Tag: pain

Arthritis Of The Foot

Arthritis Of The Foot
Dr. Jeffrey A. Oster, Medical Director Of Myfootshop.com.

Arthritis is a term used to describe a number of diseases that cause inflammation of joints and results in the progressive destruction of joints. Arthritis is actually a collection of many different joint diseases that affect the body and the foot in many different ways. In this article, let’s talk a bit about arthritis and how it affects the foot. We normally discuss treatment alternative for conditions, but due to the scope of this topic, we will not discuss treatment of each of the individual forms of arthritis.

Osteoarthritis

Osteoarthritis is by far and away the most common form of arthritis. Osteoarthritis is known as the wear and tear type of joint disease and will effect most of us at one point in our lives. In our discussion on osteoarthritis, please refer to the nomenclature and anatomy sections below for definitions of the terms that my be unfamiliar to you.
When I think of osteoarthritis (OA), I think of my grandmother’s hands. Those hand have done a lot of work in their time and have a bit of arthritis to show for it. The fingers, crooked and bumpy show many of the changes brought on by osteoarthritis. The bumps on the fingers are called Heberden’s Nodes. Heberden’s Nodes are a very obvious example of how osteoarthritis occurs. If you’ve ever known anyone whose experienced the symptoms of OA, they’ll tell you that a joint will flare for a period of several weeks. It may be mildly painful or even painful to the degree that the joint is unusable. And then suddenly, just as passively as it came, it leaves. Occasional, brief morning stiffness was not unusual for grandma. The pain that had been present in her hands was actually due to a series of small micro-fractures that occurred in the subchondral bone (just beneath the cartilage). It seems that in cases of osteoarthritis, the bone just below the cartilage becomes very fragile. When loads are applied to this fragile bone, it breaks down. The more the joint is used, the more the bone seems to break down.
Over time, as the bone undergoes a series of flare ups, the ability of the bone to support the cartilage becomes unstable. The subchondral bone creates an unstable supporting surface for the cartilage. When the joint tries to complete its’ normal range of motion, the cartilage is irregular and progressively erodes. This moves us into the second phase of OA pain, and that’s when we have joint range of motion that is bone on bone. Cartilage has no nerve endings to sense pain, but bone on the other hand, has plenty. As the joint moves and the bone is eroded, significant pain can be experienced.
This erosive process seen in OA seems to occur at different rates in everyone. In fact, every joint seems to undergo the changes of OA at a different rate. The rate of change does seem to be effected by the history of damage to the joint. In fact the classifications used to describe OA include Primary (idiopathic or no known cause) and Secondary (some known cause for the disease such as trauma). Past injuries seem to accelerate the rate of OA in most joints. We all know someone with that old football injury, right?
The cause of OA is unknown. Many authors have speculated that the cause may be mechanical as described above, but others have described changes such as biologic, biochemical or enzymatic; or even a combination of each of these.
Changes that occur in the foot with OA are numerous. The most common is midfoot pain that is diffuse. The midfoot is a jigsaw puzzle of pieces that are difficult to manage when effected by a systemic disease of this nature. Other finding include atrophy (loss) of the plantar fat pad of the forefoot and heel. The big toe joint is often effected by the changes of OA with bunions and hallux limitus as common complaints.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a very complex and debilitating disease that affects approximately 1% of the general population. Women are 2-3 times more prone to develop RA. RA is a process where the body’s immune system attacks the cell lining the joint capsule (synovial cells). The end result is thickening and fibrosis of the joint with destruction of the cartilage.
Symptoms of RA include an abrupt onset of inflammation. The swelling associated with RA may be isolated to one joint or effect several. Symmetrical involvement is typical with both hands or both feet being affected. In comparison to OA, morning stiffness seen in RA may last more than 30 minutes.
The finding of RA in the foot often progresses to subluxation of the joints, particularly the metatarsal phalangeal joints. Atrophy of the plantar fat pad is common.

Psoriatic Arthritis

Psoriatic arthritis (PA) is an interesting form of sero-negative arthritis. PA is associated with psoriasis in many cases, but it is not unusual to find the symptoms of PA in a patient with no previous history of psoriasis of the skin or nail.
The symptoms of PA in the foot include focal swelling of the interphalangeal joint (the toes). The toe will appear to have swollen and become painful with a limited history of injury or pain. X-rays often show slow changes that exhibit erosion called a pencil and cup appearance. This finding is common on the metatarsal phalangeal joint.

Reiter’s Syndrome

Reiter’s Syndrome (RS) is an unusual form of arthritis that is usually found in men.. RS is often described as a sexually transmitted disease due to the history of the disease occurring following sexual intercourse which resulted in a chlamydial infection. It is suggested to treat those with RS, and their sexual partners, for C. trachomatis infections.
The symptoms of RS include burning upon urination (urethritis), dry eyes and joint pain. Joint pain in the back and feet are common. These symptoms occur 7-14 days following sexual intercourse and subside over a period of several months to years. Recurrence of pain is not unusual. About the Author
Jeffrey A. Oster, DPM, C.Ped is a board certified foot and ankle surgeon. Dr. Oster is also board certified in pedorthics. Dr. Oster is medical director of Myfootshop.com and is in active practice in Granville, Ohio.

Acid Reflux Medication: Keeping Heartburn at Bay

In a normal digestive process, the partially digested food is being forwarded by muscular movements from the stomach to the intestines. However, for some people, the stomach contents travel back to the esophagus from the stomach. This condition is known as acid reflux.

Common symptoms of this disease include heartburn, difficulty in swallowing, regurgitation, chest pains, dental erosion, hoarseness, asthma, dyspepsia, vomiting, and many others.

If not properly treated, acid reflux can last for several months. But drug treatment can play an essential part in the treatment process of a patient.

The most common medications used include the following:

Antacids. These drugs are used to neutralize the acids in the digestive tract and are primarily taken in for relief of mild symptoms, such as occasional episodes of indigestion and heartburn. They also act to incite the defensive mechanisms of our stomach by building up the secretion of mucous and bicarbonate. Most antacids can be bought over the counter even without a medical prescription. Moreover, these drugs are one of the first to be recommended by professionals to lessen the pain brought about by heartburn or mild symptoms. The three basic ingredients of antacids are magnesium, calcium, and aluminum.

Acid suppressants such as histamine blockers are also commonly used. Histamine blockers obstruct the production of stomach acids by alienating the actions of histamine. Histamine is a chemical in the body that promotes the production and secretion of acids in the stomach. Anti-histamines are available even without prescription and offers relief of symptoms in most of the patients with frequent acid reflux. Patients have to wait for 30 to 90 minutes for these drugs to take effect. But their effect also lasts six to 24 hours. In cases of severe symptoms, a patient may have to take two dosages a day. In some researches, histamine blockers have shown to improve asthmatic symptoms in those who endure from both acid reflux and asthma.

However, in a study dated 2001, it was suggested that histamine blockers occasionally impart complete relief of symptoms for dyspepsia and heartburn.

Proton pump inhibitors are also employed as a medication. They act to trim down the production of stomach acids by reacting with the cells found in the stomach wall which produce and release acids into the stomach. However, researches have revealed that the use of proton pump inhibitors poses some concerns. Side effects, although uncommon, include diarrhea, headache, itching, and nausea. Moreover, these drugs should also be stayed away from by pregnant and breast-feeding mothers.

Another medication that is generally handled is the use of agents which protect the mucus lining in the gastrointestinal region. This kind of drug acts by attaching to an ulcer crater so that it will be guarded from damage caused by digestive acids. It is advisable for people undergoing maintenance therapy with mild or moderate acid reflux conditions. Likewise, it has minor side effects, including constipation.

Anti-spasm drugs are also utilized to prevent acid and even non-acid reflux. A gamma-amino acid butyric acid agonist, an anti-spasm drug is generally used to abate the spasms in the muscles. Unlike most medicines used for acid reflux, it can also lessen non-acid refluxes and amplify the pressure in the lower esophageal sphincter, a muscle that separates the esophagus from the stomach and prevents backing up of stomach contents.

Deciding Which Doctor to See

If you have more than one doctor, which many people do especially athletes then it is often confusing exactly which doctor you should see. However, if you follow some simple guidelines you should find the decision much easier. Remember, seeing a doctor is a good idea in the event of an injury, however emergencies are usually best treated in an emergency room with follow up through your normal doctor.

You should first consider why you want to go to the doctor. If you have a need rather than just simply a check up then consider exactly what is needed. If you need a simple work up or even a flu shot then seeing a standard family practitioner is usually much easier and faster. However, if you have a sports related injury then it is best to see a sports medicine doctor.

As part of your sports medicine team, you are likely to have numerous doctors all working together with a physical therapist, primary doctor and various other professionals including often a surgeon. Your first stop whenever seeing a sports medicine doctor should always be to your primary physician. After visiting with them, they can determine based off your needs exactly whom you should be referred to see next. This also often has the benefit of allowing some treatment options to get started in the meantime, rather than being forced to wait until the specialist can see you.

However, it is important to note that if you only see a sports medicine doctor and do not have a standard internal medicine or family physician that you should always see your sports medicine doctor unless they recommend you see someone else. With sports medicine doctors covering a large gamut of specialties it is possible to only use sports medicine doctors if preferred.

If you are running a fever, or else have a rash that has appeared, the best doctor to often see is your primary care physician. If however, you have been experiencing leg pain then it is best to see the sports medicine doctor. Anytime you have a problem or injury that has resulted because of sports, or can impact sports it is best to see a sports medicine doctor.

In the event that you have a pressing issue that needs immediate treatment, often the decision over which doctor to see becomes blurred. This is because many times doctors have very long waits before being able to secure an appointment. If you discover that this is your problem, you best bet is to check with both doctors and see who can fit you in sooner. If neither doctor is able to see you fast enough, you may be best to see the emergency room in your area and schedule a follow up visit. While not everyone is pleased with seeing an emergency room rather than their normal doctor it is a necessary action at times where there are serious complications or in the event of an emergency.

While emergencies may mandate the usage of the emergency room, appointments that are not emergencies should be scheduled with the appropriate doctor to ensure that you receive the best care possible. For example, if you are using a sports medicine doctor and also an internal medicine doctor you should schedule your normal yearly check ups with your internal medicine doctor, as well as your yearly flu shot. However, if you are looking into creating a new exercise program or even starting a new sport then a visit to your sports medicine doctor is most appropriate.

As the number of sports medicine doctors offering varying specialties continues to increase the decision over which doctor to choose for visits is likely to become even more confusing, however you are not alone and by carefully considering the purpose of the visit, you should be able to easily determine which doctor is the best choice for your individual needs.

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The American Academy of Medical Acupuncture

It is surprising to many people that a large and growing number of traditional physicians support the use of and practice of acupuncture techniques. The American Academy of Medical Acupuncture was organized by physicians who want to further the use of acupuncture in regular medical treatment. The Academy was founded nearly twenty years ago by a group of physicians trained in acupuncture, which graduated from courses sponsored by the UCLA School of Medicine.It used to be that acupuncture practitioners had vast knowledge of the traditional acupuncture techniques and philosophy, but little or no training in traditional western medicine. At the other end of the medical spectrum were physicians, who knew nothing about traditional Chinese medicine, and looked with some doubt on the claims of acupuncture treatment. However, a number of studies and experiments showed that acupuncture gave consistently good results in a number of areas, and so physicians started referring their patients for particular problems, such as persistent pain. After some time traditional physicians starting learning and using acupuncture techniques as part of their own methods of treatment. In addition to the techniques, they learned the long history behind the current acupuncture techniques.

The Academy (known as AAMA) is important to both physicians and patients, for members of the AAMA meet the highest standards for both traditional medicine and certified acupuncture practitioners. Most patients implicitly trust physicians, both for their extensive training and for their high standards of practice. They extend both of these to the practice of acupuncture within their offices.

One of the goals of the AAMA is to spread knowledge and appreciation of acupuncture to other physicians and health professionals that presently know little about its use. Most physicians in hospitals have heard of the possible use of acupuncture instead of anesthesia, but it is also becoming more accepted in other areas, such as minimizing pain and nausea for the patient once the operation is over and the patient is in the recovery room. Acupuncture also has some interesting uses possible in emergency room treatments.

The AAMA is also very dedicated to pursuing research and studies into new applications for acupuncture in both the hospital and physician office settings. It is especially interested in researchers to look into the fundamentals of why certain acupuncture techniques are as successful as they are. In other words, many doctors want a traditional medical explanation of the process that the acupuncture treatment starts. It seems that a simple insertion of a number of needles is a mystifying way to accomplish the results, and there is a good deal of research into how to exactly explain the mechanisms that occur. Doctors who do research into these areas may publish their results in a magazine called
Medical Acupuncture, the official journal of the American Academy of Medical Acupuncture. These magazine presents authoritative papers, case reports, and research findings that integrate concepts from traditional and modern forms of acupuncture with Western medical training. This publication covers the effectiveness and safety of acupuncture in pain relief, cancer, stroke, pulmonology, urology, OB/GYN, gastroenterology, and much more.

The existence of a large and growing numbers of qualified physicians that are also trained acupuncturists guarantees that the benefits of each discipline will continue to make current American health practice better for the patients.