Swanson Implants for First MTP Joint Arthritis

The first metatarsophalangeal joint (MPJ, MTP Joint, or MTPJ) is highly susceptible to arthritis. This is the joint in your foot that attaches the big toe to the first metatarsal. It is a very important joint, and allows for propulsion during gait. There is a great amount of force that is put through the joint when walking, which is quickly absorbed through a number of joints in the foot. Because of this great amount of force place through the joint, it is also highly susceptible to arthritis.

Arthritis of the great toe joint, much like arthritis of any other joint, can be very difficult to treat. It is a painful condition that doesn’t always respond well to medications. There is no real cure for arthritis, and some people are affected by it at a much earlier age than others. Arthritis of the first MPJ is complicated by the fact that it is a weight-bearing joint.

Conservative treatment of first MTPJ arthritis is generally focused on preventing the advancement of arthritis by accommodating any foot deformities that may be present with orthotic devices. A foot deformity that increases pressure or force at the first MTPJ will speed up the progression of arthritis. Non-steroidal anti-inflammatory drugs (NSAIDs) are often used, such as naproxen or ibuprofen. Icing, protective measures, heat, and a number of other non-surgical therapies are often used with varied results.

Surgical options for the treatment of first MTPJ arthritis include a number of procedures, including fusion of the joint, osteotomies (bone cuts), resection of some of the bone, and joint implants, to name a few. Joint implants come in a variety of designs.

One of the types of implants commonly used is the Swanson-type implant. This is an implant that is made of a silicone, and has two stems. One stem is placed into the metatarsal, and the other into the proximal phalanx. Some of the bone must be removed for each stem to fit into its respective end, and a small hole is reamed out to place the stem. Once the implant is placed, it creates a false joint. The first MTPJ, therefore, would have a more functional and painless range of motion. This is the goal of the surgery.

The implants have a lifespan of around 30 years, and are generally well tolerated. Occasionally the implants can breakdown at a faster rate, and cause a condition known as detritic synovitis. This is a condition caused by small particles of the silicone being sheared off within the joint, which leads to inflammation.

These double stem silicone implants are not for everyone, and are generally not used in younger patients, due to the lifespan of the implant. There are a number of different surgical methods for treating first MTPJ arthritis; this type of implant is only one.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

863-299-4551

www.FLFootandAnkle.com

Classification of Ankle Fractures

Ankle fractures are one of the most common injuries to the lower extremity. The injuries are almost always due to a twisting injury, where the foot is planted flat on the ground and the leg is forced in a twisting or sliding pattern. Ankle fractures are a frequent occurrence in high impact sports, as well as from everyday-type injuries. The anatomy of the ankle helps to define this injury, and a number of structures are at risk.

The ankle joint is composed of the tibia and fibula, which are the bones of the lower leg, as well as the talus, which is a bone of the foot. The tibia and fibula join at the syndesmosis, a structure that is key in holding the ankle in place. The tibia and fibula form a groove for the talus to move through, ensuring stability through range of motion at the ankle. A number of ligaments hold these structures together, mainly the lateral ankle ligaments and the medial ankle ligaments. The medial ankle ligaments are commonly referred to as the deltoid ligament.

A series of tendons run across the joint from the leg into the foot. These tendons belong to muscles that control the movement of the foot, including plantarflexion (pointing the foot in a downward position), dorsiflexion (bringing the foot upwards), inversion, and eversion. There are also a number of arteries, veins, and nerves that run across the ankle joint that provide blood and sensation to the foot.

Injuries to the ankle, as common as they are, can be described by several different classification systems. The two most commonly used are the Lauge-Hansen and Danis-Weber systems.

The Lauge-Hansen system classifies ankle fractures based on the mechanism of injury, taking into account both the position of the foot at the time of injury as well as the movement of the leg. For example, one of the categories for the classification is supination-external rotation. The first term denotes that the foot was in a supinated position at the time of injury. The second term indicates that the leg was externally rotated in relation to the foot, causing the injury. The four categories originally described by Lauge-Hansen included supination-external rotation (the most common mechanism of ankle fracture), pronation-external rotation, supination-adduction, and pronation-abduction. Another category was later added, pronation-dorsiflexion, indicating that the force causing the injury was an axial force through the bottom of the foot that would drive the talus bone up through the tibia. This, however, is more appropriately addressed as a pilon fracture.

Within each category of Lauge-Hansen mechanism, there are different stages indicating how extensive the damage is to the ankle joint. These stages correlate with the ankle structures effected by the injury. Shown in the diagram above, starting from top left and moving clockwise, are the supination-adduction, pronation-abduction, pronation-external rotation, and supination-external rotation injuries. The stages indicate the structures involved.

Another commonly used classification system for ankle fractures is the Danis-Weber classification. This is based on the anatomy involved in the injury, particularly the tibia-fibula syndesmosis, which is the joint between the two bones. The classification is based on the level of the fibular fracture associated with the injury. If the fracture is below the level of the syndesmosis, it is considered a type A injury. Type B would be at the level of the syndesmosis, and type B would be above the level. Danis-Weber classification helps to indicate the amount of damage to the tib-fib syndesmosis. Levels B and C are associated with damage to the joint, which may lead to instability of the ankle if not addressed during the treatment of the fracture.

The classification of ankle fractures is a very academic topic, and is used primarily to communicate between physicians treating the injured patient. Other descriptors may be beneficial in describing the injury, but the classification systems are a quick and easy way to relate what is going on with the injury between doctors and those involved. Because of the reliable patterns of ankle fractures, these classification systems are fairly universal, and have a good inter- and intra-observer reliability.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

863-299-4551

www.FLFootandAnkle.com

Accessory Navicular

The navicular bone, located on the medial (inside) foot, is sometimes associated with an accessory bone. This accessory bone is most commonly referred to as an accessory navicular or os tibiale externum, but may also be called navicular secundum, prehallux, bifurcate navicular, accessory tarsal scaphoid, extra scaphoid, or a divided navicular. The accessory bone may be fused (attached) to the navicular, or it may be located within the tendon of the posterior tibial muscle, which attaches to the navicualr at this point.

Accessory navicular is present from birth, and results from a secondary ossification center of the bone. This means that there is an additional area of bony growth in the growing foot, which may eventually attach to the main portion of the navicular by either a bony attachment or with cartilage.

Symptoms of an accessory navicular include pain associated with shoes rubbing against the bony prominence, or pain developing from an eversion-type twisting injury. In the event of a twisting injury, the accessory bone may become detached from the main body of the navicular, essentially acting as a fracture of the bone.

Identification of the os tibiale externum, or the accessory navicular, begins with a thorough hirtory and physical examination. Frequently the accessory bone can be felt through the skin, or even seen on gross examination. X-rays are typically required to differentiate the accessory bone from an enlarged navicular or any other type of fracture of the bone. An MRI is not always necessary, but may be ordered if the diagnosis is not definite.

Once the condition is recognized, treatment may begin with conservative therapy, often involving padding the area and preventing it from rubbing against a shoe. In the event of a fracture through the bone, or a detachment of the bone from the main body of the navicular, it may be immobilized in a hard or soft cast. A number of factors play a role in this clinical decision-making.

Eventually, surgical removal of the accessory bone may be required to alleviate the symptoms. Depending on the particular type of accessory navicular, a number of different surgical techniques may be used. This is at the discretion of the treating foot and ankle surgeon. Typically, the offending bone will be removed in order to relieve the symptoms.

Post-operative care generally consists of protection with a cast, or a soft bandage and a surgical boot. Keeping off of the foot is usually indicated in allowing the foot to heal. Some pain and swelling should be expected. Analgesics may be used to alleviate some post-op pain, and elevation, ice, and rest are typically used to remove some of the swelling associated with the surgery. Details of the surgery may be discussed with your foot and ankle surgeon, including post-operative planning and the risks associated with surgery.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Dyshidrosis

Dyshidrosis is a disorder of the skin that is characterized by small blisters on the hands and/or feet. It is also known as pompholyx, podopompholyx, cheiropompholyx, acute vesiculobulbous hand eczema, and dyshidrotic eczema.

Most commonly the condition presents on the fingers and toes, in particular it may be present on the lateral sides of the digits. Dyshidrosis is a pruritic, or itchy, condition, particularly when it is located on the sides of the digits. It typically begins as a number of small, tense blisters, which are deep seated in the skin. Over time these small blisters may coalesce into larger blisters, but do not commonly rupture. However, if the vesicles do rupture, this may lead to secondary bacterial infections.

It was previously believed that dyshidrotic eczema was caused by faulty sweat glands, which led to the name “dyshidrosis”. However, this hypothesis has been refuted due to the evidence that shows that the vesicular lesions are not in fact related to the eccrine sweat glands.

It is commonly accepted now that dyshidrotic eczema is a multifactorial disorder, which is commonly related to other skin conditions and precipitating factors. In particular, atopic diathesis (such as hay fever, eczema, asthma, and allergic sinusitis) has been shown to be present in as many as 50% of patients with Dyshidrosis.

While excessive sweating may not cause it, dyshidrosis has historically been linked to an excessive output of sweat. However, cases reported of dyshidrosis without hyperhidrosis (excessive sweating) dispute the causation. It is possible that dyshidrosis is linked to anxiety, stress, and frustration, which may cause outbreaks or exacerbate the symptoms.

An association with nickel sensitivity has also been reported. Systemic exposure to high levels of nickel may be from foods that are high in nickel, such as cocoa, chocolate, whole grains, and nuts. Diets that restrict intake of these foods have been shown to reduce the number of outbreaks of dyshidrotic eczema.

Chemical and mechanical irritants have also been indicated as a cause of dyshidrotic eczema outbreaks. This may include things such as keeping the hands and feet damp, using strong soaps or detergents on the hands and feet, exposure to latex or other materials that cause documented allergic reactions, such as bandages, skin tapes and plasters. Dyshidrosis may also be seen in correlation with fungal and/or bacterial infections of the feet. There has also been a well-documented inheritance pattern and genetic predisposition to dyshidrotic eczema.

Dyshidrotic eczema is diagnosed by first ruling out a number of other possible diagnoses. This may include infection, allergic reaction, blistering disease such as pemphigus vulgaris, and a number of other dermatological conditions.

Treatment of dyshidrosis is largely symptom based, and many cases will clear spontaneously within several weeks. Topical steroids are often used to reduce itching, and oral steroids are occasionally used in cases of intense outbreak. When blisters are present, draining of the blisters may be appropriate, as well as using compression bandages with drying agents such as Burow solution. A number of other treatments have been used experimentally, such as Botox injections, UV-A light therapy, Nickel chelators, and a number of oral medications.

Other therapies include diet modifications to avoid exacerbating foods, as well as behavioral modifications to avoid irritating substances. Allergy testing may be indicated for patients with a known or suspected allergy to certain substances.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Nail Changes in Systemic Disease

(Hutchinson’s Sign in melanoma)

An important aspect of the clinical exam for podiatrists is the careful examination of the toenails as well as the fingernails. A variety of systemic diseases can appear in both the hands and feet, and analysis can often lend itself to revealing an underlying systemic condition. The following is a brief list of some of the changes to the nail and fingers and toes, as well as the underlying conditions associated with the changes.

• Nail Clubbing – This is a condition that is caused by a thickening of the soft tissue beneath the proximal portion of the nail plate (the area closest to the knuckle, or the distal interphalangeal joint). A specific finding of nail clubbing is to put the two index fingers next to each other, with the nails facing each other. If the distal interphalangeal joints of the two fingers touch, and the distal end of the nails do not come in contact with each other, it may indicate clubbing of the digits. Nail clubbing is most commonly associated with pulmonary disease, such as emphysema, cystic fibrosis, lung abscess, pulmonary fibrosis, and bronchogenic carcinoma. It is also commonly seen in inflammatory bowel disease, celiac disease, and cirrhosis of the liver.

• Nail Pitting – Most commonly associated with psoriasis, nail pitting is a series of small, punctate depressions in the nail. It is caused by a defect in the layering of the nail plate as it grows out of the nail matrix. Nail pitting may also be seen in systemic diseases such as Reiter’s syndrome, connective tissue disorders, sarcoidosis, and pemphigus. A localized dermatitis may also cause nail pitting, if it disrupts the normal growth of the nail plate.

• Koilonychia – Also termed “nail spooning”, koilonychia gives the nails a spoon-like appearance, with a central depression of the nail plate. It may be due to repeated chemical exposure or trauma to the nail, but is also associated with a variety of systemic conditions. Hemochromatosis and iron-deficiency are two of the conditions that the clinician should be suspicious of when koilonychia is found. Koilonychia can also be a normal variant in the infant child, which usually resolves with age.

• Onycholysis – This is a separation of the nail plate from the underlying nail bed, most commonly at the distal end of the nail, and usually caused by trauma, warts, onychomycosis, or as a finding of psoriasis. However, in the absence of these explanations, it may be associated with hyperthyroidism. When onycholysis is seen in hyperthyroidism, the condition is termed “Plummer’s nails”.

• Leukonychia – Any whitening of the nail in a random, non-linear pattern may be termed leukonychia. It is a very common finding in the nails of both children and adults. Many people will have several white spots on one or more nails, that grow out with time. These are benign lesions that are of no consequence, are believed to be caused by random microtrauma to the nail matrix. A whitening of one or more nails in a linear fashion that parallel the lunula (the half-moon shaped lighter portion at the proximal end of the nail) may indicate a number of systemic disease, and should be evaluated by a physician.

• Longitudinal Linear Lesions – Darkened lesions that run longitudinally along the nail should always be shown to a clinician. Benign lesions must be distinguished from melanoma, which can be seen growing underneath the nail plate. Unexplained darkening in a longitudinal pattern along the nail plate should be considered malignant until proven otherwise with a biopsy.

This is simply a brief listing of some of the changes seen in the nail and surrounding tissues associated with a variety of systemic diseases. Always let your doctor know of any recent changes to your nails.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Dog Eats Toe, Saves Owner’s Life

Strange news from Grand Rapids, Michigan today as a Jack Russell terrier saved its owners life after gnawing off the man’s big toe.

Yes, you read that correctly.

Forty-eight year old Jerry Douthett’s dog, Kiko, sniffed out an infection that had been growing in Jerry’s toe for several months. The wound had been the result of a small sliver that Douthett had attempted to remove himself by cutting at it with a knife. What ensued was a serious infection that would swell greatly over time, and eventually would spread to the underlying bone.

Douthett’s wife, a registered nurse, recognized the infection as possibly related to diabetes, and urged her husband to seek medical attention. After weeks of delay, Jerry would finally be forced to heed this advice.

The canine-amputation resulted in a hospital visit that would uncover Jerry’s type II diabetes, as it was undiagnosed at the time. Doctors removed what was left of the gnarled and infected toe at the hospital.

Kiko had been sniffing at the wound for quite some time, but was finally able to rid his owner of the infected toe when Jerry came home from a bar. Jerry had drank several beers and margaritas, and fell fast asleep upon arrival. Jerry would wake up later to a missing toe and pool of blood in his bed.

"The toe was gone," said Douthett. "He ate it. I mean, he must have eaten it, because we couldn't find it anywhere else in the house. I look down, there's blood all over, and my toe is gone."

What Kiko was able to sniff out is unfortunately a fairly common situation in the diabetic foot. A loss of pain sensation in diabetic peripheral neuropathy can allow someone to have a serious foot infection without much pain. This is also what would help Kiko chew off the toe without causing too much pain. Combined with the diminished immune system of the diabetic patient, this sets up a dangerous situation.

Now that Douthett is out of the hospital, he has sworn off drinking and is trying to take better care of his health. This starts with working to control his diabetes.

For diabetic patients, it is crucial that they check their feet for open wounds or areas that look like the skin is breaking down. These areas can quickly become infected. For a person with diabetes, something as simple as a hangnail could turn into a big problem. Jerry Douthett learned this in a difficult way.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Rickets

Rickets is a softening of the bones in a child, sometimes referred to as childhood osteomalacia. It is caused by a decrease in calcium absorption, most commonly due to a decrease in activated vitamin D.

Vitamin D is an essential component of calcium metabolism in the body. Activated vitamin D allows for the absorption of calcium from our diet. Without it, much of the ingested calcium in our diet passes through the intestines without being absorbed and utilized by the body.

The activation of vitamin is a complex reaction that is activated by UV light, in particular UV-B from the sun’s rays. A certain amount of exposure to sunlight is required to generate activated vitamin D everyday. In an adult, it takes approximately 15-20 minutes of direct sunlight on non-protected fair skin to generate approximately 10,000 IU of vitamin D everyday.

In children, however, the amount of time required to activate an appropriate amount of vitamin D is unknown and is difficult to measure. Factors such as age, skin tone, body mass, geographical location and season will all play a role in altering the total. In children, 400 IU of vitamin D are required daily to prevent Rickets and to maintain a healthy level of calcium in the body. It has been shown that children with darker skin pigmentation may require 5-10 times as much sunlight exposure as fair skinned children to activate the daily requirement of vitamin D.

Children aged 3-18 months are at a particularly high risk for the development of rickets, because their bones are growing rapidly at this point in development. High risk groups include children that are strictly breastfed, children with darker skin pigmentation, and children with very limited exposure to sunlight.

In developed countries like the United States, the incidence of Rickets is extremely low (approximately 1 in 200,000 will develop the condition). However, in the developing world, it remains as one of the more common conditions attributable to malnutrition. A lack of vitamin D in the diet is to blame; foods rich in vitamin D include eggs, butter, fish liver oils, fortified milk, and oily fishes such as tuna, herring and salmon.

Symptoms of rickets are due to a lack of calcium, most notably the skeletal deformities that result from the softening of the bones. This includes the classic bow-legged appearance of the tibia and femur, cranial and spinal deformities, and costochondral swelling (swelling along the ribs at their attachment with the cartilage, also known as “rachitic rosary”). Other symptoms include muscle weakness, growth disturbances and failure to grow, dental problems, bone pain, and an increase risk of fractures.

The Indoor Air Quality Act of 1989 reported that Americans spent roughly 93% of their day indoors, which only further compacts the problem of limited sunlight exposure and the development of rickets. Due to the modern lifestyle of developed countries, as well as campaigns to limit sun exposure due to its influence on developing various forms of skin cancer, it is predicted that the incidence of rickets may rise in the future. This has already been observed in Western countries.

Treatment of rickets may be multi-faceted, but includes supplementation with activated vitamin D as the mainstay. Increased exposure to sunlight may be recommended in some cases, though the risk of skin cancer from over-exposure warrants a word of caution. In cases where skeletal deformity has developed, accommodative bracing, orthotics, and other devices may be used.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

Ingrown Toenails

Ingrown toenails can be an excruciating experience. They happen when the nail grows into the skin around the toe, and can lead to a tremendous amount of pain, or even infection.

The best way to avoid getting an ingrown toenail is to cut your nails straight across, without rounding off the corners. When the corners of a toenail are trimmed, they have a tendency to grow back into the skin.

If you have diabetes, nerve damage to the legs and/or arms, or are otherwise prone to infections, do NOT try treating an ingrown toenail yourself. This can lead to serious complications. If you fall into this category, you should consult with your podiatrist or primary physician immediately.

If you’ve got an ingrown toenail and it’s starting to turn red, or if there is pus coming out of the skin, it is most likely infected already. In this situation, your doctor may prescribe antibiotics, as well as trim out the offending nail border. This can be done in several different ways.

Often, a podiatrist may cut out the entire border of a nail. This is especially done in situations where an ingrown toenail is a recurring event. By removing the entire border of the nail, the chances of the nail growing back into the skin are very low.

When the entire border of the nail is to be removed, your doctor will first numb the area with a local anesthetic. This is to ensure that you have no pain during the procedure. The procedure is fairly quick, and it involves cutting into the nail and removing a small piece.

The root of the nail is often removed as well. The idea behind removing the root of the nail is that this is where the nail grows from. If the root of the nail is gone, then the nail will not be able to grow into the skin. Thus, the problem of the ingrown toenail is solved.

Many people have a problem with recurring ingrown toenails. The key is to prevent infection. Infection of an ingrown toenail is known in the medical community as a paronychia. Paronychia is usually a problem that will go away with treatment, but can evolve into a more complicated situation if left untreated. This is particular true in someone with a compromised immune system, such as a diabetic patient.

In the diabetic patient, the immune system is not functioning at full capacity. The same may be true for patients that are on oral steroids for rheumatoid arthritis or other systemic disease. For these patients it is especially important to seek treatment right away.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Varicose Veins

Podiatrists are known to treat the foot and ankle and leg. To the average person, it seems like the typical problems a podiatrist is limited to are bunions and warts. The common conception is that their expertise is confined to the foot in the areas of the muscle, bone and skin.

However, podiatrists are well-versed in many aspects of the foot, ankle and leg – nervous system disorders, musculoskeletal pathologies, dermatopathologies and vascular anomalies! Varicose veins are one such anomaly that is quite common in the population.

What are veins? Veins are a type of blood vessels that take the blood from different parts of the body TO the heart. They only function in ONE direction. The one-way direction is due to the one-way valves that are within the vessels. Varicose veins arise when the valves are malfunctioning. When a valve stops working properly, blood which was destined to the heart starts to flow back towards the legs (or other extremities). The blood is now going in the opposite direction it was supposed to be going! As a result of this backward blood flow, pressure in the veins starts to rise and causes varicose veins! Varicose veins are essentially veins that are receiving so much pressure that the start to expand and engorge. The elastic properties of the vein allow for it to expand due to pressure and it thus it protrudes out of the skin.

There are a variety of risk factors which can cause the veins to start swelling due to the pooling of blood.

A. Family history is one factor – you may genetically have valves that are incompetent;

B. Occupation – standing on your feet for greater periods of times increases venous pressure

C. Obesity

D. Pregnancy

E. Age – with increased age, vessel function starts to deteriorate

Varicose veins are not usually painful but you may feel a deep ache in the area. Swelling and discoloration may also be noted in the area of the engorged veins. The color starts out reddish and may turn to brown with time. The most common complaint is the fact that these veins just look ugly! If untreated, skin erosions can occur; this may progress to venous stasis ulcers which have a poor ability to heal! If you find that you do have varicosities, don’t hesitate to see your podiatrist! They have the knowledge and expertise to guide you to a solution and prevent this medical condition from becoming worse!

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com

Small Girls and Tall Heels!!

Every little girl has tossed on a pair of her mom’s high heels, doused herself in red lipstick, put on a string of pearls and topped off her ensemble with a floppy oversized hat! It is one thing to play dress up; however, it’s another thing when infants or little girls are seen wearing high heels for any period of time!

Many women are already well-aware of the damaging effects of heels on the feet. Heels themselves are a hazard for walking because they alter your center of gravity. In addition, all of your body weight which is meant to be distributed evenly across your feet is now on the ball of your foot. The ball of your foot is not designed to bear your weight and does not function well in terms of shock absorption. So the impact of the forces from the ground and the body weight from above leading to pain called metatarsalgia!

Other conditions that can occur with heels are Morton’s neuromas, corns, calluses, bunions, and hammertoes. The damaging effects of heels are not just limited to feet either! Heels affect your posture by pushing your hips and spine out of alignment! The knees are also prone to injury because heels place additional force on the inside of your knee! The calf muscles may shorten and tighten as a result of excessive contraction needed to adjust to the angle of high heels.

Many podiatrists are concerned with the advent of celebrity moms dressing their children in high heels and being seen in public. High heels are ill-advised in adults and the implications on children can be even more devastating. The bones of a child are not yet fully-formed or fully-calcified; bone formation in the foot in particular partly relies on how the forces are transmitted. The wearing of high heels alters these normal forces and can affect the normal ossification pattern of the bones! And remember, foot problems will not be the only problems that will arise from wearing high heels too early. Knee, hip and back problems can occur due to the change in the body’s center of gravity as a result of high heels. These are not problems young children should ever have! One way to AVOID these musculoskeletal problems is to delay wearing heels as long as possible! Talk to your podiatrist about the implications and possible complications of wearing high heels at any age!

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com