Kobe Bryant Achilles Rupture

Kobe Bryant, from the suburbs of Philadelphia, has suffered a season and possibly career ending injury. While playing basketball, he ruptured his Achilles tendon. The Achilles tendon is the thickest and strongest tendon in the body.  A rupture is a devastating injury and can be a career ending injury for some. In basketball, Charles Barkley and Shaquille O'Neal both had Achilles tendon concerns and ended their careers early.  In baseball Ryan Howard suffered one, but he has been back to playing baseball full time.

To get back into activity, it can take anywhere from 9 months to a year for a full recovery. Kobe has already said that he is looking forward to returning and playing once he is healed from this. He will undoubtedly get a lot of physical therapy during his postoperative course.

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Kevin Ware Louisville Basketball Leg Injury

By now everyone has heard of Kevin Ware, the unfortunate basketball player who landed while trying to block a shot and fractured his tibia. It is not the play that has made the news but the type of injury that he sustained that has gotten such attention. His injury has been likened to the injury sustained by Joe Theismann, a career ending injury for the quarterback of the Washington Redskins. Both players sustained not only a fractured tibia but an open fracture which means the fractured bones have penetrated the skin and are exposed. How could this happen? What does this mean for Kevin Ware's future?

This injury was caused by the amount of weight placed on his tibia, the weight bearing bone of the lower leg, and then angle in which he was landing. The tibia snapped like a pencil causing the fracture to pierce through the skin. What can make these such concerning injuries are a number of things. First has the blood supply been disrupted at the level of the fracture? Second,  has there been nerve damage? Has the skin been compromised, will the skin be too damaged to repair and need skin grafts to heal over the bone? Lastly, with the bone exposed there is a concern of developing an infection. For all these reasons an open fracture is considered a surgical emergency. The blood supply and nerves must be evaluated and repaired if necessary. Antibiotics must be immediately started. The bone must be stabilized. The time to treatment is extremely important in these cases. "The Golden Hour" is the period of time after an injury is sustained that prompt medical treatment will result in the best outcomes from the injury.

Example of rod used in repair

For Kevin, immediate medical treatment allowed him to receive antibiotics to prevent infection. His doctors were able to set the fracture and place a long metal rod within the bone. His wounds were washed out and closed. He has a long road of recovery ahead of him but the prompt treatment he received will hopefully allow him back to the basketball court next year.

Dr. Alexandra 'Sandie" Grulke
http://www.podiatrycarespecialists.com/

Doggie EHR

Ironically over the weekend, my lovable happy idiotic yellow lab hurt his foot. I looked at his paw but I could not see any obvious reasons for his foot pain. He began limping on Saturday night but by yesterday morning he wasn't putting any weight on it at all, so I called the vet. When we entered out vet's office, which thankfully we haven't done for over 6 months, I noticed some rather big changes. First, they took a picture of him. Immediately they uploaded his picture into a computer. They took notes of his complaints, symptoms, history of injury and weight and typed into their laptop as part of his digital chart. After his examination, she typed her finding into his chart and then took some digital x-rays. We examined these together, luckily no breaks, but then the images were uploaded into his chart. At the end of our visit, he was diagnosed with a simple sprain and I was given electronic instructions in which I was told to rest his paw and avoid stairs and running. We were checking out they asked me for my email so that they could connect his chart to a "puppy portal". This would allow us to have access to his medical  record via the Internet. This is exactly the direction health care is migrating towards.

Currently the government is encouraging doctor's office to move to a digital patient record, or Electronic Health Record (EHR). The goal of moving this way is to better track patients progress, track data over time, monitor preventative screenings, and its use as an important tool in patient safety and quality of care. Research has actually proved there are tremendous benefits of documentation, viewing, test ordering, prescribing etc. in regards to patient care and safety. So why doesn't every doctor's office have these systems yet? EHR systems, by itself, is a huge financial burden with an average cost of $24,000 per physician of up-front cost. These costs will continue to spiral with the addition of hardware, computer stations and servers , IT support, back up systems, and security. Also, there is a large amount of EHR vendors, each one with their own terminology. With these large variances of systems, data exchange between EHR providers/health institutions can be difficult. Often, lab values or x-rays need to be manually added to the digital record because of an incompatibility between the one facilities EHR and the physician's EHR. Eventually, patients and medical professionals who are authorized to do so, will be able to assess these records via the Internet. These records will be stored in a secure storage on the Internet called a Patient Portal, such as Microsoft Health Vault TM. This allows doctors and hospitals to access this information urgently, especially in cases where the patient is unable to communicate pertinent medical history, allergies or current medications.

There are many obstacles before we are able to get everyone on board and all systems able to comminucate. However, as you can see the benefits are great. At Podiatry Care Specialists, PC,  we have been using EHR since October 2010. For the most part, it has been a seemless transition and as our practice grows and we open new office locations, it has enabled us to quickly and efficiently access our patient's records no matter which office they are being seen. 

By the way, my dog is not following his printed instructions.

Dr. Alexandra 'Sandie" Grulke
http://www.podiatrycarespecialists.com/

Don't Let Foot Pain Sidetrack your New Year's Resolutions

How often do you hear resolutions that sound like this; "I want to be healthier, I want to lose weight, I want to start exercising more, I want to start taking better care of myself." All of those are great but it can be difficult to keep these resolutions. Many of these resolutions include starting an exercise regiment. It is important to follow these simple tips to prevent injuring yourself and keep on track with your New Year's goals. Common foot problems such as plantar fasciitis or heel pain can occur after starting an exercise program. Here are some tips to prevent heel pain.

Proper stretching before and after the activity planned is essential to prevent heel pain or strains/ sprains. Stretches should include stretching of the achilles, hamstrings and lower back stretches.

Wearing good supportive shoes that are designed for the sport or activity you are performing. For example, a hiking shoe is not appropriate for running. Each sport has specific designs incorporated into the shoe based on the support the feet need during the particular activity.  Aerobic shoes have greater side support to account for the repetitive side to side motion.  Running shoes need to be light weight and cushioned to help absorb the forces of running on the feet and legs. Running shoes have become very sophisticated and can help even correct some foot problems. The shoes can help limit pronation (a flattening of the arch), or supination (a higher arched foot), or maintain a neutral position. It is important to get the appropriate correction in your shoes or you may injury yourself. Understand that the arch height is determined when you stand on your foot. Quite often patients tell me that they have a high arch but once they stand up it is obvious they have an arch that is collapsing.  Have a trained professional evaluate your arch before spending money on shoes that may not be appropriate.

If you have pain that last more than 5 days and is not responding to rest or ice, you should call your podiatrist. Your goals to become healthy this year should not be sabotaged by foot pain.

Dr. "Sandie" Grulke
http://www.podiatrycarespecialists.com/

Fungal meningitis

Making headlines recently are numerous people who have become infected with fungal meningitis. The CDC has linked the infections from a compounding pharmacy in New England which has contaminated injections for epidurals. What is fungal meningitis?

Fungal meningitis occurs when a fungus enters the Central Nervous System, i.e the brain and spinal cord. The protective covering of the spinal cord and brain is called the meninges. When this becomes inflamed due to infection it is called meningitis.  Fungal meningitis is very rare, much more common is bacterial or viral. However, when a fungus infects an area near the central nervous system or in these cases is introduced through epidural injections, fungal meningitis can occur.

One question I get regularly about fungal toenails, "Can these fungal toenails cause fungal meningitis or another systemic fungal infection"? The answer is No. The fungal infection is localized to the toenail and does not enter the body or the bloodstream. The only possible infection that can result from fungal toenail is athlete's foot, a fungal skin infection. Again this is a localized fungal infection and extremely unlikely to cause any systemic fungal infections.

Dr. "Sandie" Grulke

http://www.podiatrycarespecialists.com/

Are you and your feet ready for some football?

The NFL kicks off its season tomorrow night. The same is true for fall sports. Just as its important for the Philadelphia Eagles to keep Michael Vick on the field, so is keeping you child or yourself healthy and injury-free this season. Here are some tips to keep them having a fun and healthy season.

Most importantly, muscles and tendons need to be stretched out. Stretching prior to playing sport warms up the muscles and prevents strains and pulls. Second, stretching increases range of motion at joints and can prevent injury. Important stretches include hamstring stretches, achilles stretches and lower back stretches.

Secondly, your shoe gear is very important. Make sure the proper shoewear is being used for the particular sport. You should never wear flip flops or sandals to run. In general, cleats tend to be flat and non-supportive leading to achilles problems both in children and adults. You should try to purchase cleats with support and give traction on multiple areas of the bottoms, not just in a few spots. Cleats should have some arch support or a removable lining so that one can be placed in them to help prevent potential problems.

 

Thirdly, to prevent athletes foot infections, wear socks and shoes that wick moisture away from your feet. Athlete's foot infections are from a fungus. Fungi (plural for fungus) likes that dark moist environment. By wearing socks and shoes that wick the moisture away from your feet, the fungus cannot exist in your shoes and therfore can prevent fungal infections. Try to rotate your shoes to allow them to dry out overnight. Also, an antifungal shoe spray should be used weekly to kill the fungus that lives in every one's shoes such as the one pictured below, Mycomist from Gordon labs TM

These are some simple tips to keep you on the field this year. And of course...

E....A....G....L....E....S!

Dr. "Sandie" Grulke

http://www.podiatrycarespecialists.com/

Common College Foot Problems

You have just dropped off your kid at college. You are looking forward to their next visit home to see the changes that have occured with the next step in their life. However, you are not looking forward to some of the problems they can bring back from college, such as athlete's foot infections, warts or even fungal toenails. With co-ed dorms and large numbers of students living together these problems can be easily spread from person to person. here are some helpful tips to keep your college student healthy.

Wear flip flops in the shower. Warts are caused by a virus and can be easily transmitted in the shower. This virus is spread from person to person through even a small puncture area on the foot.  The virus develops an elevated lesion anywhere on the body. These lesions have small black dots and can be very painful especially if they are squeezed form side to side. Viruses are difficult to eradicate but can be treated. Warts are more difficult to treat on the feet than the hands. Those found on the bottom of the foot are called plantar warts. Over the counter treatment tend not to be effective on the bottom of the foot because of the thickness of the skin and because we walk on the soles of our feet so they get pushed inward.

Don't share shoes. Fungus is found in shoes. The fungus likes the dark moist environment. By sharing shoes you can develop a fungal skin infection, called athlete's foot or tinea pedis. Or the fungus can get underneath the nail causing a fungal toenail, called onychomycosis. The treatment can be difficult because the medication needs to be able to penetrate the nail to kill the fungus within the nail, as well as under the nail. There are some effective topical treatment options, oral medication and laser treatments.

No barefoot walking. College dorms are not always the cleanest. Make sure your child wears shoes to prevent foreign bodies in the bottom of the foot. These can easily get infected, so early treatment is essential.

These are some simple tips to prevent your student from returning with more than just an education.

Dr. "Sandie" Grulke

http://www.podiatrycarespecialists.com/