pediatrics

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<p>Sever’s disease (also recognized as calcaneal apophysitis, or inflammation of the heel bone growth plate) is one of the most common causes of heel pain in growing children and adolescents. Sever’s disease is caused by repetitive stress to the heel that most often occurs during a child’s growth spurt as the muscles, tendon, and other soft tissue structures begin to change rapidly and become tight. Young patients who participate in athletics are at an increased risk for developing heel pain as the Achilles pulls on the back of the heel growth plate and causes irritation and pain.</p>



<p>Sever’s disease is more commonly observed in young boys since boys tend to have later growth spurts and may typically develop heel pain between the ages of 10 and 15. In young girls, the condition usually happens between the ages of 8 and 13.</p>



<h2 class="wp-block-heading"><strong>Symptoms</strong></h2>



<p>Symptoms related to Sever’s disease are similar to those representing an injury of the foot and ankle, which is why it is important to schedule an appointment with a Foot and Ankle specialist. Your child may begin to complain of pain, swelling, or redness in one of both heels. The heel pain usually is worse after running and/or jumping and feels better with ice and rest. The pain is particularly worse at the beginning of a sport season or with wearing hard, stiff sole shoes. You may see your child limping during or after physical activity and some patients may walk on their tiptoes to alleviate pressure on the Achilles tendon and heel bone. A classic presentation of Severs disease is tenderness and tightness on the back of the heel that becomes worse when the sides of the heel bone are squeezed.</p>


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<h2 class="wp-block-heading"><strong>Examination</strong></h2>



<p>During your appointment, the foot and ankle specialist will examine your child’s foot and ankles and take X-rays to rule out any potential injury to the bone. The doctor will apply pressure to the heel bone on both sides and the bottom of the bone, which may be tender for a child with Sever’s disease. In addition, the doctor will ask your child to walk, run, jump, squat, or walk in order to determine whether any specific movement elicits painful symptoms. The physician will ask for your child to sit against a strong flat surface and perform small stretching exercises on the patient in order to determine the tightness of specific muscle groups which may be causing the pain to the back of the heels.</p>



<h2 class="wp-block-heading"><strong>Non-Surgical Treatment</strong></h2>



<p>Conservative (nonsurgical) management is the mainstay for the treatment of Sever’s Disease. A child with Sever’s disease should reduce or even avoid all physical activity until the pain subsides. However, walking and non-bearing exercises, such as swimming and/or riding a bicycle is allowed. If you see your child limping or complaining of pain, along the heel bone, conservative treatment is warranted consisting of placing ice or a cold pack on the heel every 1-2 hours for 10-15 minutes at a time. This will help limit inflammation to the back of the heel. If the pain is severe, give your child Ibuprofen (Advil, Motrin, etc.) to subside the pain. Sometimes your doctor will place your child in a CAM walker for short-term immobilization to allow the muscles in the back of the leg and the growth plate of the heel bone to calm down. Wearing gel heel cups will protect the heel bone from direct impact and limit the amount of pressure on the back of the heel. However, appropriate daily stretching exercises are the key to treating Sever’s disease and gradually returning to physical activity. Make an appointment with a Foot and Ankle<br>Specialist for further evaluation.</p>



<h2 class="wp-block-heading"><strong>Surgical Treatment</strong></h2>



<p>Surgical treatment for Sever’s disease is not indicated.</p>


Pediatric Heel Pain


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<h2 class="wp-block-heading">Why Every Diabetic Needs Routine Foot Care</h2>



<p>Living with diabetes requires consistent attention to various aspects of your health, including your feet. It might not seem like a top priority, but proper care can prevent amputations, and life long health complications.</p>
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<h2 class="wp-block-heading">How Diabetes Targets Your Feet</h2>



<p>Diabetes can affect nerves and blood circulation in your feet. Blood vessels can become narrowed and hardened. And damaged nerves can result in the loss of sensation making it hard to feel pain and injuries.</p>



<p>Early detection and management are key. Regular foot check-ups and proper care can identify issues early on, preventing them from escalating into major problems.<br><br>People with diabetes should preform a comprehensive foot evaluation at least annually to identify risk factors for ulcers and amputations. And patients with evidence of sensory loss or prior ulceration or amputation should have their feet inspected at every visit. </p>
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<h2 class="wp-block-heading">Diabetes and Feet in Fresno, CA</h2>



<p><strong>How diabetes and foot health intersect with the Fresno population:<br></strong><br>Prevalence: Fresno County struggles with high diabetes rates. As of 2021-2022, 10.8% of adults in Fresno have diabetes, exceeding both the state (10.7%) and national (11.5%) averages.<br><br>Disproportionate Impact: This burden falls disproportionately on minority communities and the elderly, populations often with limited access to healthcare or preventive resources.<br><br>Amputation Risk: With poorly managed diabetes, foot complications like amputations become a significant concern. In Fresno County, age-adjusted death rates due to diabetes are above the national average, highlighting the severity of the issue.</p>
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<h2 class="wp-block-heading">Preventative Measures</h2>



<p>With diabetic foot care, consistency is key.</p>



<p>Using a combination of proper hygiene, foot inspections, proper footwear, and blood sugar management, you can lay the groundwork for healthy feet thought your life.</p>
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<h3 class="wp-block-heading">Hygiene</h3>



<p>Wash your feet daily in warm, not hot, water with mild soap.<br>Dry thoroughly, especially between the toes, to prevent moisture buildup and fungal infections.<br>Moisturize dry skin, but avoid applying lotion between the toes.</p>
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<h3 class="wp-block-heading">Foot Inspections</h3>



<p>Check your feet daily for cuts, blisters, redness, swelling, or changes in nail color or texture. Use a mirror if needed or ask for help.<br>Look for corns, calluses, or ingrown nails, which can lead to ulcers.<br>Report any concerns to your doctor immediately.</p>
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<h3 class="wp-block-heading">Footwear</h3>



<p>Invest in well-fitting,&nbsp;supportive shoes made from breathable materials.<br>Avoid tight shoes,&nbsp;high heels,&nbsp;and open-toed footwear that leave your feet exposed.<br>Check your shoes for objects before putting them on.</p>
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<h3 class="wp-block-heading">Blood Sugar Management</h3>



<p>Keeping your blood sugar levels within your target range helps improve circulation and nerve function in your feet.<br>Work with your doctor to develop a personalized management plan.</p>
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<h2 class="wp-block-heading">Common Types of Diabetic Foot Ulcers</h2>



<p>Neuropathic ulcers: These are the most common type of diabetic foot ulcer, caused by nerve damage that reduces sensation in the feet. As a result, people with neuropathy may not notice cuts, injuries, or pressure points that can develop into ulcers.</p>



<p>Ischemic ulcers: These ulcers are caused by poor blood circulation to the feet, which can be due to peripheral artery disease (PAD). PAD narrows the arteries, reducing blood flow and oxygen to the feet, making them more susceptible to tissue death and ulcer formation.</p>



<p>Neuroischemic ulcers: These ulcers are a combination of both neuropathic and ischemic factors. People with diabetes often have both nerve damage and PAD, which increases their risk of developing these complex ulcers.</p>



<p>Perforating ulcers: These ulcers develop on the bottom of the foot and have a deep, punched-out appearance. They are often painful and can become infected easily.</p>
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<h2 class="wp-block-heading">Sources</h2>



<ul>
<li>https://diabetesjournals.org/care/article/43/Supplement_1/S135/30443/11-Microvascular-Complications-and-Foot-Care</li>



<li> Adults with Diabetes &#8211; Healthy Fresno County:(https://www.healthyfresnocountydata.org/indicators/index/view?indicatorId=81&amp;localeId=247</li>



<li> https://www.healthyfresnocountydata.org/indicators/index/view?indicatorId=100)</li>



<li>Centers for Disease Control and Prevention: https://www.cdc.gov/diabetes/library/features/healthy-feet.html</li>
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Diabetic Foot Care


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<p>The foot and ankle are made up of numerous bones, joints, ligaments, muscles, and nerves, making it difficult to detect the exact source of pain or discomfort. Many conditions can cause similar symptoms which can lead to misdiagnosis.</p>



<p>Imaging is a common way to get an objective and detailed view of the foot.</p>



<p>X-rays are primarily good for visualizing the foot’s bones and alignment.</p>



<p>Ultrasounds can provide real-time imaging of muscles and some ligaments. Ultrasounds, however, miss issues in deeper tissues and joints.</p>



<p>Magnetic resonance imaging (MRI), is capable of creating a high-quality images of the entire foot. Including Muscles, ligaments, and blood vessels.</p>



<p>Some musculoskeletal conditions, like early arthritis or stress fractures, might have subtle presentations initially, making them easy to miss.</p>



<p>MRI imaging Can make conditions easy to diagnose and treat.</p>
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<h2 class="wp-block-heading">X-Rays</h2>



<p><strong>Strengths:</strong> Excellent at visualizing bones, fractures, and dislocations.</p>



<p><strong>Weaknesses:</strong> Limited visibility of soft tissues like muscles, ligaments, tendons, and nerves, which are crucial for musculoskeletal issues. Cannot assess inflammation or subtle bone injuries.</p>



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<h2 class="wp-block-heading">Ultrasounds</h2>



<p><strong>Strengths: </strong>Provides real-time imaging of muscles, tendons, and some ligaments. Relatively portable and less expensive than MRI.</p>



<p><strong>Weaknesses:</strong> Limited penetration depth, making it less effective for deeper structures like bones and joints. Cannot fully visualize certain structures like nerves or assess bone marrow changes.</p>



<h2 class="wp-block-heading">MRI</h2>



<p><strong>Strengths:</strong> Provides extremely detailed 3D images of ALL foot and ankle structures, including bones, joints, muscles, ligaments, tendons, nerves, and blood vessels. Can detect inflammation, tears, abnormalities, and subtle bone injuries invisible on X-rays and ultrasounds.<br><br>Weaknesses: Can pose dangers for some patients with metal implants, and not always readily available.</p>
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<p><strong>MRI&#8217;s ability to visualize everything outweighs its limitations. It allows for:</strong></p>



<ul>
<li>More accurate diagnosis: pinpointing the exact source of pain or dysfunction, leading to more targeted treatment.</li>



<li>Early detection: identifying issues like stress fractures or arthritis before they worsen.</li>



<li>Improved treatment planning: guiding surgical interventions, injections, or physical therapy based on precise information.</li>



<li>Reduced need for invasive procedures: avoiding exploratory surgeries or injections by providing clear visualization.</li>
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<h2 class="wp-block-heading">Musculoskeletal Conditions That Can Be Diagnosed Early Using MRI:</h2>



<ul>
<li>Plantar Fasciitis: MRI can help visualize inflammation and thickening of the plantar fascia.</li>



<li>Achilles Tendonitis/Tendinopathy: MRI can reveal changes in the Achilles tendon, such as inflammation, thickening, or degeneration.</li>



<li>Morton&#8217;s Neuroma: MRI can identify the enlargement or inflammation of the interdigital nerve typically occurring between the metatarsal heads.</li>



<li>Tarsal Tunnel Syndrome: MRI can be used to assess compression or entrapment of the posterior tibial nerve within the tarsal tunnel.</li>



<li>Stress Fractures: MRI is sensitive to detecting stress reactions or fractures in the bones of the foot and ankle.</li>



<li>Arthritis (Osteoarthritis or Rheumatoid Arthritis): MRI can show joint space narrowing, cartilage degeneration, and synovial inflammation.</li>



<li>Ligament Tears or Sprains: MRI can reveal injuries to ligaments such as the anterior talofibular ligament (ATFL) or calcaneofibular ligament (CFL).</li>



<li>Bursitis: MRI can detect inflammation of bursae around the foot and ankle, such as retrocalcaneal bursitis.</li>



<li>Ganglion Cysts: MRI can help identify fluid-filled cysts around joints and tendons.</li>



<li>Tendon Tears or Ruptures: MRI can visualize tears or ruptures of various tendons, such as the peroneal tendons.</li>



<li>Osteochondral Lesions: MRI can reveal damage to the articular cartilage and underlying bone, commonly found in joints like the ankle.</li>



<li>Synovitis: MRI can show inflammation of the synovial lining of joints or tendon sheaths.</li>



<li>Accessory Bones or Os Trigonum: MRI can assist in identifying extra bones or abnormalities within the foot, such as an os trigonum.</li>



<li>Infections or Abscesses: MRI can be useful in detecting soft tissue infections or abscesses in the foot.</li>



<li>Tumors and Masses: MRI can help in characterizing soft tissue masses or tumors within the foot and ankle.</li>
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Lower Extremity MRI: Advantages of MRI Over X-rays and Ultrasounds


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<p>For individuals living with diabetes, maintaining optimal foot health is crucial. Diabetes, a chronic condition affecting blood sugar, can lead to amputations, usually in the feet. For individuals living with diabetes, maintaining optimal foot health is crucial. Proactive measures can significantly reduce the risk.</p>
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<h2 class="wp-block-heading">Why Diabetes Causes Amputation</h2>



<p>High blood sugar damages nerves and blood vessels, leading to poor circulation and diabetic neuropathy (nerve damage). These complications increase the risk of foot ulcers, infections, and ultimately, amputations. Managing blood sugar levels effectively is key to preventing these serious consequences.</p>



<p>Inadequate management of blood sugar levels increases the risk of nerve damage and poor circulation, elevating the likelihood of complications.</p>



<h3 class="wp-block-heading">Peripheral Artery Disease (PAD)</h3>



<p>Diabetes often contributes to the development of peripheral artery disease. PAD restricts the blood flow to your legs or feet by clogging or narrowing the arteries.</p>



<p>This lack of oxygen and nutrients can lead to a cascade of problems, including:</p>



<p>Painful cramping: Especially noticeable during activity, this pain often forces you to stop and rest, impacting your daily life</p>



<p>Non-healing wounds: Minor cuts or scrapes on your feet can struggle to heal due to poor blood circulation, increasing the risk of infection and amputation.</p>



<p>Diabetic foot ulcers: This serious complication occurs in up to 25% of people with diabetes and PAD, often leading to amputation.</p>



<p>Diabetic foot ulcers are the leading cause of non-traumatic lower limb amputations, with PAD being a major contributing factor. Studies show that almost half of all people with diabetes and foot ulcers also have PAD.</p>
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<h2 class="wp-block-heading">Detecting Diabetic Foot Amputation Warning Signs</h2>



<p>Early detection and management of diabetes are crucial. Regularly inspect your feet, wear proper footwear, control blood sugar, and seek immediate medical attention for any wounds or concerns. Safeguarding your feet is crucial. Follow these simple steps for optimal foot health:</p>
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<h3 class="wp-block-heading">Early Detection and Management</h3>



<p>• Regularly monitor blood sugar levels and act promptly on any changes or concerns.</p>



<p>• Regular Foot Inspections: Examine your feet for cuts, bruises, or swelling. Early detection prevents complications.</p>



<p>• Proper Footwear: Choose supportive shoes with a wide toe box to reduce the risk of friction and pressure points.</p>



<p>• Blood Sugar Control: Maintain stable blood sugar levels through a balanced diet, exercise, and prescribed medications.</p>



<p>• Immediate Medical Attention: Don&#8217;t ignore any signs of wounds or infections. Seek prompt medical attention to prevent complications.</p>
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<h2 class="wp-block-heading">What to Do When You Get a Cut On Your Foot</h2>



<p>For any foot injury, even minor, visit your doctor immediately. Prompt treatment can prevent complications like infections and gangrene. Remember, your proactive approach to addressing foot injuries plays a pivotal role in preserving your overall foot health. Stay vigilant, prioritize regular check-ups, and collaborate closely with healthcare professionals to navigate this challenging journey.</p>
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<h2 class="wp-block-heading">What If I Don’t Have A Provider</h2>



<p>For those without insurance or a primary healthcare provider, If uninsured or lacking a doctor, contact local health clinics or community resources for immediate medical attention. Foot health should be prioritized. These resources often offer assistance to those in need, ensuring that financial constraints do not hinder crucial healthcare decisions.</p>



<p>Don&#8217;t hesitate to ask questions and advocate for your well-being. Proactively exploring community support services can connect you with healthcare professionals who can assess your situation</p>
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<h2 class="wp-block-heading">Effects of Foot Amputation</h2>



<p>Amputations can significantly impact mobility, independence, and mental well-being. Emotional support and rehabilitation are crucial for adjustment. Loss of independence and alterations in body image may affect mental well-being. Emotional support from friends, family, and healthcare professionals is vital during this adjustment period.</p>



<p>Additionally, rehabilitation plays a pivotal role in helping individuals regain functionality and adapt to the changes in their lives post-amputation. Recognizing and addressing the holistic impact of foot amputation is crucial for a comprehensive and supportive recovery process.</p>
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<h2 class="wp-block-heading">Diabetic Foot Amputation Recovery</h2>



<p>Recovery from amputation involves physical therapy, pain management, and learning to use prosthetics (if applicable). A strong support system plays a vital role. Undergoing foot amputation is a life-altering experience that necessitates adjustment on various fronts. Understanding what to expect can help individuals facing this journey prepare for the challenges and embrace opportunities for recovery</p>
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<h2 class="wp-block-heading">Amputation Alternatives</h2>



<p>Explore alternatives like specialized shoes, wound care procedures, and hyperbaric oxygen therapy before considering amputation. Discuss options with your doctor.<br><br>While amputation may seem like the only solution, in some cases where severe tissue damage is not present, there are other alternative treatments that can decrease the likelihood of amputation. Specialized shoes, or custom orthotics, are designed to offload pressure and prevent further injury. It can be used to help promote healing in existing wounds as well as prevent more wounds from forming. Additionally, advanced wound care techniques like debridement (removal of dead tissue) can significantly improve wound healing rates and reduce the risk of infections.</p>
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<h2 class="wp-block-heading">Visit a Doctor</h2>



<p>If you have a doctor, leverage their expertise to navigate the complexities of a potential foot amputation. Seek a detailed explanation of why amputation is suggested, ensuring you fully comprehend the severity of the situation. Engage in open communication about your concerns and explore alternative treatments that may be available. Your doctor can guide you through the decision-making process, offering valuable insights and support. Seek clarification if amputation is suggested. Understand the severity of the situation and explore alternative treatments.</p>
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<h2 class="wp-block-heading">Sources</h2>



<ul>
<li>American Diabetes Association: https://diabetes.org/advocacy/amputation-prevention-alliance</li>



<li>National Institute of Diabetes and Digestive and Kidney Diseases: https://www.ncbi.nlm.nih.gov/books/NBK537328/</li>



<li>https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/amputation-and-diabetes/art-20048262</li>



<li>American Academy of Orthopaedic Surgeons: https://pubmed.ncbi.nlm.nih.gov/33146723/</li>



<li>Amputee Coalition: https://www.amputee-coalition.org/</li>



<li>Johns Hopkins Medicine: https://www.healthhub.sg/live-healthy/road-to-recovery</li>



<li>American Podiatric Medical Association: https://www.apma.org/Patients/content.cfm?ItemNumber=1530</li>



<li>Wound Care Today: https://r3healing.com/treatments/diabetic-wound-care/</li>



<li>A Review of Disparities in Peripheral Atery Disease and Diabetes–Related Amputations During The COVID-19 pandemic &#8211; PMC &#8211; NCBI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9780019/)</li>
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Diabetes & Amputation


<p>Magnetic Resonance Imaging (MRI) serves as a crucial diagnostic tool, offering detailed insights into the body&#8217;s inner workings. Facilities that attain &#8220;IAC accreditation&#8221; have demonstrated exceptional proficiency in MRI procedures, ensuring patients receive the highest standard of care. This accreditation signifies a commitment to excellence and continuous improvement, providing patients with the assurance of quality healthcare.</p>



<p>Magnetic resonance imaging (MRI) is a safe diagnostic tool that can help us diagnose and monitor foot ankle and leg conditions pain-free. MRI machines do not use radiation instead it uses a large magnet and radio waves to produce high-quality three-dimensional images. Medical imaging helps us look at the soft tissues and bones of your foot, to better understand your future treatments.</p>



<p>Our accredited MRI location is located in our Fresno location.</p>



<h2 class="wp-block-heading">About Valley Foot &amp; Ankle Specialty Providers</h2>



<p>Valley Foot &amp; Ankle Specialty Providers(VFASP) is a multi-specialty podiatry clinic located in Fresno, CA and Clovis, CA. We take pride in providing our patients the best possible care. Our team is made up of a dedicated group of professionals whose personal goal is to make coming to Valley Foot and Ankle Specialty Providers an unforgettable experience.</p>
