Corns are often seen in:

Athletes

Elderly Patients

Diabetic Patients


Types of Corns:

Hard Corn (Helloma Durum)- Commonly found over the joints of toes.

Soft Corn (Helloma Molle)- Found in interdigital locations and has a macerated texture.

Periungual Corn- Found near the edge of a nail.


Presentation:

Corns present with a growth on the foot or toes. Pain is associated with walking or wearing shoes.

Direct pressure generally cause pain to the affected area.

After debridement a corn may have a central plug of skin.



Intrinsic causes:

Foot deformities such as a bunion or a hammertoe

Extrinsic causes:

Activity

Poor fitting shoe gear


Work Up:

X-rays of the feet while weight-bearing can help identifying bony prominences.

Pressure studies- Can help locate the exact location of pressure.

After trimming the lesion the examiner can attempt to determine if the lesion is a corn, callus, or wart.


Treatment:

Hard corns- Pare or debulk the lesion utilizing a small blade. Removal of the centralized plug.

This should be performed regularly in high risked patients such as diabetics.

Regular debridement might decrease the risk of ulceration.


Soft corns- Hygiene is important to decrease the chance of infection. The patient should wear a pair of properly fitting shoes.

The use of an antifungal or antibacterial powder may be helpful.

Toe spacers can also be beneficial.


Other treatment:

Keratolytics such as salicylic acid, urea cream, or lactic acid cream may be prescribed by your doctor.

Good fitting shoe that match the length and width of the patient's feet.

The use of a pumice stone for careful debridement.

The use of good foot hygiene.

The use of a silicone sleeve.

Orthotics


Surgical care:

If conservative treatment fails surgery may be indicated to remove bony prominences.

How is the Metrodome like a bunion pad?

An analogy from Dr. Andrew Schneider, a friend and colleague of Dr. Feeny's

This past Sunday, football fans everywhere marveled when a blizzard caused the roof of the Metrodome, home of the Minnesota Vikings, to collapse. It was the fourth time in the stadium's 28 year history that the roof collapsed. As I was searching for the video on YouTube to show a friend of mine, I came across an article that compared the roof to a bunion pad.

An interesting comparison, don't you think? At first glance, you'd think they were made of similar materials. I learned that the roof was made of a fiberglass cloth that's 1/16" in thickness. Surprisingly a bunion pad is thicker than that!

What the article was referring to was both an air supported, inflatable roof and a bunion pad are cheap and unsophisticated methods of treating a complex problem. Let's face it...it's Minnesota...it really snows there...you really need a proper dome on your stadium!

Similarly, using a bunion pad to control the pain associated with a hallux valgus deformity is the easy way out. It is simply addressing the pressure on the bump on the side of the foot against the shoe. Nothing more. It doesn't address the function of the foot that caused the bunion to form in the first place and will cause it to continue to grow. It does not address the rotation of the metatarsal bone that is causing the bump to form. It's merely helping to cushion the bone today, to allow you to wear shoes today, hoping that it will feel better tomorrow, but it won't.

Treating the bunion requires, at the very least, good mechanical control to return stability and efficiency to the foot. This will stop the foot from deforming further and prevent the bunion from getting bigger. If a bunion is already painful in shoes, then surgery to correct the bunion may be the best option. It's better to address that sooner than later since the complexity of the procedure and recovery will change depending on how bad the bunion is.

It's not worth wasting time on a bandaid solution. In Minnesota, they'll patch the flimsy roof and reinflate it. But when it comes time to treat your painful bunion, take a smarter approach. If you haven't seen the collapse of the roof yet, watch it here!

Dr. Andrew Schneider is a podiatrist with Tanglewood Foot Specialists in Houston, TX.

What is Athlete's Foot?

No, it's not just something athletes get. Athlete's foot is a skin disease caused by a fungus that can occur on the feet and between the toes. The term "athlete's foot" became popular because athletes who used these facilities would develop the fungal infection. Some symptoms of Athlete's foot are dry skin, itching, burning, scaling, inflammation, blisters, and pain.

Athlete's foot can happen to anyone, and the fungi grow abundantly in many common places. Shoes create a warm, dark, and humid environment, the ideal environment for the growth of a fungus, which is why a the feet are a common spot for a fungus to attack. Breeding grounds for fungi can also be found around swimming pools, showers, and locker rooms.

You can prevent Athlete's foot by practicing good foot hygiene and washing your feet daily with soap and water. Be sure to dry your feet well, especially between the toes, and try to change your shoes and socks often to decrease the moist environment. You can also decrease excess perspiration by using a talcum powder. If you are in an environment where a fungus can be found - such as a pool, locker room, public shower, or dressing room - avoid walking barefoot and wear shower shoes when rinsing off.

If treatment does not respond to good hygiene or self treatment, make an appointment with a podiatrist. The podiatrist will determine if the condition is a fungus or some other problem and determine a plan of treatment, which may involve topical and oral antifungals.