Friday, March 19, 2010

Morton's Foot

Dr. Dudley Morton practiced in the 1930's, first describing a number of foot ailments including Morton's foot (aka Morton's toe), and Morton's neuroma. Morton's foot is a common but dysfunctional variant of foot structure occurring in more than 25% of the population. By the time one hits middle-age, however, the instability caused by this condition can lead to pain and an inability to walk pain-free into the golden years.

Check out the sketch below from The Trigger Point Therapy Workbook for a look at Morton's Foot which is also known as short first metatarsal syndrome. The metatarsals are the longish bones beneath each toe, and the first metatarsal meets up with the big toe at a most critical juncture known as the 1st MTP (metatarsal phalangeal) joint which should be one of the primary weight-bearing areas of your foot.

If you've been issued a stumpy first metatarsal (arrow B), your weight is transferred to the 2nd MTP joint (arrow A) beneath your 2nd toe (arrow C). As a result, your weight can wobble inward towards the arch or outwards towards the little toe which has been likened to 'walking on ice skates'. The 2nd toe may extend beyond the big toe in persons with this Morton's business; while some call this long 2nd toe a sign of nobility. In my experience, it's a sign that you may give up walking for exercise.

Then look out, it's like a veritable aging house of cards cascading down your midline. The arches fall, a bunion may pop out, the ankles hyperpronate (see below), your calf muscles start working overtime to hold up your body,your knees knock together in the midline causing arthritis and collapse of your lateral knee joint,

you start to hate walking, gain weight, and plummet into old age way before your time.

So if that info knocked your socks off, check yourself for Morton's foot thusly:By pulling your toes downwards, you'll be able to see the locations where the metatarsals end and Morton's mayhem begins.

Got Morton's? I do. Custom-made orthotics and Pilates have changed my life. If you've been short-changed on your first metatarsal and are starting to hobble with pain, a trip to the podiatrist is definitely worthwhile. For more information, check out

Tuesday, March 09, 2010

Milk thistle for liver protection

I had a patient in yesterday whose medical records show a long history of elevated liver function tests. These enzymes, namely aspartate aminotransferase (ALT) and alanine transaminase (AST), are part of routine blood test panels often ordered to screen for disease. Normally present in liver cells, elevated levels in the blood can indicate disruption of the cells by inflammation or disease. Even minor elevations are taken seriously if they persist over time as progressive destruction of the liver from hepatitis or other disease can occur without major changes in the transaminase values.

Further testing indicated she might be suffering from auto-immune liver disease wherein a misguided immune response against one's own tissue can cause damage to the organ. She wondered what she could do to promote liver health while pursuing a definitive diagnosis with a specialist. I recommended milk thistle only to read the following today on the Consumer Lab web-site.

Consumer Lab is an independent organization that tests nutritional supplements for quality, assuring that these products are pure, contain what they claim, and are free of contamination. The nominal yearly subscription fee is well worthwhile if you are a fan, as am I, of supplements. One of their recent reviews covered milk thistle.

Only one brand was found on testing to contain the amount of active ingredient indicated on the label. Furthermore, the evidence that milk thistle changed the course of chronic liver disease caused by hepatitis or alcohol was weak. The research suggesting that the herbal preparation protects against liver toxicity from acetaminaphen and anti-seizure meds was stronger. The active ingredient in milk thistle--silibinin--has been the subject of recent cancer research and seems to have some promise as a chemotherapeutic agent.

I don't feel quite so enthusiastic about my recommendation now. If you're considering milk thistle supplements, have a look at the ConsumerLab site to choose the best brand.

Tuesday, March 02, 2010

Rheumatoid arthritis, disability, and dismay

One of my favorite patients struggles mightily with the pain and disability of rheumatoid arthritis. Unfortunately, she got hooked on Oxycontin that she started taking for the pain of infected foot ulcers brought on by the immune-suppressive drugs she takes to control her disease.

Each time I see her, I'm dismayed with 1) how quickly life can unravel due to disease and disability, and 2) how difficult it is to be taken seriously when you take too many pain meds no matter how legitimate your need for same. I spent over an hour on the phone today with the patient and a pain specialist she consulted last month. The latter never even examined her when she came to his office seeking help with pain control and narcotics withdrawal. "I could have you committed," he told her, "for your illegal use of drugs. What on earth did he think he'd accomplish with nonsense like that except to drive her to tears (which he did).

So now she's fallen and sustained four compression fractures of vertebrae made thin from steroid use. The orthopedist she sees for degenerative disk disease never mentioned to her that her new, dreadful pain was due to fractures. I have no idea what my colleagues think they're doing here. But I do know if you're malnourished, angry, and you look older than you are due to the ravages of pain and illness, it's extraordinarily hard to be taken seriously.