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By Dr. Kuvent, November 9, 2010 3:50 pm

We all know what fractures are. Many of you have probably fractured a bone or two in your lives. You fall out of a tree or get violently tackled on the football field and suddenly you’re in the hospital and the doctor is telling you you’ve got a broken bone. While this is easily understood by most, when prefaced by the term “stress”, people are often confused when they’re told they have a fracture. It’s not uncommon for podiatrists to hear this response after telling a patient they have a stress fracture: “but doctor, I don’t remember any trauma to my foot”. While they may not recall any specific traumatic event causing the fracture, the patient indeed suffered trauma significant enough to cause a fracture, it just wasn’t the type of “trauma” everyone thinks of when discussing fractures. Continue reading 'The Dreadmill: Common Causes of Stress Fractures'»

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By Dr. Kuvent, April 29, 2010 12:50 pm

          When you think of tumors you may think of cancer, and when you think of cancer, you probably don’t immediately think of the foot or ankle. However, there is in fact a very wide variety of tumors which do show up primarily in the foot and ankle. Thankfully, ten times as many of these lesions are benign as they are cancerous, but it’s still intriguing to note that 45% of soft tissue sarcomas occur in the lower extremity. One of the more common benign tumors of the foot is known as a “plantar fibroma”.

          Plantar fibromas are generally found in patients in their 20s, 30s, and 40s and are most commonly seen in men. About half of cases involve both feet, and they are more common in people with epilepsy, diabetes, and alcoholics with liver disease. Also, they are classically associated with a condition involving the hands in which the ring and small fingers are contracted forwards and are unable to be straitened. This is called a Dupuytren’s contracture. Of course, it’s important to remember that not all individuals with this condition fit these criteria.

          Essentially, plantar fibromas are thickenings of fibrous tissue within the plantar fascia which is a normal band of tissue that runs along the sole. These nodule-like thickenings are usually found towards the middle or inside of the sole, and they sometimes arise in non-weight-bearing areas making them asymptomatic. On the other hand, the lesions can grow to 2 cm in diameter, and although they are not cancerous, they can be locally aggressive leading to significant pain and discomfort when walking.

          A major key to properly managing plantar fibromas is achieving the correct diagnosis. This is because there are so many other possible tumors and lesions-both benign and malignant-within the foot and ankle. Your local Chandler podiatrist can help you in determining whether your condition is actually a ganglion cyst, an infection, hernias of the fat pad, tumors involving nervous tissue, a cancerous lesion, or indeed a plantar fibroma. In some cases, an MRI may be requested to help the doctor make this distinction.

          The treatment for plantar fibromas is based on the grade, size, and location of the tumors as well as the nature of your symptoms. Foot doctors like to start out as conservatively as possible by implementing certain medications, shoe-gear modifications, steroid injections, and other modalities before moving on to surgical intervention. In severe cases such as those involving pain, difficulty fitting into shoes, or a growing lesion, the doctor may recommend surgery to excise the lesion. There is a chance of recurrence, however.

          If you have symptoms of a plantar fibroma, such as painful ‘lumps’ on the soles of your feet, feel free to call and make an appointment today.

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By Dr. Kuvent, March 17, 2010 9:23 am

          With roughly 52 bones in both of our feet, it’s easy to imagine that each of the joints in our feet must be able to work in a precise, coordinated fashion in order for us to stand and move without problems. This is something that’s easy to take for granted when we’re pain-free. After all, our hands also contain numerous bones and they don’t usually give us trouble, right? Unlike hands, our feet must bear the weight of our entire bodies with each passing step. Consequently, the result of dysfunctional foot joints can become much more devastating. In many such cases, fusing of the joint or joints in question is actually a very feasible solution.

          Depending on the case, there are several regions of the foot where podiatric surgeons consider fusion procedures. One area is within the toes. If you try curling them you may notice that each toe has several small joints which allow the curling motion. When one or more of these joints is fused, it converts the toe to a rigid lever and helps eliminate any grinding or other disease process occurring in that toe. Some indications for this may include traumatic arthritis, hammertoes, a cavus or high-arched foot type, and other various deformities.

          Another possible fusion may include the area between the ball of the foot and the first (big) toe. These procedures may be done for several reasons including stiffness or arthritis in the area as well as revisions for a previous bunion correction or in response to dysfunction of a tendon. If this is done, the doctor will typically fuse the joint in such a way that its position is optimally placed according to your needs and lifestyle. Your X-rays and foot structure will also be taken into account when the decision is made.

          Yet another common fusion site is between the bones of the mid-foot and the long bones of the forefoot. These procedures are similarly done in cases of arthritis, joint mal-alignment, Charcot disease, instability, and in certain bunion cases. Often times, these cases are especially effective in creating stability and providing for a large degree of correction.

          With any surgical procedure, there are certain benefits as well as potential risks. The site of fusion as well as the means of fusion (usually screws, wires, or small plates) will vary from individual to individual. Your local Chandler podiatrist can help answer any questions you might have about fusions and whether or not it might be a good option for you. The post-operative regimens also vary; some procedures will allow you to walk 

          With roughly 52 bones in both of our feet, it’s easy to imagine that each of the joints in our feet must be able to work in a precise, coordinated fashion in order for us to stand and move without problems. This is something that’s easy to take for granted when we’re pain-free. After all, our hands also contain numerous bones and they don’t usually give us trouble, right? Unlike hands, our feet must bear the weight of our entire bodies with each passing step. Consequently, the result of dysfunctional foot joints can become much more devastating. In many such cases, fusing of the joint or joints in question is actually a very feasible solution.

          Depending on the case, there are several regions of the foot where podiatric surgeons consider fusion procedures. One area is within the toes. If you try curling them you may notice that each toe has several small joints which allow the curling motion. When one or more of these joints is fused, it converts the toe to a rigid lever and helps eliminate any grinding or other disease process occurring in that toe. Some indications for this may include traumatic arthritis, hammertoes, a cavus or high-arched foot type, and other various deformities.

          Another possible fusion may include the area between the ball of the foot and the first (big) toe. These procedures may be done for several reasons including stiffness or arthritis in the area as well as revisions for a previous bunion correction or in response to dysfunction of a tendon. If this is done, the doctor will typically fuse the joint in such a way that its position is optimally placed according to your needs and lifestyle. Your X-rays and foot structure will also be taken into account when the decision is made.

          Yet another common fusion site is between the bones of the mid-foot and the long bones of the forefoot. These procedures are similarly done in cases of arthritis, joint mal-alignment, Charcot disease, instability, and in certain bunion cases. Often times, these cases are especially effective in creating stability and providing for a large degree of correction.

          With any surgical procedure, there are certain benefits as well as potential risks. The site of fusion as well as the means of fusion (usually screws, wires, or small plates) will vary from individual to individual. Your local Chandler podiatrist can help answer any questions you might have about fusions and whether or not it might be a good option for you. The post-operative regimens also vary; some procedures will allow you to walk

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By Dr. Kuvent, October 27, 2009 11:05 pm

If you’ve ever walked barefoot across a gravel parking lot, you’re probably well-aware that human feet are very sensitive structures. That’s a good thing because it allows our feet to move and adjust to potentially damaging objects on the ground-such as a sharp stone or a piece of glass. Normally, we are able to avoid such objects with ease and protect ourselves from cuts, infections, and other risks. However, the greatest threat to our feet is more internal rather than external. It occurs when our nerves become damaged and that vital protective sensation in our feet is lost.

There are unfortunately MANY things which can lead to weakened or damaged nerves in our feet. One of the most common and well-known causes is diabetes. As individuals lose control of their blood sugars, the nerves particularly in the feet tend to become damaged and insensitive. Other metabolic issues such as B-vitamin deficiencies, alcoholism, and various toxins such as heavy metals can also lead to this problem. It’s pretty interesting to consider how certain health issues like Ulcerative colitis or Crohn’s disease can affect vitamin absorption to affect nerve function and indirectly the health of our feet!

Certain inherited and autoimmune disorders can also cause the feet to become insensitive. Things like Charcot-Marie-Tooth disease, Lupus, Guillain-Barre syndrome, allergic conditions, and blood disorders can all have this effect. Mechanical issues like an entrapped nerve or a spinal root problem may also be causing the problem. On top of these and other causes, the medications you are taking can also alter the nerve function in your feet. Various seizure medications, immunosuppressive agents, oral contraceptives, and tuberculosis drugs can all have this side effect.

Perhaps one of the biggest problems with nerve dysfunction to affect our feet simply occurs as we age. Often times, visual changes in combination with insensitive feet make it extraordinarily difficult for individuals to monitor the ground as well as the health of their feet. Believe it or not, it’s not uncommon for some people to have needles and other sharp objects lodged in their feet without them even knowing it! Not only can the individual not feel the object, but they’re also not able to see what may be a large and potentially-infected wound. This can be a huge hazard for those who live alone or do not have their feet checked regularly, as the infection can spread quickly and cause major damage.

Podiatrists have lots of experience dealing with insensitive feet. They’re able not only to closely monitor the various components of nerve degeneration, but they’re also able to check for infections, care for wounds, and determine whether a foreign body is actually lodged within the foot. Sometimes various objects show up within the foot on an X-ray which is not otherwise very obvious. If you suspect you’re having such a problem, contact your podiatrist immediately.

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By Dr. Kuvent, September 22, 2009 12:17 pm

As the Fall sports season gets underway, many fans and athletes are excited for another year of events and competition. Though no one can predict exactly what will happen this year, athletic injuries are always a given. One of the most common injuries associated with football players is referred to as “Turf toe”. While this may sound like a relatively benign issue, it can actually prove devastating to athletes, teams, and even non-athletes who encounter this condition. Even NFL stars such as Deion Sanders, Darren McFadden, and LaDainian Tomlinson have missed significant playing time because of this injury.

Turf toe basically results from hyperextension or an excessive upward bending of the first toe at the ball of the foot. There’s a major joint in this area with many important structures which can each be easily damaged in such an injury. This scenario commonly results when an individual’s foot-with the heel raised and the forefoot about to push off-receives a direct force down and through the ball of the foot. The end result is usually pain, swelling, and stiffness of the joint which, of course, depends on the extent of the injury.

The phrase “turf toe” has actually become somewhat of a junk term to refer to any traumatic injury of the big toe joint. In reality, it is a unique entity which separates it from other similar issues. For example, “sand toe” is a separate injury involving hyper-flexion or a downward over-bending of the big toe which is often seen in volleyball players. Turf toe actually ranks third in frequency behind knee and ankle injuries in football players, and though not as common as ankle injuries, it results in more missed playing time. The issue has become more prevalent over the years for several reasons. First, many sporting events now take place on synthetic surfaces like AstroTurf which have more friction and don’t allow the toes to adapt as well to various forces. Secondly, whereas older athletic cleats had a metal plate in the forefoot to limit excessive bending, newer models are generally more flexible (for speed) and less shock-absorbing.

Podiatrists typically address turf toe cases by first assessing the symptoms and possibly ordering and x-ray or an MRI to determine the extent of the damage. Based on these findings, they can classify the injury, give an accurate prognosis, and implement proper treatment. Mild cases may involve simple taping and plate splinting of the toe with return to activity in a few days. More serious cases may require the use of crutches or casting and may necessitate up to six weeks of missed playing time. Very severe cases might warrant a surgical approach to repair soft tissue structures, remove bony fragments, or provide other corrective measures. It all depends on the particular case.

Whether in sports or everyday life, traumatic injuries are certainly not fun. Thanks, however, to proper treatment and our bodies’ healing abilities, they can often be managed effectively.