Choosing a Foot and Ankle Specialist

     Lately, more patients have been asking me about the differences and similarities between podiatric surgeons and orthopedic surgeons.  The podiatry profession has evolved immensely over the decades, which has created more parity with the orthopedic community.  In most instances nowadays the two professions have been able to find common ground from which to share opinions and accept each other as coequals regarding the treatment of foot and ankle pathology.  However, there are still many in both professions that do not see eye to eye and may consider one as inferior to the other.  I have seen many instances recently where this same attitude is manifested through the general public. The cause of this confusion is usually due to misinformation or general lack of knowledge of what each specialty is capable of performing.  For this reason, I would like to explain briefly the education and training process that a typical podiatrist currently needs to fulfill in order to practice as a licensed physician.

     Podiatrists begin their specialized foot and ankle education on the first day of medical school.   Most of the podiatry colleges are affiliated with medical schools, meaning that podiatry students are learning alongside M.D. and D.O. students.  Podiatry school is four years of comprehensive medical instruction and clinical training.  After graduating, podiatrists are required to fulfill a rigorous three-year residency program of foot and ankle surgery, including rotations through several other specialties such as Internal Medicine and Orthopedics.  Our surgical training includes everything from ankle fractures and complex foot deformity reconstructions to hammertoes, bunions, and ingrown toenail removal. Also, many podiatrists choose to apply for one-year fellowship programs after completing residency to continue their specialized surgical training. 

     There is a reason an entire profession is dedicated to the foot and ankle.  One quarter of all the bones in our body are found in our feet.  The complexity of foot and ankle pathology and biomechanics requires its own specialty in order to be treated effectively.  As a podiatrist, I am limited to treating ailments specific to the foot and ankle.  Does that mean I don’t consider the whole body and the effect systemic diseases and pathologies have on the lower extremity?  Absolutely not.  That is the whole premise our profession is based upon.  We have been trained since the beginning of medical school to look beyond the foot and ankle for answers.  As podiatrists we routinely order various labs and diagnostic studies to evaluate for specific systemic processes that correlate with the presenting foot and ankle symptoms.  Some of the best counsel I received pertaining to my career came during my podiatry graduation ceremony.  The speaker stated, “Our scope of treatment is limited to the foot and ankle, but our scope of diagnosing is unlimited”.  

     We are foot and ankle specialists in every aspect.  I hope that you can see that from all of us at Cascade Foot and Ankle.  We want you to feel confident that the care you are receiving is top notch.  Please contact us  and let us help you get back on your feet.

Sincerely,

Shawn Summers, DPM

Painful Red Feet??? What's that all a- GOUT??

      When my patients come in to see me saying they have a 10/10 pain of their great toe and cannot even let their bed sheet touch their foot, I automatically think of gout.  Usually the pain has come on overnight with no history of injury.  The pain of an acute gouty attack can be excruciating and may be triggered even by light touch or movement.  The pain can be so severe that some people even resort to emergency room treatment for pain relief.  Gout is caused by having increased levels of uric acid in your blood and then having the body react to these increased levels meanwhile causing pain and inflammation.  Most of the time the increase in uric acid levels is caused by something they have eaten.

What is happening?
     Uric acid is a product of the break down of purines in your body.  Your body not only produces purines but you can store larger amounts of uric acid secondary to a protein rich diet.  Too much of anything can be bad for you and this is very true with uric acid.  Your body thinks of the excess uric acid as an unwanted house guest and attempts to get rid of it by sending your immune cells to make it go away.  The immune response causes pain, swelling, warmth, and redness that typically accompanies an acute gouty attack.  The attacks can last between 3-5 days and prompt treatment will decrease symptoms fairly quickly.

  

     The most common person to have a gout attack is a male between the ages of 30-45.  Women usually have attacks starting post menopause, between the ages of 55 and 70 years of age.  If you have a family history of gout your chances increase as well.  Other medical conditions such as kidney disease, high blood pressure, and diabetes can also contribute to the prevalence of gout.  Medications such as diuretics (water pills) and also aspirin have shown they may increase uric acid levels. Finally, being overweight and consuming large amounts of alcohol can contribute to the cause of a gouty attack.  Certain foods that are good for you may still cause an increase in your uric acid level.

What should I do?

     So what can you do if you have a red, hot, swollen, and tender foot? You can easily try some simple home remedies such as applying ice to the affected area, elevating the limb, resting the limb, and using over the counter non-steroidal anti-inflammatory drugs (NSAID) such as naproxen or ibuprofen if okay with your doctor.  Essentially what you are trying to do is decrease that inflammatory response the body has when encountering high levels of uric acid.  You are trying to prevent the swelling and warmth by counteracting it with anti-inflammatory methods.  This is very effective and some people require no further treatment.

    If by chance your pain persists your doctor may prescribe you a stronger NSAID, such as colchicine or indomethacin, or a steroid to calm the inflammation down.  Doctors could also inject a local anti-inflammatory into the affected area and this would also decrease pain and swelling dramatically.

After the acute attack and everything starts to calm down, you may have to repeat a blood test to make sure your baseline uric acid levels are normal.  If they are elevated when no attack is happening then your doctor may consider placing you on a maintenance medication, such as allopurinol or probenecid, so as to prevent future flare ups.  You may also try to lose weight, drink lots of water, and avoid large consumption of alcohol and meats.  There are lists of certain foods that can increase and decrease the levels of uric acid. 

    If gout is something you may have problems with, schedule an appointment with us today.