Ultrasound in Podiatry

If you have children, you are probably familiar with ultrasounds. After all, it's what the OBGYN uses to take pictures of your baby while he or she is still developing. However, ultrasonography is useful in many areas of medicine to show pictures of body parts below the skin, including podiatry.

"Ultrasound" means that the machine is producing sound at a pitch much higher than what the human ear can detect. The doctor will place a transducer up against your foot, producing sound waves, and the machine detects the echoes that bounce back. Using these echoes, the machine is able to put together a picture of the different tissues in your foot in the same way that dolphins and submarines use sonar to detect other objects and hazards in the water.

So what is it good for? Since ultrasound depicts soft tissue problems, it is useful to diagnose plantar fasciitis and various tendonitis, though the list is longer. Other advantages:

• No radiation, unlike X-ray and CT
  
• Live Action—you don't have to wait for the image to develop because it's on the screen instantly
  
• The doctor can direct injections by watching where the needle is going on the screen
  

Another advantage to ultrasonography is the cost. An in office ultrasound ($100-$160) is significantly cheaper than an MRI which can cost 5 times as much. An MRI is a much more detailed image than an ultrasound, but in many cases they are not necessary. A common misconception amongst patients is that more medicine equals better medicine. While you might like to have the best diagnostic test out there, in the back of your podiatrist's mind is the question: is it worth it? Should we spend more money to get a more accurate diagnosis? Or can we get a good level of accuracy using low-tech methods? Podiatrists will disagree about the answer to these questions, since there are good arguments either way.

Luke McCown, ACL injuries, and Podiatry

This past weekend, the Jacksonville Jaguars lost their quarterback for the season due to a torn right ACL. The ACL refers to the anterior cruciate ligament, found in the knee, and tearing it is a relatively common injury in football. (Anterior means front or forward, and cruciate simply means it runs diagonally instead of straight up and down.) So why would a foot doctor be interested in a knee injury? As I discussed here, podiatrists are more than just foot doctors. We study the entire lower extremity. While knee surgery is technically outside of our legal scope of practice, many of our patients are athletes and will suffer this injury. Besides, anatomically speaking, the knee is one of the coolest joints in the body.

The knee is marvelously complex. Unlike other joints, it is held together entirely by soft tissue—ligaments, cartilage, and muscles. The ACL is one of these ligaments, and its job is to prevent the lower leg from sliding forward on the thigh by connecting the top of the shin bone (the Tibia) to the bottom of the thigh bone (the Femur). In fact, one of the ways to test for an ACL rupture is for the doctor to pull on the shin of a person lying back to see if it slides forward.

Surgical repair is often necessary for an ACL rupture, since it will not heal on its own. This is where the podiatrist needs to pass the patient on to the orthopedic knee specialist. The repair is performed arthroscopically, meaning a tiny camera is inserted into the joint, minimizing the invasiveness of the procedure. Despite that the procedure is minimally invasive, the patient will still have many months before returning to 100%, and this is why Mr. McCown will spend his season on injured reserve.

One of the clichés of our profession is that podiatrists and orthopedists have an adversarial relationship, fighting over which group is the final authority over which region of the body. However, the truth is that we can work together to our mutual benefit. The podiatrist refers out the patients with knee injuries to the orthopedist, and the orthopedist refers out to the podiatrist patients with the foot and ankle issues. While this is an idealized picture, this sort of multi-specialty cooperation results in much better patient care.

Ingrown Toenail

After some unanticipated technical difficulties, we here at On Your Feet are back online and proud to resume blogging! We herald our return by discussing one of the more common sights to any podiatrist: the ingrown toenail, also known as onychocryptosis. If you feel pain around the sides of your toenail, or if they appear red, the nail has probably grown into the side of the foot and is digging in. Furthermore, redness is a sign of infection, and your podiatrist will prescribe antibiotics.

Ingrown toenails arise in various ways. Sometimes you cut your nail too short, changing the way it grows. Other times, you might bump your foot, and that is the cause. And then, you might just be born with it.

You can attempt to deal with an ingrown nail on your own by soaking it and wearing shoes with a wider toe box. Your podiatrist can also treat an ingrown toenail surgically. However, to call it a surgery is a bit of an overstatement, since you will be wide awake and perfectly capable of walking out of the office under your own power. The podiatrist will simply numb up your toe, and trim away the portion of the nail causing irritation. He or she might also apply chemicals to ensure that no further nail grows back.