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By Dr. Kuvent, October 22, 2009 8:47 pm

Considering the nearly endless discussion on healthcare reform these days and the constant presence of ads from pharmaceutical companies, it’s not much of a stretch to think that our country must be pretty sick! Actually, if you were to guess, what would you say is the number one cause of disability for people over the age of 18 in the US? If you were to say “joint problems” you’d be correct. “Arthritis” or a painful condition of the joints unfortunately affects tens of millions of Americans. One especially debilitating example of this is called “osteoarthritis”.

Osteoarthritis or “Degenerative Joint Disease” is the most common form of arthritis. Unlike Rheumatoid arthritis, it is not due to inflammation or to an autoimmune process. Rather, osteoarthritis typically results from the simple wear and tear that joints undergo in the normal progression of life. Over time, the cartilage which ‘pads’ the joint wears down until eventually the end of one bone starts to grind against the adjacent bone. As you might expect, this can be exquisitely painful and lead to structural damage within the bone itself. Eventually, inflammation along with weak ligaments and muscles can also become a part of the problem.

Multiple factors including genetics, dietary habits, and biomechanical issues may predispose one to developing osteoarthritis. A previous traumatic incident or a history of inflammation may be contributive as well. Typically, people tend to experience symptoms which progressively get worse towards the end of the day and are localized to a joint on just one side of the body (not both sides-as in RA). Individuals may also suffer from stiff or sore joints which oddly tend to flare up prior to a change in weather patterns. Finally, bony enlargements in joint areas are also not uncommon.

While degenerative joint disease can affect nearly any joint within the body, the ball of the foot is one of the most commonly affected areas. For this reason, podiatrists have lots of experience in addressing this condition. Thankfully, unlike many disorders affecting the bones or joints, osteoarthritis can usually be diagnosed on X-ray and doesn’t often require an MRI or more invasive test for confirmation. This and other clinical findings can help your podiatrist to rule out other potential scenarios such as RA, gout, or fractures.

Once the diagnosis of osteoarthritis has been established, the doctor will discuss with you an appropriate treatment regimen tailored to your needs. This will typically include modalities aimed at pain relief and include conservative measures like physical or occupational therapy, management programs, and assistive devices. Various medications may also be administered to help with pain relief. Finally, more aggressive measures might include things like joint remodeling surgeries or injections with gelatinous materials to cushion the joint.

Adequate motion within the joint spaces of our feet is critical for maintaining our mobility. When osteoarthritis begins to compromise that motion, your podiatrist can help to maximize joint function and your quality of life.

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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.