Welcome to: CREATIVE FOOTWORKS (Jewelry) brought to you by Dr. Marc Blatstein. CREATIVE FOOTWORKS similar items to what is shown, offers functionality, whimsy, and humor. Commemorate a special event, delight a friend or graduate, surprise a co-worker, appreciate a patient, remember your boss and indulge yourself Let our feet do the walking for you!
Gout is an abnormal accumulation of uric acid in the blood stream according to Dr Marc Blatstein. This results in crystals being deposited in joints which in turn elicit pain. While the big toe joint (classically) is mainly affected, symptoms can also result in the knee (Pseudo Gout) with other joints also being affected. Physically, there is associated swelling, redness and increased warmth, with the chief complaint being; that “it even hurts when my bedroom sheets touch my feet”.
Blood tests (and/or possibly a Urine analysis) taken during an attack of gout may or may not demonstrate an abnormal uric acid level. According to Dr Marc Blatstein, a good clinical exam with history is very helpful in a diagnosis of Gout, and at times is all that is necessary. While the Gold Standard is aspirating the involved joint to so that it can be evaluated for crystals, this is a very painful procedure.
An attack of gout can resemble an infection, and if left untreated for years can actually cause boney destruction. When left untreated, the damage to the bone is so severe that when evaluated surgically, has changed the bone to a consistency soft, similar to cottage cheese- demonstrating its bone destruction.
Treatment often consists of medications: Indocin (an NSAID) for inflammation, colchicine to stabilize the cell wall of the WBC & allopurinol to inhibit the further release of crystals into the joint. In extreme cases, non weight bearing with the use of crutches is useful. Once proper medication is prescribed, the symptoms of gout will usually start to subside quite rapidly.
Factors that contribute to the onset of gout are alcohol, red meats just to mention a few (a change in diet is usually recommended), aspirin and certain medications. Patients who may have kidney damage from diabetes or other causes, and due to their diseases
can also develop gout. These patients may exhibit atypical forms of gout.
Hallux Abducto Valgus or Bunion pain is one of the more common foot conditions treated by Dr. Marc Blatstein. Dr. Marc Blatstein’s patients usually relate pain either when wearing shoes, or when there is pressure applied to the side of the big toe. Bunion pain can become such that “it hurts” both in and out of shoe gear. Treatment, Dr. Marc Blatstein relates may start with a varying the types of shoe gear worn during the day, padding the area around the bunion, orthotics and eventually changing the types of shoes that you wear
When conservative measures fail, you & your physician can discuss what other options are appropriate, including surgery. Should surgery be what is agreed upon, then a review of your history & physical exam along with a review of your x-rays can help determine the best option for your care. Regarding surgery, most surgical procedures require cutting and at times adjusting the angle of the first metatarsal bone.
After surgery, while bone can take 6-8 weeks or longer to heal, it may practically take up to a year to feel 100%. Surgery is both an art and science, and complications can occur, so it is very important to follow all of your surgeon’s instructions following surgery. Marc Blatstein, Hallux Valgus or Bunions. After all both you and your doctor want you to get the best result possible. Follow Marc Blatstein on twitter.
According to Marc Blatstein, it’s not usually thought of, but Q-Tips are often overlooked as one of the most mundane tools around the house. But they can be one of the most useful tools to have. There are many uses for a Q-tip, from the simple cleaning of ears, to the intricate cleaning of electronics, all just to mention a few.
With all the warnings to not put the q tip into your ear, most of us continue to do so. Interested? Dr. Marc Blatstein has the answer. Please look for our next published article. Theses topics will cover (lower extremity) as well as your overall health.
Marc Blatstein comments that Peripheral Neuropathy is a nerve condition that may affect the arms, hands, legs, and feet. The most common form of peripheral Neuropathy is due to diabetes. Mostly it affects your arms & hands, Legs & feet.
People with diabetes have an abnormal elevation of their blood sugar, and this blood glucose (sugar) abnormally enters nerve tissue damaging the nerve. The nerve damage that Dr Marc Blatstein says occurs is often considered to be permanent.
This results in the protective sensations being adversely affected, including your ability to determine the difference between sharp and dull, hot and cold, pressure differences, and vibration. Initially there is a burning sensation in the toes and progresses up the foot in a “stocking distribution”. A general feeling of a painful numbness starts gradually getting worse. Some people will feel as though a pair of socks on their feet, others describe the feeling of walking on cotton, or a water-filled cushion. The feet may feel like they are cold, however, to the touch, they have normal skin temperature.
There also is the greater potential for skin ulceration’s which may lead to infection & hospitalization. Then there is the possibility of amputation. Even something as simple as an ingrown toenail can progress to a severe infection. As a Podiatrist, Dr. Marc Blatstein recommends to his patients that they inspect their feet daily, especially after they shower or bath, carefully drying between their toes, as well as to avoid walking barefoot. These plus good foot hygiene along with regular office visits with their doctor, will add years to their lives.
There are several ways to treat diabetic nerve pain at home; another options are; a prescription vitamin, Metanx , for neuropathic pain. In addition to Diabetic Peripheral Neuropathic pain, there is also the potential for general neuropathic pain issues. As a prescription vitamin, your physician may elect to do a procedure that would involve taking a small biopsy of skin from the area of your ankle so that both you and your physician can evaluate your small nerve fibers, giving you an understanding as to the current condition to your nerve fibers. While this test gives an actual representation of you, please understand with treatment, you may feel the benefit without actually seeing a positive improvement as demonstrated in your follow-up biopsies.
Surgical decompression of peripheral nerves in patients with diabetes is another option that both you & your physician can & should discuss. With a team effort let’s try & add life to our years.
Marc Blatstein – Painful Peripheral Neuropathy
Dr. Marc Blatstein comments that a ganglion to touch is a firm, rubbery mass that can occur on the top of the foot (as well as on other parts of the body), and they can enlarge and/or shrink in size. They generally occur without any apparent cause, but as a result of repetitive micro trauma. They can also arise spontaneously from a weakness in the soft tissue covering of a joint or tendon sheath, extending into adjacent joints. They become noticed as they enlarge often becoming painful. At times they may appear to resolve over time only to appear then to regrow back even larger.
Physical exam will reveal a firm, rubbery mass that can be moved side to side manually appearing to have discrete boundaries. Marc Blatstein states that an MRI is not necessary to make the initial differential diagnosis. If a ganglion was suspected within the deep structures of the foot, an MRI would be useful diagnostic tool should surgery be a consideration, to help identify its location, size and mass.
Should the ganglion lump enlarge & become painful, surgical options can be considered. Marc Blatstein recommends a consult with your physician, and following a detailed history & physical exam, both of you can consider all conservative and surgical options. Then together a treatment plan can be achieved.
Manicures & pedicures together make up a six billion dollar a year industry, and according to Dr. Marc Blatstein, both share several things in common. Each has the ability to create a beautiful result, or a medical nightmare. Therefore, with information that is readily available on the internet along with a little time & perseverance you too can become an empowered consumer. The changes in our health care delivery system alone cannot take care of all aspects of our lives, and so the old adage still holds true, “an ounce of prevention is worth a pound of cure” .
This is the beginning of a series of articles that Dr. Marc Blatstein has put together, combining 22 years of patient care along with informative sites that he has found helpful. Where he has found something noteworthy on the web, we have provided a reference link so that you too can read for yourself.
To start with, there are some things you should know: Shaving calluses (or other skin surfaces) should always be done by a qualified physician, and in most states is prohibited by a non-trained, non-licensed medically trained professional. The best time to get your Pedicure is first thing in the morning, and before you shave your legs.
The next time you visit your salon, Dr. Marc Blatstein recommends taking a moment to look around and see if it appears clean to you. Do they have a sanitation log that is kept up to date, ask to see where they serialize their instruments- do they use an autoclave, or just wipe their instruments with a damp cloth, these are just some of the things to look for.
In closing, quoting “from Consumer Reports: “….warning signs to watch out for”:
- Your salon uses bottles in unmarked containers; the technician cannot tell you what’s in the products.
- The products smell unusually strong or have a strange odor; your skin is being abraded or cut
- The salon is not clean, the instruments are not sterilized, Licenses for the salon and individual operators are not visibly posted your skin or nails hurt, the gels do not soak off easily in solvents designed to remove acrylics, you see swelling, redness or other signs of infection
Orly Avitzur, M.D., Consumer Reports medical adviser
According to Dr Marc Blatstein, hammertoes appear with the toes bent in a clawing fashion. Hammertoes, they may be flexible or ridged, flexible infers that you can manually straighten the toes, while it is not possible to straighten a rigid toe. Because most of us wear enclosed shoe gear, the pressure caused by the shoes gear we wear causes the toes to become painful. On top this pressure forms a hard corn, while on the bottom of the foot the toe actually pushes the metatarsal bone down forming a callus. Treatment of hammertoes can be approached many ways. Dr Marc Blatstein starts by recommending a combination of: a functional orthotic prescribed as a shoe insert to help the hammertoes from progressing or getting worse. In the very initial stages while the toe is still flexible, they can be tapped into their corrected position, also utilizing a functional orthotic. This conservative treatment also consists of hammertoe and buttress pads all available over the counter, in addition to open toe shoe gear. With continued pain correction of the deformity while successful, depends on whether they are rigid or flexible. While the hammertoe is still flexible, a simple tendon release following with taping it in the corrected position is usually effective. Then a functional orthotic may be prescribed to help maintain this correction. With a rigid hammertoe, the surgical procedure consists of removing some skin along with a small section of bone. Dr Marc Blatstein told us that in cases of a severe hammertoe deformity a pin may be used to hold the toe in its corrected position for several weeks & then it is removed. In all cases it is very important to follow your surgeons after surgery instructions in order to get best result.
According to Dr. Marc Blatstein, morning heel pain’s most common complaint is that of pain upon standing first thing in the morning. While the pain initially is excruciating, with ambulating the pain may subside only to come back again with a vengeance after sitting and then standing up again.
The plantar fascia, is a ligament attached at one end to the bottom of the heel, then fanning out into the ball of the foot, attaching onto the toes, thus acting like a shock absorber for the foot. As the foot impacts the ground, with each step the plantar fascia stretches slightly. When these excessive pressures of pulling the plantar fascia on the heel occur over time, or with an innocent step (like stepping on a marble or off a curb), they create small tears in the plantar fascia (the ligament on the bottom of the foot) resulting in a small amount of bleeding, pain & inflammation. Medical literature originally thought that heel pain was due to a bone spur on the bottom of the heel bone (or calcaneus). We now know that the pain is due to excessive tension on the plantar fascia as it tears from its attachment into the heel bone.
In the diagnosis of heel pain, Dr. Marc Blatstein relates that over the years, patient care has demonstrated that not all bone spurs are painful, and everyone with heel pain (or plantar fasciitis) does not necessarily have to have bone spurs. A complete history and physical exam plays a large role in approaching this diagnosis, along with weight bearing x-rays, are useful in determining if a heel spur is present, or if other pathologies are contributing to the diagnosis.
Initially, treatment by Dr. Marc Blatstein can start with a combination of one or all of the following: padding & taping of the foot in a supportive nature, taking oral anti-inflammatory medications, immobilization of the foot in a walking cast, physical therapy as well as implementing specific stretching exercises. Should additional treatment be necessary, cortisone injections as well as orthopedic functional foot orthotics may be prescribed. Should any or all of these treatments fail, and after a detailed review of X- Rays, Lab results with your physician; surgical intervention may be considered, and according to Dr. Marc Blatstein is very effective. Here an Endoscopic Plantar Fasciotomy is one (of many) of the possible procedures that could be recommended. A plan then is formed between you and your doctor for a successful outcome that is meant to add a full and enjoyable life to your years.
Similar in complaint to Carpal Tunnel, Tarsal Tunnel Syndrome is due to compression of a nerve called the Posterior Tibial Nerve. Dr. Marc Blatstein, a Podiatric Surgeon, explained that Tarsal Tunnel Syndrome occurs over time as the nerve becomes inflamed resulting in symptoms such as burning, electric shocks, tingling, as well as a shooting type of pain. Other factors that Dr. Marc Blatstein, has found that contribute to Tarsal Tunnel Syndrome come from either an overly pronated foot which puts a stretch on the nerve, pressure on the nerve from soft tissue masses such as ganglions, fibromas, or lipomas that physically compress the nerve, as well as other insults to the nerve.
The diagnosis is usually quickly made by physical exam as well as the patient’s history of their complaint. Observation may reveal a slight swelling just on the inside of the ankle joint. As part of the physical exam, Dr. Marc Blatstein finds that gently taping the inside of the ankle joint in the acute phase will result in a tingling sensation that may shoot, both up the leg and/or into the foot. Nerve conduction studies are another tool that will reveal if there is damage to the nerve.
Treatment of Tarsal Tunnel involves many different components, some of which are: correcting the abnormal pronation of the foot [which is accomplished with prescription functional foot orthotics]. Along with this, oral anti-inflammatory medications, vitamin B supplements, &/or steroids may provide some benefit, but are rarely curative. Should there be a soft tissue mass compressing the nerve, then surgical removal of the mass may be necessary. Surgical correction of Tarsal Tunnel Syndrome has a good chance of success, at the same time the over-pronation of the foot still needs to be followed with functional foot orthotics.