The news is out that Kristen Stewart sustained a foot injury on the set of the latest Twilight Saga movie.  I can't say I'm really a fan of the series, although that Taylor Lautner certainly is in shape.  Apparently Kristen suffered a puncture wound to her foot, though we’re not exactly clear what object caused the puncture (probably not a vampire tooth).  The wound was so bad that she had to wear - gasp! - sensible shoes during an interview with Jay Leno.  So, what is the deal with puncture wounds, anyway?  

If I got a nickel for every object that I’ve pulled out of patients’feet in my NYC podiatry office over the past eight years... Well it's more than a nickel, but it requires more effort than you would think.  The feet are quite prone to puncture wounds, in which a foreign object - you guessed it - punctures the skin of the foot, often while walking barefoot, and penetrates the skin.  As expected, these wounds are quite common in the summer months.  Some of the objects I have fished out include splinters, glass, cactus spines, and most frighteningly, insulin needles from diabetic feet.  This last category is especially worrisome due to the fact that diabetics can develop numbness in the feet, known as diabetic neuropathy, which prevents them from feeling an initial puncture wound allowing then a small wound to quickly develop into a big problem.

It can be very difficult to extract these objects from the feet in the office, and I certainly would advise against anyone digging for treasures themselves at home.  Foreign bodies can appear superficial, but in fact be deceptively deep.  And if left untreated, there is risk of infection, especially in patients who suffer from diabetes or peripheral artery disease.  Fortunately, my NYC podiatry office is equipped with diagnostic ultrasound and fluoroscopy, two imaging modalities that allow visualization of soft tissue and foreign bodies in real time.  Thus, these objects can often be removed in the office under local anesthesia, with minimal damage to surrounding tissue.

So this summer, enjoy the beach and outdoors, and consider the use of sunscreen and shoes.  And if something should happen, make an appointment and head on over to our NYC office.  Kristen - I can even squeeze you in for an appointment.

See you in the office.

Dr. Ernest L. Isaacson

Well it’s over.  My first marathon is behind me, and I am now a runner.  All that training, motivation and hard work paid off in the form of a beautiful Sunday morning run through the streets and parkways of Long Island, and in the end I was left with a medal, an achy body, and a big fat check off my bucket list. 

So how was it? It was hard.  Up until about 17 miles I was OK, but after that point, even though I’ve kept up with running tips, I think my body was ready to be done.  It took some serious motivation and some slow walks through the hydration stations to continue the marathon.  I learned that the body can indeed be pushed harder and farther than I thought possible, and that the mind is a powerful force.  Upon hitting the wall at the 17 mile point, I had to tell myself that I was not going home without finishing, failure was not an option, and I was going to show the marathon who was boss (to phrase it for a PG rated audience).  These are the moments that make us, and I had plenty of my own. 

At the 23^rd mile mark, I was able to summon a burst of energy to run until the end, but my quadriceps muscles were not happy about it.  Despite their protest, I carried through to the end, reached the finish line, and emerged a different type of runner, finally joining the ranks of so many who have also completed the full 26.2, going all the way back to Phidippides.  After hydrating, tweeting, and posting, I took the long walk back to my car, a victor in the battle against the Wantagh Parkway.

Now four days later I am recovering nicely.  After resting and stretching, I am now once again able to descend stairs without having to hold on to the banister.  My toenails feel better after I drained the blood from under the nail plate using an 18 gauge needle – one of many conditions I’ve treated in my NYC podiatry office.  And I can still feel the endorphin rush.  Not ready to run quite yet, but really looking forward to the next race.  Think I’ll take a short 10 mile run on Sunday.

See you in the office.                                                            

Ernest L. Isaacson, DPM

For the past few months, I have been chronicling my journey to the Long Island Marathon, or at least Tweeting my training runs.  It's now the final stretch, two days to go, and this Sunday I’ll hopefully have one more check on my “bucket list”.  Of course everybody has their own list, and ideally it seems that the items added should be just a bit more unattainable than they were in past lists.

We all start out with our own lists- crawling, walking, running, finishing high school, not getting stuffed into a locker again, finishing college, graduate school, career, family, some subjective form of success.  But it's nice to have other goals.  This is a big one for me personally, and leaves me with a few, such as finishing an entire cycle of the Talmud, which I plan to do this year (more on that later), as well as some professional and personal goals.

But believe me, if this NYC foot doc can do it, anyone can.  I am by no means a natural athlete, and was always the guy picked last for the team and voted most likely to run the ball the other way (don't ask).  As I mentioned in an earlier blog post, I started out slow, and there was a time that 3 miles seemed like a really long run.  Moving further away from my regular route forced a bump up to five miles for my regular short run.  After a little push, 10 miles became the standard, and now 15 miles is fairly effortless, albeit a little rough on the knees (!).  So despite the advice of my friend the orthopedic surgeon, I continue to run and increase my mileage (making sure, of course, to implement important running and stretching routines).

And this is where the lesson is brought home.  Just like running, life is a mind trip.  We have to keep going, move beyond our comfort zones, do what doesn't seem possible, and maybe sometimes, ignore minor aches and pains.  The endorphin rush will propel us forward, and in the end, upon reaching the goal, it is all worth it.  And of course, the journey should be a blast.  I'm just hoping I can make it through those last few painful miles and triumphantly cross the finish line so I can tweet some good pics. 

See you in the office.

Dr. Ernest L. Isaacson

An interesting picture of Steven Tyler, lead singer of Aerosmith, has been circulating recently.  Said picture shows his toes going west, young man, with a surprising degree of overlap, and toenail polish.  Dude looks like a lady, indeed.  Apparently the deformities have been attributed to a Morton’s Neuroma and the surgery which Steven underwent to remove the neuroma and, according to his book, some of the surrounding bones.  Well, the surgery itself may have disrupted some of the ligaments and tendons that hold the toe in a straight position, but as far as the neuroma itself leading to those unhappy feet, all I can say is- dream on.

What is a Neuroma?

A neuroma is a condition I see very commonly in my NYC podiatry office, in which a nerve in the ball of the foot becomes inflamed and swollen, leading to symptoms including pain, burning, tingling and numbness- certainly not a sweet emotion.  The most common location is in between the third and fourth toes, followed by the space between the second and third toes.  Tight shoes and heels tend to aggravate the condition, and wide shoes usually relieve the pressure and pain.  The condition is diagnosed through the history and location of the pain, and ultrasound and MRI can have some role in clarifying the diagnosis.

How is this treated, and can I still have love on an elevator?

Not sure about the second part.  Initial treatment usually involves an injection of cortisone, as well as some strategic padding and the use of a comfortable shoe.  If that fails, the nerve can be surgically removed or released.  In my NYC podiatry practice, I tend to favor multiple cortisone injections.  While they are decidedly not terribly pleasant, in most instances the pain is relieved by this method, and my patients would usually take any number of injections to avoid surgery, and I tend to agree.  I rarely remove the nerve, and tend to favor a newer procedure that allows me, through a very small incision and with endoscopic assistance, to cut a ligament that exerts pressure on the nerve.  This technique relieves the pressure while preserving the nerve.

So if you’re feeling a burning or aching pain in your forefoot, don’t keep “Livin on the Edge”, because that’s just “Crazy”.  Seek treatment while the problem is still manageable.

See you in the office.

Dr. Ernest L. Isaacson

A rather interesting photo surfaced in the British newspapers, featuring Chelsea Clinton, whom you all remember as the daughter of the former President and current Secretary of State Bill Clinton, wandering about the streets of Manhattan in a fracture boot.  The nature of her injury is unclear, although it may be related to a prior heel fracture that almost made Chelsea’s walk down the aisle a limp down the aisle two years ago.  All which brings us to the topic- what is a fracture boot and how can it be used to treat injuries, sprains, and fractures of the foot and ankle?

Some of the more common ailments that I treat in my NYC podiatry practice are fractures, especially in the toes and metatarsals.  These injuries as well as sprains, ligament injuries, and stress fractures are usually due to overuse or sports injuries.  In most cases, the injury will heal well, given some time and rest.  As I often tell my patients, the body wants to heal, we just have to enable it to do so. 

One of the best ways to accomplish this is through the use of a CAM (controlled ankle motion) walker or fracture boot.  You’ve probably seen these boots- they look like ski boots, large plastic boots with Velcro straps, and extend to the mid-leg or knee.  A foot in a CAM walker moves as one unit with the ankle, limiting foot motion and relieving pressure from the joints and bottom of the foot.  The bottom is a rocker, or rounded, which limits heel-toe walking and distributes pressure more evenly along the bottom of the foot.

So instead of placing my NYC podiatry patients in a fiberglass cast and requiring the use of crutches, patients who are injured or recovering from certain types of surgery can walk in a fracture boot, maintaining nearly full mobility while healing.  This has ushered in a quiet revolution in healing foot and ankle injuries, and in my practice, casts are almost never used for injuries--only to facilitate recovery after limited types of surgeries. 

This is great for the active patient, which includes almost everyone in Manhattan-including, Chelsea.  So if that injury doesn’t heal, I’ll squeeze you into the schedule; it would be great to have a patient who comes in, rather than leaves, with a Bill.

See you in the office.

Ernest L. Isaacson, DPM