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Hi! My name is Jonathan and I am a Chiropodist (Foot Specialist) in Toronto, Canada.

May is ‘Foot Health Month’ in Canada and I am going to try to use this month to give you guys as much advice and information about how to keep your feet healthy.

FOOT HEALTH MONTH 2018 #15

Sometimes we step on things and can get splinters or other objects stuck in the toe. If left untreated, what can start as a small splinter can turn into a foot wound which could even progress into an amputation.

If you feel that you have something stuck in your foot, it is very important you visit your family doctor or foot specialist in order to have your foot examined.

Today we have an unbelievable case of a splinter gone missing. A patient suffered an injury where something got stuck in his foot. He was able to take some of it out but couldn’t find anything else. His foot was not getting better so he went to the emergency room, had x-rays and ultrasounds done, but unfortunately no one could find anything. After doing more research, he found a foot specialist (Chiropodist) that could help him.

Love,

The Toe Bro

PS…This was unbelievable and wanted to share this with you guys as soon as possible!!!

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Dr. Ebraheim’s animated educational video describes the history and examination of painful and injured knee.
A history of dashboard injury or fall onto a plantarflexed foot will cause a posterior cruciate ligament PCL injury.
PCL injury is examined by performing the posterior drawer test. The posterior drawer test will be done in 70-90 flexion. Watch for the sag. The amount of translation in relationship to the femur is observed. In general if the knee is bent or the foot is plantar flexed, this can give you a PCL injury. However, if the knee is extended, in valgus or there is a hyperextension injury, this can give you an ACL injury.
A noncontact pivoting injury with large swelling of the knee after hearing a “Pop” is usually an anterior cruciate ligament injury ACL. The middle genicular artery will be injured and there will usually be hemorrhaging inside the knee joint. The Lachman’s test is used to diagnose injury of the ACL.
Lachman’s test
•Bend the knee to about 20-30 degrees of flexion.
•The tibia is reduced and when you pull it forward, the instability can be seen.
•At this point the tibia is subluxed forward.
Pivot shift test
•The pivot shift test is also done for ACL tears.
•It is used more for chronic ACL tears.
•The pivot shift test is different from the Lachman’s test.
•When the knee is straight, the lateral tibial plateau will be subluxed in extension.
•In 20-30 of flexion, it will be reduced in flexion by the iliotibial band.
Patellar fracture
•If the patient has a history of a fall onto a dorsiflexed foot, the patient may have a patellar fracture. The patella can fracture due to a direct impact injury or indirect due to eccentric contraction.
Meniscal injury
•Occurs due to a twisting injury. There will be some swelling and pain that is worse with twisting or squatting motions. The patient may complain of locking of the knee.
•Examination will show joint line tenderness which is specific of a meniscal injury.
•The McMurray’s test is used to diagnose the presence of meniscal tear.
McMurray’s test
•A painful click may be obtained as the knee is brought from flexion to extension in either internal or external rotation.
•There will be a “click” or “pop” with valgus plus external rotation with injury to the medial meniscus.
•A “click” or “pop” sensation will be felt during internal rotation and extension of the knee with injury to the lateral meniscus.
Pain in the knee around the patella with climbing stairs or during sitting may be a sign of a patella problem.
The lateral patellar apprehension test is performed to check the knee for symptoms of dislocating or subluxing patella.
Lateral patellar apprehension test
•With the finger placed on the patella medially, try to push the patella laterally.
•If this causes pain and apprehension, then the test is considered positive.
Isolated injuries of the posterolateral corner are rare and often cause instability and varus thrust. By performing the dial test, you can detect if there is an isolated or combined injury of the posterolateral corner of the knee.
Dial test
•In isolated posterolateral corner injury, the dial test will be positive at 30 of flexion.
•The test is better when done in the prone position and always compare the two sides together.
•Flexion at the 90 angle will test the posterior cruciate ligament (PCL) for injury.
•More than 10 of external rotation asymmetry at 30 and at 90 is consistent with posterolateral corner and PCL injury.
Medial collateral ligament tear (MCL)
•Pain on the inside of the knee with “ a popping” sound after a blow to the outside of the knee, this is probably a sign of medial collateral ligament (MCL) injury.
•The typical mechanism of injury of the MCL is due to a valgus and external rotation force.
•Proximal tear of the MCL usually heals well, and this is the most common location of the tear.
•Examine the MCL with the valgus stress test (30 of flexion).
•The valgus stress test at 30 of flexion tests the superficial part of the medial collateral ligament (MCL).
•If the MCL appears to be lax in 0 of extension, then this will signal a combined injury (MCL plus other ligaments and possibly posterior capsule injury).
Lateral collateral ligament tear (LCL)
•Lateral collateral ligament (LCL) injuries result from a varus force across the knee. Contact injury, such as a direct blow to the medial side of the knee, or a non-contact injury, such as hyperextension stress, which may result in a varus force across the knee injuring the LCL.

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https://www.FauquierENT.net – This video explains what occurs at the inner ear level in patients suffering from Meniere’s Disease. This condition is described as ear fullness and tinnitus that is followed by severe spinning attacks or vertigo that last hours to days. Once the dizziness resolves, hearing and balance is back to normal.

For more information about Meniere’s:
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Watch how the inner ear balance system works here:

Perform Dix-Hallpike to determine if dizziness due to BPPV:

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POSTERIOR canal BPPV treated by Epley maneuver here:

LATERAL canal BPPV treated by Lempert maneuver here:

SUPERIOR canal BPPV treated by Deep Head-Hanging here:

Flowchart for BPPV diagnosis and treatment can be found here:
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At some point in your life, you have likely experienced dizziness. Now there are a variety of things that can give you the sensation of being dizzy, but one of the worst is a condition called Menieres disease. With Meniere’s Disease, not only do you get dizzy, but it can also cause tinnitus, ear fullness, ear congestion, and fluctuating hearing loss.

According to the US National Library of Medicine, Menieres Disease affects over 600,000 people in the United States alone with over 45,000 new diagnoses each year. If you have ever had Vertigo, which is an episode of intense dizziness, combined with tinnitus, ear fullness, ear congestion, and fluctuating hearing loss.

Menieres disease usually affects only one ear but can progress to your other ear over time, and while the sensation of vertigo doesn’t last forever, it can have a long-lasting effect on your hearing.

So what causes Menieres Disease? To understand exactly where the fluid buildup is occcuring, we have to understand the anatomy of the human ear. First, we have the outer ear which is the Pina and the Ear Canal.
Then we have the Middle ear which consists of the Eardrum, the 3 bones of hearing, known as the Ossicles, the Eustachian Tube, and the Middle ear Space.
The Inner ear consists of the Cochlea which is responsible for hearing, and the Semicircular Canals which are responsible for Balance.
Menieres Disease is thought to be related to a buildup of fluid in your Inner Ear. It is important to note that fluid buildup in the Inner ear is different than the fluid buildup in your Middle Ear which may be caused by an Ear Infection.
This buildup of fluid in the Inner Ear causes a disruption in how the cochlea, vestibular system, communicate with your brain. Which is why you typically have symptoms that involve Balance and Hearing at the same time.
In normal circumstances, your brain expects to receive similar information from both of your ears. It is this mismatch of signals between your affected ear and your non-affected ear that cause you to feel dizzy.

That being said, no one knows for sure exactly what causes Menieres Disease. Some researchers believe it could also be tied to blood vessel constriction, viral infections, allergies, autoimmune reactions, or genetic factors. Episodes of Menieres Disease may be triggered by being tired, emotional distress, dietary factors, and stress in general.

Menieres attacks can occur at random sometimes with several episodes in a short period of time, or in some cases, months between episodes. It is often diagnosed by an Ear, Nose & Throat Physician. It can occur at any age, but is most common in adults between the ages of 40-50 years old.

Since there is no Gold Standard test for Menieres disease, physicians typically look at your Medical History to identify symptoms such as two or more episodes of vertigo lasting 20 minutes each, an onset of “roaring” tinnitus, hearing loss in the low frequencies, and a feeling of aural or ear fullness. You physician will likely order some additional testing to support the diagnosis to include a hearing test, vestibular or balance testing, and even an MRI or CT scan to rule out other possible medical conditions.

When it comes to treating your dizziness, individuals typically manage these symptoms with medications and dietary changes. Medications prescribed by your physician may include Meclizine, Diazepam, & Lorazepam to reduce the effects of dizziness, nausea, and anxiety. They may also include a diuretic to reduce fluid buildup in the inner ear. Dietary modifications can include reducing the intake of salt, chocolate, caffeine, and alcohol which can all trigger a Menieres attack. You may also benefit from vestibular rehabilitation administered by a specially trained physical therapist. Hearing loss and tinnitus symptoms can often be treated successfully with hearing aids by an audiologist once your hearing loss stabilizes.

Menieres Disese is no joke so if you ever experience dizziness or vertigo along with hearing loss, tinnitus, and ear fullness, make sure you see your physician right away so you can find a treatment solution that is right for you.

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(This video was previously released but removed in order to make some necessary improvements. Thanks for understanding.)

This video is a compendium of 3 different patients who had the unfortunate experience of getting a foreign body stuck in various places in their bodies. They have allowed us to create a teaching video that covers the basics of removing these various foreign bodies successfully.
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Bladesmiths swap war stories in the forge, recounting the worst injuries they’ve ever incurred while working on a knife. From burns to bites to broken fingers, bladesmithing isn’t for the faint of heart. #ForgedInFire

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Forged in Fire
Season 3
Episode 8
Xiphos Sword

In each stand alone episode, four new contestants battle it out in a quest to prove they can build a particular weapon better than anyone else–and they’re doing it by hand. This is the show that turns the craftsmanship, legend and excitement of weapons-building into an against-the-clock battle of wits, resourcefulness, and ingenuity.

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