I’m sure most of you have never heard of a Salter Harris fracture before unless you, a sibling or one of your own children has had one. Salter Harris fracture is different from other common fractures because the fracture occurs at the growth plate; so that makes this fracture special to pediatric patients! There are 9 types of this fracture, 5 are more common, and 4 of them are very rare. We will discuss the 5 more common types. Type I is a transverse fracture through the growth plate, this fracture basically separates the bone in two by splitting the growth plate. Type II is a fracture through the growth plate and through the “neck” part of the bone above the plate. This is the most common form seen! Type III is a fracture through the growth plate and the part of the bone below the plate. Type IV is a fracture through the growth plate and the “neck” above and the area below the plate. Type V is a compression fracture through the growth plate, the fracture doesn’t separate the bone in two like a Type I, the distance of the plate is reduced making the bone “shorter”.

Since the growth plate is involved in this fracture, your podiatrist's main concern will be figuring out how this will affect the growth of the child. For Type I and II growth disturbance is usually uncommon with no functional limitations. A Type III however usually results with the child having a chronic disability, but there is usually no growth deformity. A Type IV is similar to a Type III in the fact that is causes a chronic disability, but it also can cause a deformity of the joint because of the bones fusing together. Type V is a little more difficult to diagnose because the growth plate isn’t necessarily being fracture, it is being compressed. Since the growth plate is being compressed it can cause problems in growth for the child, it can cause the growth plate to fuse earlier than it normally would.

If your child falls and you think that they may have fractured one of their leg bones, make an appointment to visit one of the podiatrists at Affiliated Foot and Ankle Care, located in both Monroe and Edison, NJ to get a diagnosis! The only way to diagnose these fractures is by x-ray; and most of these fractures will require surgery to fix and rehab will be required to regain strength of the foot and leg.

By Dr. Varun Gujral

What exactly is this? It is just extra bone growing off of normal bone. This seems like a strange thing to happen in our bodies, so how does bone that’s not supposed to be there, grow? These spurs grow in response to pressure, rubbing or stress on the normal bone. In the foot this typically happens in places where tendons attach to the foot and “pull” on the bone, causing new bone to grow. This is a common sports injury in professional basketball players.  Both Kobe Bryant, of the Los Angeles Lakers and Deron Williams, of the Brooklyn Nets, suffer from bone spurs.

When people think of spurs they normally think of harmless, smooth, rounded “bumps” of bone, and this is normally what bones spurs are. But sometimes these spurs can be sharper or rubbing against tendons or muscles and can be painful. In the foot a very common place for this to happen is in the heel; this is called a heel spur. This can form from the tendons attaching to the heel being used heavily in exercise; they are also very common in women who wear high heels frequently!

Most people who have bone spurs don’t even know it, and could have them their entire lives and never need them treated. However in some cases, like Kobe’s and Deron’s, the bone spur causes a lot of pain and needs to be taken care of. The way to find out if a bone spur is the cause of your foot is pain is to make an appointment  at your local  podiatrist and get an x-ray.  The doctors at Affiliated Foot and Ankle Care, located in Edison and Monroe NJ, can help make the proper diagnosis for your foot pain!

If a bone spur is the cause of your pain there are three ways to approach the problem. The treatment can be directed at what is causing the bone spur, the symptoms or the bone spur itself can be treated. Excessive weight and strain on the tendons of your feet are common causes, so a treatment based on causes could be weight loss or reduced or changed activity. To treat the symptoms can be done by NSAIDs or shoe inserts to relieve the stress off your foot. And lastly to actually treat the spur itself your podiatrist can surgically remove the spur.

By:  Varun (Ben) Gujral, DPM

I’m sure everyone has heard about Kobe Bryant’s devastating injury, and the fact that his season, maybe even career is over. So what exactly happened to him? Kobe ruptured his Achilles tendon. If you feel at the back of your ankle, you feel a long hard thing that is your Achilles tendon. This is where your calf muscles attach to your heel bone to keep your foot and ankle stable.

A rupture/tear of this tendon can occur by suddenly pointing your toe up or down and landing on the foot in a weird position. There is an area of this tendon called the watershed area; this is a weak area of the tendon because it doesn’t receive as much blood supply as the rest of the tendon so it is more likely to be injured there. It is very common for this injury to occur in athletes playing basketball or football.

The common signs and symptoms of this injury include swelling and pain at the back of the ankle, hearing a “popping” noise when the injury occurs, and a positive Simmonds test.  When you see your podiatrist, he will perform the Simmonds test, which is when he squeezes your calf muscles and looks at the movement of your foot.  It is considered a positive test when there is no movement of the foot, and the patient is unable to point his toes downward.

Your local podiatrist at Affiliated Foot and Ankle Care in Edison and Monroe NJ can take care of you if you feel that you have experienced this kind of injury. The first thing the podiatrist will do is look at the ankle and perform tests like the above described Simmonds test, and then he will order an MRI to confirm his diagnosis.

If an Achilles tear is diagnosed, surgery will be required. The tendon will be stitched back together and then stabilized for a few months to allow the tendon to repair. After surgery physical therapy will be required to regain strength in the foot and leg. Kobe Bryant will require surgery and a lot of rehab therapy if he wants to return to the Lakers anytime soon!

By Dr. Ben Gujral

Spring is finally here! But for most of the country we haven’t seen any signs of spring-like weather yet! (I know I’m disappointed too.) Along with this extended cold weather comes the increased likelihood of something called Raynaud’s disease. Have you ever been outside in the cold for a long period of time and when you came in your toes were purple or blue?! This is Raynaud’s Disease! The cold causes the small arteries in your toes to constrict and get smaller, which limits the blood flow to the toes and causes them to become discolored. This is not the same thing as frost bite, the symptoms are different. Cold feeling toes, color changes, numb feeling and a pricking or stinging feeling as the toes warm up are the symptoms of Raynaud’s.

Most of the time this is just annoying to deal with it, but it will go away on its own. But in recurring, severe cases or cases that are secondary to another disease, it is necessary to see a podiatrist for treatment.

Some diseases that increase the likelihood of Raynaud’s Disease and would require medical attention include Lupus, Scleroderma, Carpal Tunnel, Rheumatoid Arthritis and Sjorgens Syndrome to name a few.  If Raynauds develops and you have any of these conditions it is important to go see your local podiatrist at Affiliated Foot and Ankle Care to get the proper treatment. We have offices conveniently located in Edison and Monroe, NJ. Severe cases of Raynaud’s Disease are rare but do need to be treated!

Treatment for mild Raynaud’s is to warm up the affected areas, usually heating pads work great! In more severe cases or cases with underlying conditions medications may be prescribed. These medications include calcium channel blockers which will relax the small arteries in your feet so they stay open; alpha blockers are also used, which counteract the normal hormones in your body that constrict blood vessels, so they in turn will relax the arteries.

The most important thing after treatment that your doctor will discuss with you will be how to prevent future attacks! The common recommendations are to dress in layers and make sure skin is fully covered and kept warm and dry. So for this extended winter make sure to stay warm and covered up when going outdoors!

By Dr. Ben Gujral

I’m sure a lot of people have never heard the word talus before, but when getting to know your feet it is a very important bone. It is the one that is above your heel bone and below your two leg bones; it makes up the ankle joint. So it sounds like this is a very important bone in our feet, and it is. So what happens when you break this bone?

Let’s first see how you can actually manage to break this bone. The most common way is in car accidents, but it is also common in falls from great heights, and is very common in snowboarders. I know most of us are anxious for winter to be over, but there are a few people out there like professional snowboarder Shaun White who live for the snow, but living for the snow and snowboarding puts him at a greater risk of breaking his talus!

Some common symptoms of a talar break are tenderness and swelling, an inability to bear weight on the foot and obviously a lot of pain! In snowboarders this injury is sometimes mistaken for an ankle sprain because there is tenderness and bruising on the outside of the ankle. The only way to determine if you have a talar fracture is to go see your local podiatrists at Affiliated Foot and Ankle Care, located in Edison and Monroe NJ, immediately after an injury to get x-rays.

Your podiatrist will ask you what happened when the injury occurred and will take x-rays to look for a talar break. Before a diagnosis is made however it is important to put a padded wrap around the ankle and to elevate it above the heart and apply ice every 20 minutes until you can get to a doctor.  After the doctor has made a diagnosis there are surgical and nonsurgical treatments. Most cases will require surgery; however sometimes if the bones are still in proper alignment you can get heal the fracture with casting for 6-8 weeks. A majority of cases though require surgery and casting for 6-8 weeks with no weight bearing on the foot for at least 3 months. After the cast has been removed, physical therapy will be required to restore strength to the foot.

By:  Dr. Nrupa Shah