Newsletter Articles

Neuromas - Do you suffer from a burning or tingling sensation in your toes? Is there a cramp or ache in the ball of your foot? If the answer is yes, you may suffer from a Mortons Neuroma, most
commonly seen in the 2nd, 3rd, or 4th toe. In most cases, cramping is aggravated by shoes and is often alleviated by removal of the shoe and manual massage of the area. Treatment should include anti-inflammatories in an attempt to reduce swelling, and equally as important, phyisical therapy and custom-made orthotic insoles.

New Non-Surgical Treatment - When symptoms fail to respond, we have been extremely encouraged by a new treatment technique. A safe, numbing solution is injected into the nerve. This chemically reduces the nerves ability to conduct its impulses thereby reducing or eliminating the pain.

Tarsal Tunnel Syndrome or TTS - By now, most everyone has heard of carpal tunnel syndrome. A similar phenomenon, Tarsal Tunnel Syndrome (TTS), may occur in the foot, when the nerves at the side of the ankle become entrapped. The symptoms are burning and/or tingling in the bottom of the foot. The discomfort can occur anywhere on the bottom of the foot, including the heel and toes. If diagnosed early enough, TTS may be treated nonsurgically. In many cases, surgical decompression of the nerve is necessary. Unlike, Carpal Tunnel Syndrome, TTS should not be addressed through a small incusion or endoscopically. TTS involves the compression of four nerve branches, all of which must be addressed to obtain a good outcome.

Fractures of the Feet - With twenty eight bones in each foot, it is not surprising that we all are prone to fractured bones in our feet. Due to the high activity demands at work and at play, treating fractures has become a mainstay of our practice. In most cases, early diagnosis can avoid the need for surgical repair. Our offices are fully equipped to diagnose and treat fractures thereby eliminating the need for lengthy and expensive emergency room visits.

Diabetes and Your Feet - Why neglecting your feet is risky business. With a progressive enlargement of the diabetic population, our practice continues to see a steady increase in the number of patients with diabetic foot problems. Why must diabetics be concerned about their feet? A simple harsh fact is that diabetics account for 50% of all patients who undergo foot and leg amputations in the United States. The problem stems from three important phenomenon, peripheral vascular disease, peripheral neuropathy and an inability to fight infections. First diabetics are more prone to having high cholesterol levels and are more likely to develop blockages in the arteries causing decreased blood flow to the feet and legs (peripheral vascular disease). Second, uncontrolled diabetes causes damage to the nerves in the feet and legs (peripheral neuropathy), resulting in an inability to adequately feel pain and heat. As a result, diabetics may be less likely to feel sharp objects, hot water or developing blisters on their feet. Hence, diabetics are susceptible to deep wounds (ulcers) which left untreated often become seriously infected. The third pitfall for diabetics is that high blood sugars will impair the function of white blood cells and make it extremely difficult to fight infections. The result can be an increased likelihood to develop wounds with inadequate blood supply and immune response to heal them.

Cause For Optimism - With technology advancements, we are now able to detect Diabetic Neuropathy at earlier stages. In some cases, we are able to perform surgical procedures that may arrest or even reverse the loss of protective sensation. The earlier the diagnosis of diabetic neuropathy is made, the greater the likelihood of success. The results have been promising in restoring sensation and reducing the risk of wound formation. Dr. Bachmann, Board Certified in Wound Management, is proudly affiliated with Texas Wound and Lymphodema Center. The Wound Center is a comprehensive facility, providing state of the art technology (including hyperbaric oxygen) to promote the healing of wounds.
 

Watch that First Step! - If the first steps out of bed cause you to limp or to walk on your toes, you may have heel spurs. Many people describe a pulling sensation or complain of pain on the bottom and inside border of the heel. The symptoms may improve as the patient walks, but will often return by the end of the day, particularly if weight bearing or athletic activity is involved.
What is a Heel Spur? - A heel spur is an outgrowth of bone usually seen on the bottom or back of the heel bone. The calcaneus, or heel, is a broad bone which functions as the body's initial landing pad when walking. It helps to absorb the shock and transfer it forward to the forefoot. At the
back of the heel, the Achilles tendon attaches firmly to the calcaneus. On the bottom of the heel, a wide ligament called the Plantar facia runs from the ball of the foot through the arch and attaches to the calcaneus.

During each stride the heel absorbs impact and then rolls inward while being pulled up by the Achilles tendon and forward by the Plantar facia. If either one over-pulls, it becomes inflamed. It may begin to bleed. When calcified, a bone spur develops.

DON'T TIPTOE AROUND If you want to treat heel pain, you should see a podiatrist. Many patients think that surgery is the only answer - it is not! The vast majority of our patients respond very well to conservative nonsurgical treatment. Proper treatment should involve the use of stretching exercises, physical therapy and most importantly the mechanical control of faulty foot function with the use of custom made orthotic shoe inserts. Prompt diagnosis and treatment greatly improves the prognosis for recovery. However, in the small minority of cases that do not respond to conservative care, surgical treatment is an excellent alternative.

Plantar Warts - One of the most frequent problems that we treat is the plantar wart or "verruca plantaris". The plantar wart, like all other warts, is caused by a virus, but is often located under a bony prominence. Sensitivity will increase as the overlying skin continues to build "callous." With improper care or neglect, the viral lesion can easily multiply and become more difficult to eliminate. In our hands, the safest and most reliable method involves nonsurgical topical agents. These agents can be applied conveniently in the office and in most cases will eradicate the wart or warts. In more resistant cases surgical removal can be done safely and painlessly in the office with no time off from work or school.

Arthritis in the Feet - The average person takes 5,000 to 8,000 steps a day. Given the fact that there are more than 29 joints in each foot, it is not surprising that many people suffer joint pain in their feet. It is a common misconception that arthritis is solely a disease of the aged. However the cause of joint damage is varied and indeed, we see many young patients in our practice who suffer with arthritic pain.

Types of Arthritis - Osteoarthritis (wear and tear arthritis) occurs more commonly in the elderly population. However, with the increase in athletic participation and related injuries we are seeing increasingly younger patients with this type of joint damage. Although any joint can be affected, the great toe joint is most frequently seen. This is also the most frequent site of Gouty Arthritis. Gouty Arthritis, caused by an excess of "Uric Acid" in the bloodstream, can cause redness, swelling and excruciating pain. Prompt diagnosis and treatment can prevent many a sleepless night. There are numerous other causes of arthritis, including Rheumatoid Arthritis, Systemic Lupus (SLE), Psoriasis, Scleroderma and Fibromyalgia.

Treatment Options - Before initiating treatments, thorough evaluation and diagnostic testing should be completed to arrive at an acceptable diagnosis. Blood testing and x-rays may prove helpful. Conservative treatment can include oral medication, physical therapy and shoe modifications including the use of custom moulded orthotic inserts. Over the counter supplements, such as Glucosamine Sulfate and Chondroitin may be helpful for osteoarthritis. In many cases conservative care will not suffice and surgery may be necessary. We have had a great deal of success with surgical procedures involving joint remodeling, joint replacement and when necessary, the fusion of joints. Most procedures can be performed in an outpatient setting under local anesthesia.

INGROWN TOENAILS - Painfully common, easily treated - Ingrown toenails are one of the most common foot problems. They are also one of the most misunderstood. An ingrown toenail is a painful condition whereby one or both sides of the toe nail, usually the great toe, invade the fleshy borders or tip of the toe. Initial symptoms include mild redness to irritation, burning or thickening of the skin folds around the nail. As the nail continues to advance and pierces the flesh, it may introduce bacteria, resulting in infection. Left unattended, the area will become more inflamed and develop large, bulbous, "cherry red" areas. In some cases, the underlying bone is infected, developing a much more serious condition.

Don't take shortcuts - The most common cause of ingrown toenails is improper cutting. All nails
should be cut straight across and allowed to grow out to the edge of the nail fold. In simple cases,
soaking the foot may reduce the irritation. however, most ingrown toenails will not get well on their own. Cutting a "V" in the center of the toenail, or using over-the-counter toenail medications are not an effective treatment for the problem. In most cases, symptoms usually reoccur. This type of treatment can also lead to the increased risk of infection.

A permanent solution - A simple painless procedure can be accomplished in the podiatrist's office with the aid of a local anesthetic. The offending portion of the nail is removed in such a way that permanent elimination is almost always obtained. If you suffer from ingrown toenails, don't take a short-term approach. Seek a permanent solution and consult a podiatric specialist.

Eliminate Toe Nail Fungus - Are you embarrassed by thick, unsightly toenails? You probably suffer with a fungal infection in the nail beds. The fungi causes the nail to loosen from the underlying nail bed. This results in a thickened discolored toenail that may dig in and cause pain. Over the counter medications have been proven to be completely ineffective in eliminating the fungus. On the other hand, prescription medications have proven to be quite effective in permanently eliminating the infection. A quick evaluation by a podiatrist can determine the most appropriate plan to restore your nails into shape. So, if you suffer with fungal toenails, don't despair, help is readily available.

Haglunds's Deformity - A red painful bump that appears on the back of the heel is called a "Pump Bump." It is not caused solely by wearing high heels. In fact, we see quite a few male patients with these bumps. The "Bumps" are bone spurswhich form from the back of the heel rubbing against the shoe counter. X-rays may be obtained to demonstrate the extent of the bony enlargements. Haglund's deformities may be treated by outpatient surgery. However, custom orthotic insoles may help reduce the rubbing of the heel against the shoe.

Bunions - Bunions are one of the most common foot problems that podiatrists see today. A bunion is a bony protrusion at the side of the big toe joint, characterized by progressive drifting of
the big toe toward the second toe. Many myths have developed concerning bunions and hopefully this article will help separate fact from fiction. First and foremost, bunions are not caused by wearing tight shoes. They tend to be inherited and often show up in pronated feet with flattened arches and widely spread forefeet. As they progress, the constant rubbing of the shoes will aggravate the swollen, painful bump.

Contrary to many beliefs, bunions are not exclusively found in elderly. They can be found in young adults and children. If neglected, the condition generally worsens with a continual widening of the forefoot, leaving the patient uncomfortable in conventional shoes. Often times, degenerative arthritis prevails in the big toe joint causing pain in the joint as well as pain on the side of the bump. Bunion patients are more likely to experience corns and calluses, caused by the change in structure and function of the foot. Only sugical correction can correct bunion deformity. The final myth to be dispelled is that bunion surgery will keep the patient off his feet for weeks. With the newest surgical technique, bunionectomies can be performed on an outpatient basis under local anesthesia. The patient can go home the same day and usually walk the next day in special shoes. Before undergoing bunion surgery, however, it is important that you discuss with your doctor the type of bunionectomy that needs to be performed. This varies depending on examination findings, x-rays, age, lifestyle and demand on the feet. Early diagnosis and surgical correction of bunion deformities by a podiatrist will prevent the need for a more involved surgery at a later time. If you are suffering from a bunion, contact a foot specialist now and walk away from your foot pain.

Get back on your feet fast! Only surgery will repair bunions. Leaving bunions unattended will only serve to increase the need for more involved surgery. Fortunately, a simple outpatient procedure exists. The patient can have the procedure performed on an outpatient basis and go home the same day. You can be up and around almost immediately with little or no pain.

Tailors Bunion (Bunionette) - a bony protrusion at the outer side of the fifth toe joint. It is charactized by a progressive drifting of the little toe toward the fourth toe. It is analogous to a bunion, which creates a boney prominence at the side of the big toe joint. Like bunions, tailors bunions progressively get worse with time. The deformity is caused when the outer fifth metartarsal bone drifts away from the internal fourth metartarsal. As it does, the little toe has a tendency to lean toward the fourth toe. This sets up a vicious cycle where the toe and its associated metatarsal bone continue to diverge. The fifth metartarsal head soon becomes extremely prominent and gets irritated by the constant rubbing of the shoes, leaving a red swollen, painful bump. Often times, calloused skin will develop on the side or bottom of the joint. In addition, the fifth toe, because of its abnormal internal rotation, will often develop a corn on its
top or side.

Ossa Tron for Heel Pain - If the first steps out of bed cause you to limp or walk on your toes, you may have heel spurs. Many people describe a pulling sensation or complain of pain on the bottom and inside border of the heel. The symptoms may improve as the patient walks, but will often return by the end of the day, particularly if weight bearing or athletic activity is involved.

THE SOLUTION- Have you suffered with heel pain for 6 months or more? Have numerous treatments failed to provide relief? Have you been told that surgery is your only remaining option? Don't despair! The F.D.A. has recently approved a new treatment for persistent heel pain caused by plantar fasciitis. The Ossa Tron System uses Ultrasonic Shockwaves (similar to lithotripsy treatment for kidney stones) to provide an effective treatment option that is minimally invasive and performed without an incision. The treatment takes less than 30 minutes and causes little or no pain. Patients may usually wear normal shoes the next day.

Running, jumping and pivoting may cause foot and ankle sprains, stress fractures, and heel pain. Prompt clinical evaluation, x-rays and treatment are invaluae in preventingchronic foot injuries requiring lengthy recovery periods.

Corns: More than skin deep - What you don't know is hurting you. - It is a common misconception that corns are simply skin irritations caused by tight shoes. In fact, it is not uncommon for us to see patients who have burned themselves using over-the-counter preparations or cut themselves with unsterile scissors resulting in a painful infection. Corns are caused by an upward buckling of a joint in the foot. The toe is bent downward assuming the shape of a claw hammer and is commonly referred to as "hammer toe." With a joint locked in this position, the bones become extremely prominent and susceptible to irritation. The protruding bone forces the skin to rub against the shoe. The bone enlarges in response to the pressure and creates a bone spur under the corn. Tight shoes do not cause corns, but they do aggravate the condition.

Temporary Relief - Changing shoes may offer temporary pain relief, but it will not eliminate the problem. Shaving or cutting off the dead skin, even when done by a podiatrist, only provides temporary relief. Eventually, most corns will reoccur because the underlying problem is in the bone spur.

Take the Right Step - The only corrective treatment for the permanent relief of corns is a minor surgical procedure to remove the bone spur. It is safe and painless and can be performed in the podiatrist's office. The procedure eliminates the underlying pressure which created the corn and relaxes the hammertoe into a straightened position. It also prevents the reoccurrence of the corn.

Orthotics: The support you need - Most foot pain is the result of a faulty relationship between the bones and muscles of the foot. Even the slightest misalignment can cause a great deal of discomfort. Misalignment can result in a number of problems such as pronation, flat feet, persistent ankle sprains, bunions, corns, calluses, heel spurs--even knee, back and neck pain.Today, a great percentage of foot problems can be alleviated by the use of prescription orthotic devices. Orthotics are custom made inserts designed to lay inside your shoes in such a way as to gently realign the bones and muscles of the lower extremity. Each pair is custom-designed from plaster impressions to specifically fit an individual's foot shape and problem. They are NOT arch supports, nor do they work on the principles of "supporting" the arch. Perhaps the greatest success of orthotics lies in limiting those symptoms with excessive pronation. Generally, people experience less foot pain when wearing orthotics. They are freely transferable from one pair of shoes to another and now can be fabricated to fit comfortably inside most men's and women's dress shoes. Orthotics support the feet that support you.

Common sign of excessive pronation:
•When standing, the heels lean inward.
•When standing, one or both knee caps turn inward.
•Knee pain develops during physical activity or athletics.
•The pain slowly goes away when resting.
•Presence of leg cramps in children.
•Pain on the bottom of the foot or heel.
•Presence of bunions.

 

Marathon Precautions - Fall is the time of year when many people are training for Houston's Marathon. Since we see so many marathon hopefuls heartbroken by training injuries, we areproviding some training tips.

1. Avoid overtraining - stick to a tried and proven schedule
and do not overdo it.
2. Adequately stretch before and after runs.
3. Use proper fitting shoes designed for your foot type
(over pronator or over supinator).
4. Do not ignore black toenails. They are often a sign of
ill fitting shoes and lead to fungal and bacterial infections.

Foot Problems in Pregnancy - The miracle of pregnancy can bring misery to the feet. The most common complaints that we hear from pregnant women involve swollen feet and ankles, painful ingrown toenails and severe heel pain. Foot swelling in pregnancy is usually caused by the compression of mom's abdominal veins by the growing fetus. The best remedies are elevation and
proper fitting shoes. The swelling in the toes often leads to the formation of ingrown toenails. Ingrown nails can be safely and painlessly removed in the office during all trimesters. Heel pain is probably the most common ailment that we see during pregnancy. Pregnancy involves a hormonal surge that causes ligamentous relaxation in the pelvis allowing for the delivery of the baby. Unfortunately, the ligaments in the feet also relax. This causes a lowering of the arch and overstretching of the ligaments on the bottom of the feet. The result is pain and inflammation where the ligaments attach to the heel. Don't despair, this problem can be treated with stretching exercises, use of supportive shoes and fitting with a custom moulded orthotic shoe insert.

Fore: Golfers Beware - We see alot of golfers in our practice. The golf swing puts alot of stress on the arch and ball of the foot. This often results in a strain of the plantar fascia ligament in the arch and associated heel pain. In addition, Morton's Neuroma, a benign nerve cyst in the ball of the foot, is common. These conditions are often worsened in golfers who walk. The good news is that good fitting golf shoes and custom made orthotic inserts can eliminate the cause of these problems. A podiatrist can provide shoe recommendations and fit for custom moulded orthotics to alleviate the problems.

Reversing Nerve Damage in Diabetic Patients - A podiatric surgeon affiliated with Tomball Regional Hospital is one of only about 100 physicians in the world and one in three physicians in the state of Texas who are trained to use a new surgical procedure that restores sensation and relieves pain in lower limbs of diabetics. Dr.Brad Bachmann, DPM, with the Texas Wound and Lymphedema Center at Tomball Regional Hospital, is utilizing a new technique called "Peripheral Nerve Decompression Surgery" to reverse nerve damage in diabetic patients. The surgical procedure involves restoring function to nerves that are swollen and have become compressed in the canals in which they are located. This condition is called neuropathy and it results in pain, burning and numbness. For many years physicians believed that diabetic peripheral neuropathy was irreversible because medication would numb the pain but never eliminate neuropathy. Before this procedure existed, there was an increased risk of ulceration, infection and ultimately amputation. Dr. Bachmann stated that Peripheral Nerve Decompression Surgery reverses neuropathy by restoring the function of the nerve.

The leading cause of neuropathy is diabetes, and most diabetics will have neuropathy in different ways. As sugar enters the nerve from the blood, it is converted to another type of sugar called sorbitol, which draws fluid into the nerve. The increased amount of fluid in the nerve causes the nerve to swell and become compressed within its canal. This swelling greatly reduces the amount of neuroelectrical impulse that is transmitted. The process of reducing neuropathy involves a series of surgical procedures on the foot and lower leg. The surgery decompresses an entrapped nerve at designated target locations. According to Dr. Bachmann, microsurgical instruments and special surgical glasses called telescopic loupes that magnify the surgical field are used for the procedure. The small canals in which the nerves travel are opened and the nerve is released so that the impulse can be transmitted through the leg and foot, thus restoring sensation.

The surgery takes about two hours and is done on an outpatient basis. It can be performed only on one foot at a time, and there is a three-month waiting period before surgery can occur on the other limb. Patients generally can begin partial weight bearing within the first three weeks following surgery. Dr. Bachmann is offering renewed hope for patients through Peripheral Nerve Decompression Surgery. For more information, contact the office of Dr. Bachmann at 281-351-5599.