Dr. George Williams Announces a New Skin Grafting Technology - Xpansion Micrografting

Dr. George Williams of Ankle and Foot Center of Tampa Bay ( 38105 13th Ave in Zephyrhills, 813-715-4747) is specially trained in Xpansion Micrografting, a new grafting technique just introduced this year. Dr. Williams was the first physician in Florida to use this innovative technique to heal difficult wounds.

A brief history of the progression of grafting technology: Split thickness skin grafts are a standard reconstructive technique frequently used in patients for burns, acute wounds following surgery or trauma and chronic wounds that fail to heal with nonsurgical management. Split thickness skin grafts are considered the gold standard.

For many wounds, limited donor skin can limit skin graft availability and coverage. Intraoperative meshed expansion of split thickness skin grafts is limited to a maximum nine times and usually no more than six times.
Minced skin technology addresses the existing limitations of skin grafting. First introduced in 1958, meshing of skin grafts was limited to expansion of 9 times.

In 2002, a technique was described where it was not necessary to orient the minced skin pieces in any specific direction. This technology has been simplified and now the intraoperative expansion of 100 times is possible with complete healing of full thickness wounds using the Xpansion Micrografting System from Wright Medical.

"I have heel pain" is a comment that podiatrists hear nearly every day. Patients complain that their heel hurts when they get out of bed in the morning, or after they've been sitting for long periods of time. Heel pain is non-discriminating; just about anyone can have it. Despite the many causes, it's a prevalent problem, but one that can have solutions. The heel bone, the largest in our foot, withstands a great deal of abuse as we cram it into our shoes day after day and subject it to our full weight with every step. With such abuse, it's no wonder that heel pain (most commonly called plantar fasciitis) is a problem for so many of us. In our pursuit of healthy bodies, we often let our heel pain go without treatment for much too long. Heel pain is generally the result of faulty biomechanics (walking/gait abnormalities), that places too much stress on the heel bone and the soft tissues that attach to it. The stress can also result from injury or a bruise incurred while walking, running, or jumping on hard surfaces. It can also be due to wearing poorly constructed footwear or from being overweight. Many people complain of heel pain after a night's sleep. As you walk, the heel pain may lessen or even disappear, but that may be only a false sense of relief. The pain usually returns after prolonged rest or extensive walking. Heel pain is commonly accompanied by a heel spur, a bony growth on the underside of the heel bone. The spur, visible by xray, appears as a protrusion that can extend forward as much as half an inch. Heel spurs are a result of strain on the muscles and ligaments of the foot, or a stretching of the long band of tissue that connects the heel and the ball of the foot. Your podiatrist can evaluate and treat this condition and recommend options that help to alleviate pain. Plantar fasciitis can usually be treated without surgery, using exercise or orthotics (custom-made or prescription shoe inserts). There are many other causes of heel pain other than plantar fasciitis. These can include arthritis, Achilles tendonitis or bone bruises. Stress fractures of the heel bone can also occur, although infrequently. When children suffer from heel pain, a visit to the podiatrist is imperative because their problems may be quite different from those of adults. Regardless of the cause, evaluation by a podiatrist is your first step to relief. To prevent heel pain, try some of these tips recommended by podiatric physicians:

• Always wear properly fitted shoes specific to your activity with shock-absorbent soles, rigid shanks and supportive heel counters.
• Replace shoes frequently and avoid excessive wear and tear.
• Warm up and stretch before and after exercise. Pace yourself when starting new exercise routines.
• If you are overweight, consider losing weight to reduce the stress on your feet and other bones and muscles in your body.
• Avoid walking barefoot on hard surfaces, both inside and out.

Do you suffer from "Flat feet"?
Recently an article ran in the New York Times, My Left Foot: The High Costs of Fallen Arches Click to Read the Article. Jennifer Prestifilippo interviewed one of our physicians, Dr. Jason Bottoms for more details.

What are "flat feet"?

A condition where the arch of the foot collapses, with the entire sole of the foot coming into complete or near-complete contact with the ground.

Why is there pain associated with "flat feet"?

Pain occurs because soft tissues (tendon and ligaments) have been stretched or torn. As the soft tissues continue to be stressed, symptoms tend to worsen. When pain in the foot, ankle, back or knees does occur, the feet should be evaluated.

What is the treatment for "flat feet"?

Anti-inflammatory medications, icing, physical therapy, supportive taping, bracing, and orthotics are common treatments for painful progressive "flat foot". (Please consult your physician before taking any medications.) In some cases, a surgery may need to be performed to repair a torn or damaged tendon and restore normal function.

If conservative treatment doesn't work what are my options?

In less severe cases of adult "flat foot", procedures involving tendons and ligaments (i.e., soft tissue procedures) may suffice. These usually result in less recovery time and postoperative discomfort. However, if the problem is a more severe deformity and arthritis has developed in the joints, then bone work may also be appropriate. In these types of procedures, bones are realigned and fixed in position as to actually construct an arch in the foot. Often times, joints are fused in order to eliminate pain that results from movement of these joints. These procedures usually require more recovery time in order for the bones to heal in the correct position.

As you head to the beach this summer we wanted to discuss some common injuries to look out for and some simple preventative treatments that you can utilize.Wear shoes to protect your feet from puncture wounds and cuts caused by sea shells, broken glass and other sharp objects. If jellyfish tentacles stick to the foot or ankle, remove them, but protect your hands from getting stung too. Vinegar, meat tenderizer or baking soda reduces pain and swelling. Also, do not forget to apply sunscreen to the tops and bottoms of your feet. Sand, sidewalks and paved surfaces get hot in the summer sun. Wear shoes to protect your soles from getting burned, especially if you have diabetes. Walking, jogging and playing sports on soft, uneven surfaces like sand frequently leads to arch pain, heel pain, ankle sprains and other injuries. Athletic shoes provide the heel cushioning and arch support that flip-flops and sandals lack. The 20 million Americans with diabetes face serious foot safety risks at the beach. Any type of skin break on a diabetic foot has the potential to get infected and ulcerate if it is not noticed right away. Diabetics should always wear shoes to the beach, and remove them regularly to check for foreign objects like sand and shells that can cause sores, ulcers and infections.

What Causes Blisters?
There are three main factors that contribute to blisters formation.

* Heat
* Moisture
* Friction.

It is difficult to do anything about the heat when running a race, so most blister prevention strategies concentrate on keeping feet dry and reducing friction.

Tips for Keeping Feet Dry
It doesn't matter whether a runner's feet are wet from sweating or running through water, but feet that stay wet are a major cause of blisters. Feet that stay wet become prune-like and blister very easily. Therefore, one focus for blister prevention strategies is keeping feet dry.

Strategies to keep feet dry include:

* Moisture wicking running socks

* Foot powders and ointments.

Running Socks
The first rule for all runners is to avoid cotton socks. When cotton socks get wet, they stay wet. The runner's feet never have a chance to dry out and therefore blister easily. Runners should wear socks designed for running that are made of moisture wicking fabrics. Modern technical fabrics do a good job of wicking the moisture away from the runner's feet, which then have a chance to dry out. Moisture wicking fabrics for running socks include CoolMax, Olefin, and Capilene. Injinjii toe socks also help prevent blisters on the toes.

Foot Powders and Ointments
Foot powders are a common strategy for runners to keep their feet dry. Talcum powder and cornstarch are two inexpensive low-tech foot powders. Zeasorb, Odor-eaters, Bromi-talc, and Gold Bond foot powders are all even more absorbent. Blister Shield Powder both absorbs moisture and reduces friction by combining micronized wax and cornstarch. Runners can pour these products into their socks to help absorb moisture when they start the run and when they change socks.To reduce sweating, many runners apply antiperspirants to their feet.

There are also ointments that can help runners keep their feet dry. Hydropel Sports Ointment both repels moisture and helps lubricate feet. Gurney Goo and Brave Soldier's Friction Zone are also designed to be waterproof and reduce friction. Runners can rub these ointments on their feet before they start and every time they change socks.

Tips for Reducing Blister Causing Friction
Friction is a major cause of foot blisters for runners. Many blister prevention strategies focus on reducing friction. First and foremost running shoes must fit well. If the shoe doesn't fit, don't wear it. Runners' feet will swell during an ultramarathon, so many ultrarunners wear shoes a size or two larger than normal.

Other strategies for reducing runner's foot friction include:

* Toe socks and multiple socks

* Friction reducing ointments and powders (Vaseline, BodyGlide, Udder Balm, Hydropel, Gurney Goo, SportShield, Gold bond, blister shield powder)

* Duct tape (sometimes works to place over blister prone areas for protection)

Tips for Purchasing Running Shoes
Proper fit is key when investing in running shoes:
1. You should have about a thumb's width of room at the toe.
2. The shoes should hold your foot securely around the midfoot and at the heel.
3. The shape of the shoe should match the shape of your foot.
Most shoes are returned because they're too small. Running shoes generally don't need to be broken in - they should feel good right out of the box.
After purchasing your running shoe, use it for running only. This will extend the life of the shoe and will reduce the likelihood of injuries.

Biomechanics and proper shoe selection
There are many terms to describe foot types and shoe types. The three major foot types are supinators, neutral position and pronators.

Typically supinators do well with neutral cushioned shoe, neutral foot type does well with stability and neutral cushioned shoes and pronators usually benefit from stability or motion control sneaker.

However these are just guidelines and comfort is the most important factor when choosing a sneaker.

Some of the better running shoes are certain types of new balance, asics, brooks and saucony sneakers. Additionally most foot types will benefit from a supportive insole, be it a good over the counter or custom insole.

Stretching Tips
There are a few dos and don'ts for stretching that all runners should follow in order to avoid injury and increase running performance:

- Do not stretch cold muscles -this could result in tearing or pulling the muscles. Instead, do only very slight stretches until you have warmed up for at least 10-15 minutes.

Do not bounce -bouncing could result in a torn or pulled muscle. Instead, hold each stretch for 30 - 40 seconds. In doing this, you may note that the muscle begins to relax and you can go further into the stretch. It is important, however, not "over-stretch" to the point where you feel muscle resistance or pain.

- If you feel discomfort or pain, stop. - If you stretch to the point of feeling pain, you could be hurting your muscle and be causing an injury that will keep you from running.

- Do stretch slowly - Move into all stretches in a slow and controlled manner. If you stretch too quickly, the muscle will contract and you will find yourself to be unable to relax the muscle and increase flexibility.

- Do stretch, but do not stretch too much - Remember to stretch, but do not forget that your reason for stretching is to get on the road or trail for your run! Runners need to stretch, but do not let this part of your workout become your entire workout.

Some basic leg stretches for runners:

- Keeping knees slightly bend, fold the torso forward and reach for your toes. Hold for 30-40 seconds. This will stretch the calves and hamstrings.

- Stand facing a chair or ledge. Place your right foot onto the chair. Keeping your leg straight, lean slightly forward until you feel a stretch all the way down the back of your leg. Hold for 30-40 seconds. Repeat on other side. This stretches the hamstrings and calf muscles.

- Place your hand on the back of a chair or a wall. Bend your right leg behind you and catch your right foot in your hand. Pull the right foot toward your buttocks. Hold for 30 - 40 seconds. This will give you a good stretch on your quadriceps.

- Begin on all fours. Place your right foot between your hands. Put your left foot behind you so that you are up on the ball of your foot. This gives you a good calf stretch. Hold for 30-40 seconds, and then switch sides.

- Sit on the floor with the soles of your feet touching in front of you. Wrap your hands around your feet and gently press your elbows onto your thighs, allowing the thighs and knees to release closer to the floor. Hold for 30-40 seconds. This stretches the inner thighs and groin muscles.