Alex Trebek, of Jeapordy fame,  has ruptured his Achilles tendon.  He states he had this injury while chasing down a burglar while staying in a hotel in San Francisco."   

He related that a woman broke into his hotel room at the downtown Marriott, while he and his wife were sleeping.  He was startled by the intruder and as she tried to escape, he ran after her down the hallway and felt his Achilles tendon snap. He added that he is scheduled for surgery on Friday, July 29.

Sudden sharp pains in the back of the lower leg can reveal an injury to the strongest and longest tendon in the body, the Achilles tendon.  Some people relate that it feels like a gun shot to their leg.  If you feel the area, you may notice a gap or indentation in the back of the leg.  This is where the tendon hasruptured or torn apart.

A tear of the Achilles tendon can occur if the tendon is tight and you start an explosive movement, like sprinting, before the tendon is warmed up.  There is a weaker area of the tendon, because of a poor blood supply, where the tendon usually tears.  This is very likely what happened to Alex that evening.

Sometimes conservative care with casting and non weight bearing can be can be a form of treatment, however surgery is at times needed.

If you suspect an injury to the Achilles tendon, see your podiatrist immediately.

Golfers can end up having pain in the feet in many places.  The more common areas are:

1.  The big toe joint.  This is because of the foot motion during the golf swing.  There is increased pressure noted in the big to joint, putting extra stress on this area.  If there are any arthritic changes in the joint, this increased pressure can cause pain.  Over time, bone spurs can form restricting motion further at the big toe joint making normal ambulation painful and at times trying to move the big toe very painful as well.  The golf swing will then exacerbate the problem.
    
2. Heel Pain.  Many golfers experience heel pain.  The motion of the foot during the golf swing can put increased pressure and pulling of the plantar fascia.  This can result in pain overt time.  The plantar fascia is the tight band going from the heel to the ball of the foot.  After playing a round of golf, patients relate increased pain later that night of the next day.
    
3. Toe Pain.  Hammertoes, or the contracture of the toe, can cause pain in golf shoes or other shoes.  There is friction and pressure to the toes causing redness and inflammation.  Corns, or thickening of the skin, can develop and cause pain.

These problems are very common with golfers.  There is no need to suffer; podiatrists can keep you playing golf for many years without pain.   See them early on for the best treatment options.

Plantar plate

Do you notice that your toe is lifting up off the ground all of a sudden?  Do you have pain under the ball of the foot?  This may indicate a problem with the plantar palate.  The plantar plate is a ligamentous like structure which is located under the metatarsal phalangeal joint, (MPJ.)  If this structure gets injured or tears, the stability of the MP joint is compromised.  This can allow the toe to move medially (inward) or laterally (outward) on the metatarsal head.  It can also allow the toe bone to lose its stability at the joint and starts to move upwards off the ground.

You can tell if you have this problem by palpating the area.  If the plantar plate is injured, you will have pain on the underside of the toe near the ball of the foot.   A tuning fork can reveal pain in this area.

The podiatrist may try a maneuver to move the toe up and down to evaluate the looseness in the area.  This may cause pain indicating a tear in the plantar plate.

Treatment can be started conservatively with many patients getting better.  Splinting the toe down to relieve stress, using pads to the area, and functional orthotics has been successful for many patients.  Surgery can be done if the above measures fail.  Seeing your podiatrist early for a definitive diagnosis is very important.  X-rays, ultrasonography can be used to help diagnose the problem. 

Peripheral Arterial Disease-Do You Have It?

Peripheral arterial disease, (PAD), is a disease where fatty deposits can build up on the inside linings of the arteries.  This causes a restriction or decrease of blood flow to the various organs and muscles of the body.   Especially vulnerable are the stomach, kidneys, arms, legs and feet.

Did you know that this disease, PAD, accounts for nearly 50% of all the amputations which occur in diabetics!  It is also a major cause of amputations in the non-diabetic population as well.

PAD affects 12-20% of the people in the United States who are age 65 years or older.  Diabetics over the age of 50 have a 3 times greater risk of developing PAD than non-diabetics.  The reason this is important is that PAD carries with it a five year mortality rate of 30%.

If this is not enough of a concern; a patient with PAD faces a six to seven fold increase in risk of having a heart attack or stroke.

Not every person with peripheral arterial disease will have symptoms.  Diabetics, because of neuropathy, may not have any symptoms but have advanced stages of PAD.  The neuropathy is masking the symptoms normally associated with PAD.  Pain in the legs, thighs, or buttocks when walking; and is relieved by rest, is a symptom of PAD.  Pain in the legs or feet while lying in bed, that is relieved by hanging the feet down or getting up and standing is another symptom.

Early detection of peripheral arterial disease is important to helping you maintain a healthy, active lifestyle and decrease the above risks associated with PAD.  Your podiatrist is often the first doctor to diagnose PAD as we are aware of subtle changes which occur in the lower extremities which can indicate the disease process.   If you have any symptoms of PAD, see your podiatrist for further evaluation.

Jennifer Grey, the reigning champ from Dancing with the Stars, recently had surgery for her neuroma. She had continued pain throughout the contest and eventually needed surgery. High heels and tight shoes can aggravate the problem causing increasing symptoms. Many times the person takes their shoe off and rubs the foot to relieve symptoms. X-rays may be taken to rule out any bone problem. Ultrasound can be used to visualize the neuroma.

Do you have pain in the ball of your foot? Do your toes cramp up when in a shoe? Do you have an electric shock which radiates into the adjacent toes? If you answered yes to any of these questions, you may have a neuroma.

What is a neuroma? A neuroma is and enlarged nerve which can occur in the foot. There can be inflammation of the nerve also. When this occurs, pressure from the metatarsal bones, the long bones behind the toes, can cause further irritation to the nerve and pain.

Treatment can consist of wearing wider shoes, insoles, functional orthosis, injections, anti-inflammatory medications. If these forms of care are not enough, then surgery may be necessary.