COVID 19 Signs in the TOES of People Without Symptoms

COVID 19 manifestations are now seen in young people, including kids, that are otherwise asymptomatic.   Due to the changes in the arteries and clotting issues, a variety of changes are showing up in the toes.

Discoloration, small sores and even just signs that look like an ingrown nail may be present. Please keep an eye out for these changes in your kids and in younger adults.  It could be a sign that they ARE infected even thought they may not have any respiratory symptoms.

(thank you to the mom's podiatry group for photos with permission).

SNOW!! More Dangerous than Ice!

Most people  think of ice when they think of the dangers of winter.  While our office receives emergency calls due to slips and falls from the ice all winter long,  we see even more foot problems that become symptomatic from walking on snow!

 

While walking the uneven surface of snow laden sidewalks, drives and alleys, many existing problems worsen.  Many people feel that they are more protected wearing snow boots but in reality snow boots give a false sense of security because most snow boots don't provide any ankle stability.  And the continued fashion of Uggs and similar boots cause people with all foot types to have problems in the winter!

 

 If you find yourself feeling unstable while walking on the uneven snowy surfaces or have pain on the outside of the foot just below the ankle bone, you may be experiencing an inflammatory problem called Sinus Tarsi Syndrome (STS).  STS is very common in people with more flexible feet and is often misdiagnosed as an ankle sprain.  If you have fallen or sprained an ankle and the emergency room treatment or that provided by your primary doctor doesn't seem to help, it is very possible you have STS.  STS can be caused by an injury but just as frequently can be caused by a foot that has excessive motion.  Flexible flat feet are feet that lose their arch height when you bear weigh.  STS is probably one of the most common misdiagnosed causes of pain to the foot or ankle because the joint involved, the sinus tarsi, is very close to the ankle and it is often confused by a doctor who does not specialize in the foot and ankle.

 

To diagnose STS, the joint is isolated and injected with local anesthesia to confirm that at the pain is coming fro that joint.  Since treatment for STS consists of injections of cortisone into the sinus tarsi, it is added to the initial diagnostic injection.   STS, in its early form, is an inflammatory problem and responds quite well to one or a few of cortisone shots.  Treatment also consists of controlling the flexible foot type and the excess motion by using custom orthotics or the placement of a stent within the sinus tarsi to block the excessive motion.

 

However, as time goes on and the problem is ignored, the tissue within the joint becomes thickened and almost like scar tissue and may not respond as well to the injections. If the injections fail to help, we will often order an MRI to confirm the diagnosis and to evaluate the tissue within the joint.  Surgery, either arthroscopic cleaning of the joint or opening the joint to clean out the thickened tissue.  The surgery is not very invasive and allows return to work and activities quickly.

 

Like many foot problems, the key is to treating the problem early before the problem becomes chronic.  Remember - foot pain is never normal!!

 

Frostbite - Should Health Women Worry??

When we think of frostbite in Chicago and other large cities, most people think of the homeless and others out without proper foot protection from the elements.  But working women, especially those who commute downtown, should also be cautious!

So many of my patients commute to the city.  They take the train from Naperville or surrounding western suburbs and walk to their offices from the train.  I can tell you that most of these women are not wearing Uggs as part of their winter foot wear if there is no snow.

Most women tend to wear the same dress shoes and hosiery for their multiple block walks to and from the train - unless they wear sneakers for a previously discussed foot problem.  These shoes, or fashion boots, lack the warmth that winter boots provide and most dress shoes leave a good part of the foot exposed.  This exposure - especially when the temps dip into the teens - can lead to frostbite in some people.

Risk factors include anyone with circulation problems or diabetes but even health women should be cautious if they are smokers, take certain medications or have something called Raynaud's. 

Raynaud's is often associated with some rheumatic diseases (Raynaud's phenomenon), but it can also be present by itself   Raynaud's is fairly common - even my 15 year old daughter has it!  Toes and occasionally fingers get very cold and even turn white when exposed to cold temperatures or other stressful triggers.  It is more common in women and those who live in colder climates.  Even while at home, my daughter's second toe often turns white.

I have my daughter rewarm her toe in warm water or with a warm compress until the normal color returns to her toe; but prevention is the key with women who experience this problem.  Wearing socks (even in the house during the cold months), wearing boots when outside and limiting exposure to the very cold air.  On the really cold days, I recommend to my patients that they take a cab to and from their offices and the train.

Raynauds is a vasospastic problem of the arteries which blocks the blood flow to the toes or fingers.  Risk factors for health women include the use of cold medications that include pseudoephedrine (Chlor-Trimeton, Sudafed) and birth control pills.  Women should not smoke if they have Raynauds - its the perfect and very real reason to give my daughter not to start smoking!