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It’s finally May, and we’re all spending more time outside and enjoying the warmth and the sun after another long, brutal Ohio winter.  However, May is also Skin Cancer Awareness month, and we need to remember that our skin pays the price for the enjoyment we get from blue, cloudless skies.  And while sun worshippers are familiar with the dangers associated with UV damage on their face, chest, and back, it’s important to remember that skin cancer is particularly dangerous on your feet.  Oftentimes, melanoma goes unnoticed by individuals with the telltale mole located on the sole of their foot- a surprisingly common place for skin cancer to appear.  So, the next time you throw those sandals on, take a moment to apply sunscreen to and examine your feet.

People are generally aware of checking other parts of their body for suspicious moles but they're unlikely to examine their feet. We advise patients to check their feet daily for any changes.  Even if you have limited mobility and can’t easily see the sole of your foot, you can place a mirror on the floor and check your foot for moles, lesions, cuts, or anything else that requires medical attention.  Please focus on the three most common areas for foot melanoma: the soles, between the toes, and around or under the toenails. 

Melanoma can develop anywhere on the body including areas that receive little sun exposure, such as the feet and ankles. If a mole, freckle or spot starts to change over the course of a month and becomes asymmetrical or changes its border, color, diameter or elevation, see a doctor immediately. Those are the ABCDEs, or signs, of melanoma.

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Cuboid syndrome, also called cuboid subluxation, is a common type of foot injury, particularly in athletes. Even though it is common, it is often misdiagnosed and subsequently treated improperly.

Cuboid syndrome occurs when there is an injury or dislocation on the lateral side of the foot, the outer side with the small toe. The injury is in the area of a small tarsal bone in the foot, the cuboid bone. The cuboid bone is located roughly at the midpoint of the outer side of the foot, and together with the other tarsal bones, it forms the arch of the foot. Other structures that may be involved in the injury include the calcaneocuboid joint and the surrounding ligaments.

cuboid syndromeWhat Causes Cuboid Syndrome?

Typically it is athletes who develop cuboid syndrome, either after an injury, or as lateral foot pain that appears without a noticeable injury. Athletes presenting with cuboid syndrome are often runners or ballet dancers, and one study showed that as many as 80 percent of cuboid syndrome patients also have flat feet.

Cuboid syndrome is often associated with repetitive movement of the foot, such that which occurs during running or dancing. The muscle that is believed to be associated with cuboid syndrome is the peroneus longus muscle, a muscle located on the outside of the lower leg and is responsible for stabilizing the midfoot. Continual or repetitive movement of this muscle may result in a malalignment of the cuboid bone.

Another possible cause of cuboid syndrome is an injury, such as a sprained ankle. An ankle sprain in which the foot turns inward (called an inversion ankle sprain) may damage the ligaments connected to the cuboid bone. This type of ankle injury can happen to almost any athlete, but is common with basketball, football, and soccer players.

Signs and Symptoms of Cuboid Syndrome

- Pain, particularly in the lateral midfoot, especially when walking.

- Redness and/or swelling.

 -  If the cuboid syndrome is associated with an ankle injury, there may also be pain, swelling, redness, and restricted movement in the    ankle.

Diagnosing Cuboid Syndrome

During a physical exam, the following findings point to a diagnosis of cuboid syndrome:

Pain: The lateral midfoot is tender, and palpating the area may be painful. There may also be redness in the area (erythema) and slight swelling. Patients may also experience pain when hopping on the affected foot, or may even be unable to hop.

Decrease in motion: Patients with cuboid syndrome may find inversion ankle movement to be painful, and may resist or avoid these movements.

Uneven gait: Patients with cuboid syndrome may exhibit an antalgic gait — i.e., they seek to avoid putting weight on the affected foot. Pain during walking may occur as the foot pushes off the floor.

There is no one specific test that can be conducted to accurately diagnose cuboid syndrome, but there are maneuvers that may aid in diagnosis.

Midtarsal adduction test: While stabilizing the ankle joint with the right hand, the left hand is used to hold the foot around the midpoint. The foot is then moved inward, in the direction of the other foot. This movement compresses the patient’s calcaneocuboid joint and may cause the symptoms of cuboid syndrome.

Midtarsal supination test: In this test, the ankle joint are again stabilized while the foot is manipulated in roughly a half-circle (this is also called triplane motion). This motion will also cause the pain of cuboid syndrome.

Treatment of Cuboid Syndrome

Treatment of cuboid syndrome involves manipulation of the cuboid. In cases in which cuboid syndrome was secondary to an ankle injury, treatment may be postponed until the ankle has healed sufficiently. If there is redness, swelling, or a hematoma present on the foot, those conditions should be adequately resolved before manipulation of the cuboid is attempted.

After manipulating the cuboid bone, further management of  the patient consists of massage, cryotherapy (ice), non-thermal ultrasound and/or electrical stimulation. In some cases, manipulation may need to repeated.

Further Treatment and Prevention for Cuboid Syndrome

Other treatments may be used to prevent the injury from recurring or to provide relief from any lingering symptoms after manipulation.

Padding and taping: Supporting the cuboid bone with padding or a wedge may help prevent recurrence. Taping may also be used to support and stabilize the bones of the midfoot.

Exercise: Exercises that can help with symptoms and prevent the injury from occurring again.

Orthotics: Because many people who develop cuboid syndrome also overpronate, orthotics may be useful in preventing recurrence. Orthotics are worn inside the shoe to promote the proper alignment of the foot.

If you or someone you know is experiencing this condition please given one of our offices a call for a consultation.  We are here to help!

April 23, 2015
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The feet have more sweat glands than any other part of the body, which means they have the ability to sweat profusely. With your feet encased in your shoes all day and the sweat unable to evaporate, bacteria will begin to grow rapidly. The presence of certain bacteria begins to break down the sweat, generating an unpleasant odor from the direction of your feet. Other factors can contribute to increased perspiration including anxiety, hormonal changes, medications and various skin conditions.

 If you suffer from foot odor, rest assured that simple lifestyle changes and improved personal hygiene can help reduce and eliminate the smell.

Since most foot odor is caused from excess sweat and the growth of odor-causing bacteria, it's relatively easy to control and reduce foot odor on your own. Start by taking the following preventative steps:

  • Keep your feet clean by washing them with an antibacterial soap on a regular basis to minimize bacteria.
  • Keep feet dry as moisture enables the growth of bacteria.
  • Alternate shoes and avoid wearing the same pair for multiple days in a row.
  • Choose open shoes such as sandals when possible, allowing air onto the feet which evaporates sweat and slows the growth of bacteria.
  • Wear cotton socks which wick away moisture and absorb perspiration.
  • Apply foot sprays and powders to the feet. Ask our office for recommended products.
  • Disinfect, wash and discard foul smelling shoes as necessary.

The causes of foot odor are typically not harmful to your health, but do create an environment for the growth of fungus and bacteria. It's not unusual for infections such as toenail fungus and athlete's foot to develop as a result.

When improving your foot hygiene doesn't help reduce the smell, please contact one of our offices for an appointment.  We are here to help!

April 02, 2015
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It’s time to get out of the house and enjoy warm weather activities like walking and running. But be cautious! Sudden increased activity following a winter of inactivity can result in unwanted heel pain, also known as plantar fasciitis.

This painful condition results from inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. Starting repetitive activities such as a new exercise routine, even continuous standing or walking on a daily basis, can put a lot of stress and strain on the ligaments in the foot, resulting in the inflammation and pain.

The good news is heel pain can be cured. The key to success in eliminating the pain is early treatment; heel pain can become chronic and debilitating if not cared for properly. Our offices can help you find relief with therapies including:

• anti-inflammatory medications

• stretching exercises

• Orthotics

• physical therapy

• footwear modifications

• activity limitations

Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgical options can be discussed.

Don’t let heel pain stop you from enjoying the beauty of spring. If you are suffering from heel pain, make an appointment with one of Our Offices so you can resume your healthy, active lifestyle.

As spring flowers begin to bloom, hikers nationwide will migrate to mountains, woods and fields, but many, unfortunately, are ill prepared for the beating their feet will take.

Hikers and others who love the outdoors often don’t realize how strenuous it can be to withstand constant, vigorous walking on uneven terrain.  Lax physical conditioning and inappropriate footwear bring scores of outdoor enthusiasts into our office each spring for treatment of foot and ankle problems such as chronic heel pain, ankle sprains, Achilles tendonitis, fungal infections and severe blisters.

Walking up and down steep hillsides and tramping through wet, slippery fields and wooded areas puts stress on the muscles and tendons in the feet and ankles, especially if you haven’t conditioned properly before hitting the trail.  Also, many don’t realize that cross-training athletic shoes aren’t the best choice for extended hiking and hunting. If patients wear sturdy, well-constructed hiking boots, they will not suffer sprained ankles or strained Achilles tendons.

Hikers should invest in top-quality hiking boots consisting of well-insulated and moisture-proof boots with steel or graphite shanks.  These boots will allow excellent ankle and foot support that will lessen stress and muscle fatigue in order to reduce injury risk. The supportive shank decreases strain on the arch by allowing the boot to distribute impact as the foot moves forward. So if a boot bends in the middle, don’t buy it!

In wet weather, wearing the right socks can help prevent blisters and fungal infections.  The first layer should consist of synthetic socks to keep the feet dry and reduce blister-causing friction. The second layer should consist of wool socks to add warmth, absorb moisture away from the skin, and help make the hiking boot more comfortable. Wool lets moisture evaporate more readily than cotton, so fewer blisters develop.

What happens if your feet or ankles hurt during a hike? Pain usually occurs from overuse, even from just walking. If you’re not accustomed to walking on sloped or uneven ground, your legs and feet will get tired and cause muscles and tendons to ache. To avoid a serious injury, such as a severe ankle sprain or an Achilles tendon rupture, rest for a while if you start hurting.

Pain is a warning sign that something is wrong. Serious injury risk escalates significantly if you continue hiking in pain.  You should view hiking like skiing, beginner skiers should take on less difficult trails until they become better conditioned and more confident, the same as hikers should do with nature trails.

If you experience persistent pain following a hiking outing please call one of Our Offices for an evaluation.  We are here to help!


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