First of all know this. Doctors do not make follow-up appointments because they “want to see you”. They make follow-up appointments because they “need to see you”. Need as in necessity. Meaning there is an indispensable need that follows a logical requirement for another evaluation and management of your ongoing condition. There may be several reasons for this.
- to monitor your medications
- to assess improvement or worsening of symptoms
- for continuity of care
- to remove and/or apply dressings for wound management
- to discuss diagnostic tests and develop a follow-up care plan
- to check for reoccurrence
Physicians treat patients based on medical necessity and must have supporting documentation for your care. If there is no need for further treatment your Doctor will discharge you from the practice. Until then periodic appointments are essential to the desired outcome of your treatment and not following up with a scheduled appointment can compromise your care.
Patient’s who routinely miss their appointments without notifying the office staff also effect other patients who may have been waiting to schedule an appointment as well as staff efficiency and wasted resources. Don’t be a “no show” (intended appointments that were not canceled or rescheduled). All healthcare providers would much prefer that you cancel your appointment or reschedule than just not show up. Most office staff and physicians would say that to forget is forgiven but habitual “no shows” (repeat offenders) create havoc in the schedule and time spent in additional documentation and concern regarding interruption of care.
A well-regarded physician schedules follow-up appointments because he/she needs to see you. Not to make more money, buy a bigger house or satisfy big drug companies by writing more prescriptions. If they do then you should find another healthcare provider and value their time as much as part of a healthcare team committed to caring for you.
Meteorologists are noting that Pyeongchang in 2018 might be the coldest Olympics since 1994 in Lillehammer, Norway. The athletes, coaches, course workers, photographers and spectators are being advised to take precautions against the cold and the serious potential of frostbite.
Frostbite is a dangerous cold-weather condition that can happen to anyone, from the most experienced winter athlete and outdoorsman to your neighbor shoveling her driveway. Frostbite can result in various degrees of skin damage from an irritation to blistering to permanent tissue death. The hands and feet are particularly susceptible to frostbite because the body is busy working hard to keep the internal organs warm.
Frostbite starts by producing a burning, tingling sensation in the exposed areas. This is followed by numbness in the affected area (toes or feet) and changes in skin color, from pale or red to bluish-gray or black and feel hard to the touch. Children, the elderly, and diabetics are more prone to frostbite because of the size of their extremities or poor circulation. Severe frostbite may necessitate amputation of the affected toe(s), or possibly the entire foot. Other consequences may include
- Frostbite arthritis , a condition resulting from damage to the bones and cartilage
- Permanent numbness or other nerve damage
- Increased susceptibility to frostbite in the future
You can avoid frostbitten feet by taking a few precautions. Wear warm, moisture-wicking socks, layering thick socks over thin ones to help trap heat. Wear warm, waterproof winter boots out in cold temperatures and limit how much time you spend in the cold.
Why early diagnosis and treatment of traumatic injuries is important.
Traumatic injuries cause damage to the cells that make up the soft tissues. These damaged cells release chemicals that cause an inflammatory response characterized by pain, localized swelling, heat, redness and a loss of function.
Too much of an inflammatory response in the early stages of an injury can delay the healing process making it longer to return to normal activity. Early attention and treatment can minimize the inflammatory phase of an injury, so that the overall process of healing can begin.
The sinus tarsi is an opening on the outside of the foot between the ankle and heel bone. It is often referred to as the “eye of the foot” because it opens towards the outside of foot. STS (sinus tarsi syndrome) was first described by Denis O’Connor in 1957 as a problem that can occur after an inversion ankle sprain or due to a “pinching” or impingement of the soft tissues in the sinus tarsi due to a very pronated (rolling in) foot.
Patients typically present with localized pain in the sinus tarsi region with a feeling of instability aggravated by weight bearing activity. Inverting the ankle or moving it into a position where it is turned inwards like it would go with an ankle sprain can cause severe pain. Patients may feel instability in ankle joint especially while walking on uneven surfaces and repetitive strain can aggravate the condition.
Medication and therapies that reduce swelling and inflammation are recommended as well as correction of any underlying biomechanical problems that contribute to the way the ankle bones move restricting the space in the sinus tarsi channel. Strengthening exercises for the ankle are suggested and helpful. When treated early, the outlook for recovery is good but without appropriate, early intervention the condition can lead to chronic pain.
Lift, shift, push, pull – construction work is a physically demanding job and most of the work is done on the move. So it’s understandable that those who work in construction come home with aching feet.
According to the Center to Protect Workers’ Rights, ankle and foot injuries are among the most commonly injured body parts for construction workers. Going up and down ladders, stairs and scaffolding and lifting heavy objects all day can create problems likes strains, sprains and bone bruising. Torn ligaments, overuse injuries, plantar fasciitis and broken bones account for loss time on the construction site. Maintaining balance and equilibrium to prevent falls and accidents are important as well as recognizing what can be done to minimize risk and prevent on the job injuries of the lower extremities. Here are a few best practices for proper care and prevention of foot and ankle injuries.
- Invest in well-made boots and if necessary prescription orthotics to compensate for any structurally abnormalities that can contribute to underlying foot problems.
- Treat minor problems before they become major problem. Yes, arch and heel pain is important, but don’t ignore your toes. Your big toe withstands 40 to 60% of your body’s weight so any injury or problem can have a big impact on your gait and ability to move effectively.
- Don’t ignore persistently swollen or numb feet, burning and tingling. These can be signs of a neuropathy, which diabetics are especially susceptible to.
- Infected or ingrown nails may develop into a cellulitis,a potentially serious bacterial skin infection that can rapidly spread to other parts of the body. Cellulitis appears as a swollen, red area of skin that feels hot and tender.
- Continued pain with activity. If your feet only hurt while you’re active, you could be suffering from a stress fracture. Without proper treatment, stress fractures can easily turn into broken bones.
We live in a society of immediate gratification. Waiting a couple of extra seconds for an Internet page to load feels like an eternity. A culture of impatience over slow website loads or less than same day delivery. We’ve come to expect things so quickly that when faced with an injury patients become easily frustrated when they are not healing as fast as they think they should.
Soft tissue injuries, muscle or connective tissue injuries often develop over time. There may be an incident of trauma, an accident, pop or accompanying fracture, however many are caused by repetitive stress, pulling forces that ligaments must resist and overtime are extreme enough to damage softer blood vessels and nerves. Long before breaking under a strain, tissue often gets “sick”, overused. Once that happens, the tissue loses the ability to tolerate even minor stresses. If these structures do become injured, their limited blood and nerve supply results in a longer recovery and healing period.
An evidence-based study of ankle ligament healing after an acute ankle injury showed that it took at least 6 weeks to 3 months before ligament healing occurred. However, at 6 weeks to 1 year after injury, a large percentage of participants still had “objective mechanical laxity and subjective ankle instability”. Alterations in the biology and biomechanics of the injured body part not only effect it but effect those structures surrounding it so that healing the area depends on contributions from multiple body systems . Physical condition, underlying medical problems, poor muscle balance, inflexibility and lack of tissue strength influence the time it takes a body to heal. You have to almost completely stop challenging the tissue, or it will never have a chance to recover.
Rebuilding, remodeling and recovery from injury takes time. Accepting the time it takes and giving your body (including the proper nutrition) what it needs to protect, heal, repair, and recover isn’t easy to do if you are a determined athlete, career-driven professional, a relied on caregiver or parent. The art of healing depends on rest and mobility. Patients need to work with their healthcare provider to find a happy medium and the time needed to do so.
Over the last several years clinical correlation studies have shown the below normal Vitamin D levels (hypovitaminosis D) may contribute to a variety of health problems. Cited sources have described Vitamin D deficiency as a “worldwide epidemic” with an estimated one billion people having inadequate levels of vitamin D in their blood, and deficiencies can be found in all ethnicities and age groups. Yet it is an often overlooked component in the treatment of foot and ankle injuries and chronic foot and ankle pain.
In the foot and ankle, stress fractures of the metatarsal bones and ankle may be seen in those with Vitamin D deficiency, as well as generalized foot pain. The prevalence of Vitamin D deficiency has been identified as one of the most common causes of fragility fractures and poor fracture healing. Healthy amounts of vitamin D are a critical factor in orthopedic healing and the healing of reconstructive surgery of the foot and ankle.
As specialists in the foot and ankle we see a variety of bone, joint, musculoskeletal and neurological problems of the lower extremity with systematic manifestations such as diabetes, arthritis and other metabolic disorders effected by low levels of Vitamin D. Patients with various –itis (inflammations) such as capsulitis and persistent and recurring tendonitis often test in the lower limits of normal for optimum levels of Vitamin D. Inadequate dietary intake, a lack of sunlight exposure, certain metabolic disorders and disorders that affect your body’s ability to absorb vitamin D can result in a deficiency. With an increasing knowledge of the health consequences of low levels of Vitamin D, doctors can benefit their patients by identifying those who are deficient and require therapeutic supplementation.