Blog | Jeffrey Kleis, DPM - Costa Mesa Podiatrist

Osteomyelitis

Our limbs and our stature set “humans” aside from the other primates.  The general upright nature of our walk, our standard vision, and the nature of our grasp with hands and dexterity of our fingers gave us an edge in noticing and controlling our world.  Because we did walk upright for basic locomotion and most tasks, we did over time lose the dexterity of our toes as they became more critical to balance and step.  With all the natural activity of our lives centered over our feet, it is a shame that most do not apply the same array of motion and exercise to feet and toes and yet they perform more than the hands and fingers.  The feet suffer from all possible alignment and rigidity issues as the hands and fingers, but the toes have the added indignity of literally being stepped on, broken, dislocated, and suffer from neglect-caused problems.  Issues of the hands are so readily visible that they are braced and treated quickly to restore their use.

Swelling in the toes following a “stub” or a crushed toe situation should reduce in a couple of days, and sensitivity will linger.  Unlike a finger which can be braced if broken, a toe is difficult to mobilize but a trained professional podiatrist will have the best advisement for your lifestyle.  If discoloration in the toenails begins (a blood blister beneath the nail) a podiatrist’s examination can determine what steps can be taken to relieve the pressure or the best method of care needed to relieve the pressure from building up under the nail.  In cases where the toenail is broken or cut deeply, the nail will fall off as a new nail solidifies but will never maintain the same shape of the original.  However, if the pain remains sharp and discoloration begins, you need to seek help from a foot professional who will offer various alternatives in treatment for walking and aesthetic results.

In the relatively mild temperatures of Southern California, there’s a tradition to wear minimal foot protection and while that’s a benefit of warmth and pleasant conditions, it can be hazardous to the toes.  Months of sandals and non-supported feet can result in callouses, flat fleet, injuries and bug bites.  Most people go on as usual with the pain from toe injuries but remember that any slight changes in your walk is having an impact on other areas of the foot.  Over time repetitive injuries, other callouses, corns, or tissue bruising can make your balance and step change and blisters or other friction discomforts surface in what were once your favorite walking shoes; this is the problem with unchecked injuries of the toes.  Repeated occurrences stemming from a person’s activities or work subject them to injuries of the feet (even through the protection of boots and shoes) can result in more severe problems if unattended.  Even the pinch and swell from ingrown toenails affect the way that you step to perhaps exaggerate problems elsewhere on the foot.

If you live in Southern California, you are fortunate to have an incredible Podiatry specialty center in that’s based in Costa Mesa.  Dr. Jeffrey Kleis DPM, Inc and his staff in their state-of-the-art Orange County facility welcomes all foot injuries and can apply 25 years of treatment knowledge to a planned path back to wellness.  Contact the Costa Mesa office at 714-760-4944 for an appointment to assess an injury or correct a lingering problem.

There are other dangers to consider when problems of the feet go unchecked.  Each time such a problem occurs, the tissue trauma can reduce flow of blood into the area, damage nerves, and repeated injuries in the same area isolate that area from the body’s natural defense.  The problems are complicated further by age, and the progression of other medical conditions such as diabetes or vascular disease.  Remember that your feet are intended to carry you for the life of your total package so it’s important to keep your step steady to keep your “gait” balanced and not place unnecessary stress on other areas of your joints or limbs or digits.  There are already dozens of conditions that the feet can suffer from with very little help like flatfootedness, neuropathy, planter’s warts and toenail fungus.  Why guess at what the complicated pains are when you can settle everything by obtaining an expert opinion. 

Stiffening of joints or arthritis can set in at any age but the treatments for different types of joint problems differ.  Osteoarthritis is the most common form of arthritis, and if you suspect this condition then make an appointment to see a medical professional who specializes in the area of the body that is most problematic for you.  In the time between your call and your appointment, keep a journal of your joint symptoms all over your body like hands, feet, shoulders, back, and even your jaw.  Feedback on all these areas will help a physician properly diagnose the type of arthritis or condition you are developing.  Your journal should record the area of pain, your remedy for relief (aspirin, compression bandage, warm water) and its effectiveness and a note on your sleep and exceptions to normal activity.  Note if the area around the joint is swollen or fluid filled, sensitive to touch or itchy.   Changes that don’t necessarily correspond with joint issues may be significant clues to the problem and solution path; hair loss, rashes, weight loss, and-or fatigue are important to note.  Physicians now reference all the latest technology and information to begin building or referring types of therapy and can, in most cases, develop a pro-active treatment plan to suit your lifestyle.

Rheumatoid Arthritis is caused by an autoimmune response that attacks the lining of the joints, painfully stiffening them with so that they ultimately become deformed.   This disease affects the smaller joints in the body first and can progress to the larger, making pain-free movement impossible.   The Mayo Clinic provides this list of risk factors that contribute to development of Rheumatoid arthritis include:

  • Your sex. Women are more likely than men to develop rheumatoid arthritis.
  • Rheumatoid arthritis can occur at any age, but it most commonly begins in middle age.
  • Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.
  • Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease.

Smoking also appears to be associated with greater disease severity.

  • Excess weight. People who are overweight appear to be at a somewhat higher risk of developing rheumatoid arthritis.[1]

One of the worst rare conditions that can arise in the feet or toes is Osteomyelitis and unfortunately it affects older people with diabetes mellitus OR a history of peripheral vascular disease.   It is a bacterial infection that appears as a swelling of an area of the foot and is warm to the touch.  The infecting organisms most commonly associated with foot osteomyelitis in patients with diabetes mellitus are Staphylococcus aureus, group B streptococci, aerobic gramnegative bacilli, and B. fragilis[2].  This condition associated diabetes requires special diagnostic procedures and can be treated with antimicrobial therapy (not to be mistaken for antibiotics).  

Foot osteomyelitis associated with peripheral vascular disease the problem comes from bone fragments or areas of tissue so damaged previously that they are removed from the body’s circulation process.  Lack of circulation means that the tissue is technically void of any cleansing, hence a prime target for dangerous pathogens to settle and invade the damaged bone.  A bone biopsy done under aseptic conditions is the preferred way to test for specific antibiotic therapy for treatment.

Dr. Jeffrey Kleis DPM, Inc and his staff in their centrally located Orange County facility are prepared to address the whole source of your foot problems.  For more than 25 years they have been pursuing the holistic approach to treatment, including research into your family history and diet for aiding in treatment.  Contact the Costa Mesa office at 714-760-4944 for an appointment to assess an injury or correct a lingering problem.

A healthier diet and the thought of more activity sometimes make people cringe, but these are necessary steps for extending your personal life and overall well-being.  Gentle movement like walking may have thwarted you because of localized pain in your feet, but with the smallest of maintenance procedures you can participate in your life instead of remaining sidelined.  Don’t take your toes for granted as they sustain your balance permit you to stand and address all the beautiful moments of your life upright.   

[1] Mayo Clinic staff, mayoclinic.org/diseases-conditions/rheumatoid arthritis

[2] RT Journal Article “Osteomyelitis in Elderly Patients,” Yoshikawa, Thomas T. & Cunha, Burke A.

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