Rheumatoid Arthritis (RA) is reported to affect 0.5% to 1% of the population. RA is an autoimmune disorder that presents in females more often than in males. People of all ages may be affected, but it is primarily presents in the fourth and the fifth decades. Rheumatoid arthritis begins in the foot approximately 20% of the time. Although signs and symptoms of R.A may not present in the feet at first, data has shown that approximately 100% of patients within 10 years from the onset of the disease, will have changes to their feet. Involvement of the feet is usually a little less common then signs and symptoms of RA in the hands.
At this point in time no one definitive cause of Rheumatoid Arthritis has been identified. Some causes are believed to be and range from immunologic susceptibility, genetic, environmental, bacterial, viral etiology or a combination of multiple factors. To be classified as having RA a person must exhibit 4 of the 7 qualifying Criteria: (although patients displaying 2 of the satisfying criteria are not excluded from the diagnosis of RA)

1) arthritis of 3 or more joint areas
2) morning stiffness
3) arthritis of the hand joints
4) symmetric arthritis
5) rheumatoid nodules
6) serum rheumatoid factor.

Evaluation for RA can be made by multiple different specialties in the medical field. Evaluation from a rheumatologist for long term treatment and monitoring is recommended, while surgical correction of foot and ankle problems related to the effects of RA are treated by a podiatrist (Foot and Ankle Surgeon). In the next blog we will focus on multiple treatment options for patients with pain and deformity related to the effects of RA, and the indications for surgical intervention and surgical procedures.

If you have any questions related to this topic email Dr.Sansone at dr.dsansone@gmail.com or make an appointment for evaluation at www.eastoceanpodiatry.com

Coming soon.

Flat Feet in Children - (Pediatric Pes Planus)
Infants are usually born with a flexible flatfoot and typically do not develop a normal arch until they are 5 to 9 years old. Although the appearance of a child's feet may progress and appear to have a more normal "look" to their feet, proper evaluation at an early age can prevent problems in adolescence years and later in life. Although most cases of flatfeet in children are mild and may only need an evaluation or mild treatment, severe "Flatfeet" deformity in children can progress and lead to debilitating conditions if unevaluated and left untreated.
History is an important part of the treatment of the pediatric flatfoot. Children may complain of "becoming tired while playing" or younger children may want to be carried a lot. Another common sign is children may lag behind other children in physical activities. All the above mentioned may be a result of improper body mechanics related to "flat feet", putting more strain on the feet and legs.
Based on the severity of the "flat foot deformity" multiple conservative treatments are available. Conservative treatments such as monitoring the condition for progression, modification of shoe gear, or the use of orthotics to realign foot position are very successful. Other treatments such as surgical correction of the deformity can be minimally invasive procedure such as the use of a "subtalar joint implant" (arthroresis) to stop the foot from flattening out. Some severe forms of "pediatric flatfoot" require more invasive procedure in order to correct the alignment of the foot and restore normal function to prevent joint breakdown and pain (osteoarthritis) later in life. The ultimate goal of surgical correction of flatfeet in the pediatric patient is to reduce or eliminate pain, reduce deformity and restore normal joint alignment, and preserve joint motion when possible.
Evaluation on presentation to the office is "painless" for children. In order to properly evaluate your child, a physical exam consisting of a "Biomechanical Evaluation" will be performed in the office. This evaluation helps the "Foot and Ankle Specialist" determine the type of flatfoot "flexible vs rigid" and will allow for proper treatment and diagnosis. While in the office, digital x-rays will also be taken in order to evaluate the severity of the deformity. Based on these evaluations and the history related to the child's flatfeet, a proper treatment plan can be discussed and implemented.

If you have any questions related to this topic email Dr. Sansone at dr.dsansone@gmail.com or make an appointment for evaluation at www.eastoceanpodiatry.com

Stress fractures also know as a "incomplete fractures" or "hairline fractures" are overuse injuries of bones. Stress fractures are caused by "unusual or repeat stress". This is in contrast to other types of fractures, which are usually characterized by a solitary, severe impact or injury. Stress Fractures typically occur in weight-bearing bones, such as the tibia (shin Bone) and metatarsals (long bones of the feet).
Stress Fractures are common sports injury, and most cases are associated with athletic activities, ranging from football to running. Stress fractures are usually seen in athletes who increase their level of activity over a short period of time. Bone is constantly undergoing changes to adapt to its environment. The increased activity level and demand placed on the bone causes the bone to remodel and become stronger in the areas of higher stress. However, if the response of the bone cannot maintain the pace of the repetitive demands, a stress fracture may result.
Another factor that can contribute to the development of a stress fracture are dietary abnormalities and menstrual irregularities. Due to the fact that both factors contribute to bone health, any problems with diet (e.g. poor nutrition) or menstruation (amenorrhea) may place an individual at higher risk for these injuries. Due to this adolescent female athletes are at particularly high risk for development of a stress fracture and older active people.
As with most conditions, a stress fracture is best diagnosed after examination by a Physician. (Podiatrist - Foot and Ankle Surgeon) X-rays usually do not show any evidence of stress fractures, until 2 weeks after symptoms start so a CT scan, MRI or a Bone Scan may be more effective in unclear cases.

If you have any questions related to this topic email Dr. Sansone at dr.dsansone@gmail.com or make an appointment at www.eastoceanpodiatry.com

Lately a lot of people have asked me the question, "Is it ok for me to run barefoot". This is a subject that can be debated by runners, researchers, and doctors like myself for days.
As we know people have been running for thousands of years prior to the creation of the modern athletic shoe. But as we know, just because something was done years ago, that doesn't mean it is better for you and that we can't improve our way of life.
In general the very complicated subject of "Barefoot Running" can be broken down into a few important points:

1) Force = Mass x Acceleration (Newton's Second Law)
This translates into the more you weight and the faster you run the more force is placed through your feet.

2) Forces which do not act uniformly on all parts (your feet) of a body will also cause mechanical stresses, a technical term for influences which cause deformation(damage) of matter (your feet).
This means that force created by your body while running is not spread out evenly throughout your body. It is unequally placed on certain parts of your lower extremity (feet), and this will cause damage of your feet as time goes on.

As humans run we usually contact the ground (strike the ground) in two common places, the rearfoot (heel) and the forefoot (ball of the foot). These two areas of the feet absorb force very differently as you are running. Most people who run long distances have heel strike involved in their gait(running pattern), while people who sprint do not have heel strike, they hit the ground with their forefoot(ball of their foot).
As stated early heel impact is very different form impact on the ball of your foot. Heel Impact leads to a rapid, high impact force about 1.5 to as much as 3 times your body weight (depending on your speed) This is equivalent to someone hitting you on the heel with a hammer using 1.5 to as much as 3 times your body weight. These impacts add up, since you strike the ground almost 1000 times per mile! Many running shoes make heel strikes comfortable and decrease the change of foot injuries because they slow the rate of loading considerably, reduce the force by about 10% and spread this force out over a greater area of the foot.
Barefoot runners that prefer "going shoeless", have to become accustom to striking the ground with the "ball" of there foot, not their heel, because force through their heel repeatedly will become very painful. Although you can train your body to run and contact the ground with mostly your forefoot "ball of your foot", the force of your body weight has to go somewhere and eventually you increase your chance of stress related changes to your feet, by not spreading out the forces evenly. If you have been a heel striker, it takes some time and work to train your body to forefoot or midmost strike, especially because you need stronger feet and calf muscles. Runners may be at greater risk of developing Achilles tendonitis when they switch from heel striking to forefoot striking, along with other conditions such as "Stress Fractures".
Another important point to bring up is that "Barefoot Running" does not protect your feet from the environment around you. Thick-soled shoes are much more forgiving when running over glass, sharp objects, and bacteria on the surfaces we run on. In conclusion, I recommend to run in proper athletic shoes, but with that said we live in a country where you can run with or without shoes, and if you happen to choose to run without shoes, rest assure that I will be here to help you if those foot or ankle problems eventually due "catch up with you".

Dr. Dominick Sansone - Foot and Ankle Specialist/ Surgeon

If you have any questions email me at dr.dsansone@gmail.com

A new light running shoe that provides superior comfort without sacrificing performance is the Nike Lunar Glide. I have found it to be one of the mpst comfortable running shoes. I have been running in them for sometime now and I strongly recommend them to my patients. It is a soft, light shoe with a spacious toe box, it is seamless inside and out to avoid any rubbing. The new foam sole provides excellent cushioning. I feel it is a good shoe for neutral to moderate pronators and medium to light weight runners.