Vascular Testing, Ankle Brachial Index

WHAT IS P.A.D. ?

Peripheral Arterial Disease (P.A.D.) occurs when there is a build up of cholesterol and plaque in the arteries of the lower extremities, causing decreased blood flow to the legs and feet.

WHAT IS AN A.B.I. TEST?

A.B.I. or Ankle-Brachial Index is a non-invasive, pain-free test. The exam often takes 15-20 minutes, It feels similar to having your blood pressure taken during your regular check-ups. You will lie down on the exam table.

Pressure cuffs will be wrapped snugly around your arms, above knees, calves and ankles. The technician will inflate the cuffs, and sensors record the pulse waves. Let the technician know if the pressure from the inflated cuffs is uncomfortable.

Your blood pressures will be recorded at your arms and ankles. The ankle-brachial index, known as the ABI, is determined by the ratio between these pressures.

PAD is diagnosed if your ankle pressure is lower than your arm pressure. With severe narrowing, the ABI or ankle pressure may be half of your arm pressure. Your doctor may recommend additional diagnostic tests if the ABI is abnormal. 

PLANTAR FASCIITIS

WHAT IS PLANTAR FASCIITIS?

Plantar fasciitis (PLAN-tur fas-e-I-tis) involves pain and inflammation of a thick, ligament-like band of tissue, called the plantar fascia, that runs across the bottom of your foot and connects your heel bone to your toes. This band pulls on the heel bone, raising the arch of your foot as it pushes off the ground. If your foot moves incorrectly, the plantar fascia could become strained. The fascia may swell and its tiny fibers may begin to fray causing Plantar fasciitis.

CAUSES

Plantar fasciitis is usually caused by improper foot mechanics. If your foot flattens out too much, the fascia may overextend and swell. If your foot flattens too little, the fascia may hurt from being pulled to tight.

SYMPTOMS

Stabbing foot pain that usually occurs with your first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally lessens, but may return after prolonged movement or after rest. The pain usually happens on the inside of the foot, close to the spot where your heel and arch meet.

MEDICAL HISTORY AND PHYSICAL EXAM

Your podiatrist may ask you about your symptoms first. Where does it hurt? When and how often? Next, he or she may examine your foot and feel for damaged ligaments, displaced bones or joints and inflamed tendons. Your podiatrist may also watch you walk to see if your symptoms are caused by improper bio-mechanics. X-rays may be taken to see if there is a stress fracture of the heel bone or a heel spur.

TREATMENTS

To relieve mild symptoms try aspirin, ibuprofen, or other medications as directed. Rubbing ice on the affected area may also help.

If your pain is due to poor foot mechanics, custom molded orthotics, shoe inserts, may help.

To reduce severe pain and swelling, your podiatrist may prescribe injections or pills. Physical therapy, such as stretching or ultrasound may also be advised.

To reduce symptoms caused by irregular foot bio-mechanics, your podiatrist may tape them or use strappings that will support the arch and temporarily controls movement. Night splints may also be used.

It may also help to avoid running on hard or uneven ground, wear house slippers that support your arch and lose excess weight.

SURGERY MAY BE NEEDED

Your podiatrist may want to do a procedure if all other treatments don't control the pain. In surgery, the plantar fascia is partially cut to release tension. As you get better, fibrous tissues fill in the space between the heel bone and the plantar fascia.

WARTS

What are Plantar Warts?
A wart is an infection caused by a virus, which can enter your skin through small breaks or cuts. Warts
are one of several soft tissue conditions of the foot that can be quite painful. Over time, the wart
develops into a hard, rough growth on the surface of the skin.


Technically only those on the bottom of the foot are properly called plantar warts.

Children, especially teenagers, tend to be more susceptible to warts than adults; some people seem to be immune.

Identification Problems
Warts are generally harmless, even though they may be painful. Many times they are mistaken for corns or calluses—which are layers of dead skin that build up to protect an area which is being continuously rubbed. The wart, however, is a viral infection. If left untreated, warts can spread to other parts of the body, like the hands.

It is also possible for a variety of more serious lesions to appear on the foot, including malignant lesions such as carcinomas and melanomas. Although rare, these conditions can sometimes be misidentified as a wart. It is smart to consult a podiatric physician when any suspicious growth or eruption is noticed on the skin of the foot in order to ensure a correct treatment and diagnosis.

Plantar warts tend to be hard and flat, may appear spongy, with tiny red, brown or black spots, with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. They can grow up to an inch or more across, occurring alone or with smaller warts clustered nearby. It is important to note that warts can persist for years and recur in the same area.

Source of the Virus
The plantar wart is often acquired by walking barefoot on dirty surfaces. Avoid going barefoot in public places like showers, gyms, and locker rooms. Wear sandals on your feet. The causative virus thrives in warm, moist environments.
Occasionally, warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.
When plantar warts develop on the weight-bearing areas of the foot—the ball of the foot, or the heel, for example—they can be the source of sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.

Tips for Prevention
• Avoid walking barefoot, except on beaches.
• Change shoes and socks daily.
• Keep feet clean and dry.
• Check children's feet periodically.
• Avoid direct contact with warts.
• Do not ignore growths or changes in your skin.
• Visit your podiatric physician.

Self Treatment
Self treatment is generally not a good idea. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes a podiatric foot and ankle surgeon to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self treatment with such medications especially should be avoided by people with diabetes and those with cardiovascular or circulatory disorders. Never use them in the presence of an active infection.




Professional Treatment
It is possible that your podiatric physician will prescribe and supervise your use of a wart-removal preparation. More likely, however, removal of warts by a simple surgical procedure, performed under local anesthetic, may be indicated. Lasers have become a common and effective treatment. A procedure known as CO2 laser cautery is performed under local anesthesia where the wart is vaporized using focused light energy in your podiatrist’s office surgical setting. The laser reduces post-treatment scarring and is a safe form for eliminating wart lesions.

Tips for Individuals with Warts
• Avoid over-the-counter preparations.
• Seek professional podiatric evaluation.
• Diabetics should be especially careful.
• Warts may spread and are catching.