Foot and Ankle Pain

Losing Weight Workouts without Foot Pain

2012-01-23T07:13:00.000-08:00

The optimistic visions of the New Year are contagious. Lofty goals are being set and we all aim high in January. Still, many of us hold back. We paddle through a long list of excuses on why this year is not the year. Weight can be a huge aggravator for foot pain. Losing weight helps foot pain, but how do you lose weight when you can barely walk without pain?

In a survey done by the American Podiatric Medical Association, 72 percent of Americans says they do not exercise because of foot pain. First, foot pain is not an excuse and will not be accepted as one in my office! If you are having foot pain that is keeping you from healthy activities then something is wrong and you need to be treated. There are a variety of reasons that you may be having foot pain. Common conditions like plantar fasciitis require treatments such as cortisone injections, physical therapy, and night splints. Occasionally surgery is needed but this is a last resort.

The first thing to evaluate is your shoes. Not just the shoes you exercise in but all of your shoes. Most of us wear bad shoes or none at all. Whether it is dress codes or personal style, we do not give our feet enough room or support. We also love to kick the shoes off. Yes, walking barefoot around your house can be very bad for your feet! Some of us need extra support all of the time. Your shoes should be wide enough, long enough and have support in the arch are a. Some athletes have trended towards the minimalist shoes or barefoot running. Is it ok? For some people, yes it is ok, but this is not for everyone and is only for the elite athlete with impeccable foot structure. Very few of us have the foot type that can bare the abuse.

Next is to evaluate the type of activities you are doing. Some sports or work outs have a higher impact on your feet than others. Swimming and biking have very low impact on the feet and are great alternatives if you are struggling with your feet. Other activities put a greater demand on your feet such as running on a treadmill or blacktop. You must also evaluate the consistency of high impact activities. Alternating between low and high impact activities will keep you doing what you love but also keep you on your feet!

It is that time of year to be optimistic. You will cure your foot pain, get back to the gym and lose the weight! First find the source of the pain, seek treatment, and stay focused. It is easy to find excuses and the foot is an easy target. Don’t let your feet get the best of you. 72 percent is an unreasonable amount of Americans struggling with foot pain.

Corns 101

2012-01-09T13:54:00.000-08:00

Corns have been the bane of your toes since the invention of closed toe shoes. People resort to all sorts of home remedies to try and relieve themselves of the little devils. The cure is really very simple…prevention.

Corns are those thick, often painful excrescences that pop up on the top joints of your toes after wearing shoes that are either too short or too narrow (or both). Toes like to lie flat inside of shoes for a comfortable walking experience. Style often dictates otherwise in the form of shoes that are too narrow, or in the case of ladies shoes, having a high heel that pushes the toes together and rubbing them at the top of the shoe. Over time, this cramping of the toes causes the tendons on the tops of the toes to shorten causing a contracture of the toe till it assumes the shape of a “hammer”. Thus the “hammertoe” is born. That round, thickened skin on the top of the toe joint is in fact the “corn”. Shaving off the corn or padding it only gives temporary relief. The cure comes in two forms.

First part of the cure would be prevention. The shape of the shoe must fit the shape of the foot. Corns and the contracted digits don’t occur with the wearing of just one pair of shoes for an evening. They occur over several years of shoe abuse to your toes. Many people feel they know the size of their feet and, and buy shoes without even trying them on. Fashion often dictates the shape of the shoes and height of the heels. Over years, this is the recipe for painful corns and hammertoes.

Second part of the cure if you fail to heed the advice of the above paragraph, would be correction. This involves the surgical correction of the digits with the removal of a small piece of bone that has come to form the corn as well as the lengthening of the tendon that caused the toe to hammer. The human body is an amazing thing. If the toes are continuously stuffed into shoes that are too small, the tendons contract and eventually stay that way. “Hammertoe” correction to relieve the pain of the corns is a simple outpatient procedure, but why not try and avoid the problem in the first place?

Ladies…I’m not saying that you can never wear fashionable, high heels shoes. All I am saying is that you should use sensibility in when and where you wear them.
Men also suffer from this painful malady. Though they may not be in high heels, men also fall victim to wearing shoes that are too narrow or too pointy for the shape of their feet.

So folks what do you say? Let’s just “shoe “ a little common sense when buying and wearing shoes. Save those high heeled and pointy shoes for the weekend.
Rob Kosofsky D.P.M.

Is Cryotherapy Painful?

2012-01-06T07:29:00.000-08:00

Virtually painless, long lasting, and now down time....Learn how to end your foot pain today!

What is a HIGH Ankle Sprain?

2012-01-04T05:54:00.000-08:00

We are glued to the TV watching the big game and there goes a key player. Out with a High Ankle Sprain!!! So….what is a high ankle sprain? Can you have a low ankle sprain? The Vikings have been struggling, and now that Adrian Peterson, their star running back, has a high ankle sprain, do they even have a chance? The answer is no, but Peterson will be just fine and back in the game soon.

A high ankle sprain is a tear in the syndesmotic ligament. This ligament lies between the tibia and fibula and connects the bones throughout the lower leg. A typical ankle sprain involves the ligaments that surround the ankle joint. As the name suggest, the Syndesmosis is above the ankle joint and thus a tear in this ligament is called a “high ankle sprain.” Syndesmotic tears occur more commonly with an ankle fracture but isolated syndesmotic tears are also reported. The typical mechanism of injury is external rotation of the foot on the tibia and fibula, as seen on the photo below, on the right.

Syndesmosis injuries are more common than classic ankle sprains. They frequently occur in collision sports or those sports that have rigid ankle immobilizing gear such as skiing. Nearly 74% of ankle injuries reported in hockey are syndesmotic sprains. In the general population syndesmotic sprains make up only 10-20% of all ankle sprains. Typically, the athlete will present with a sore sometimes sharp pain over their leg between the tibia and fibula. The pain is worse when bearing weight and often the athlete cannot bear any weight on the extremity. The diagnosis of a syndesmotic tear is not difficult on physical exam but further studies are performed to identify any associated injuries or the extent of the injury. It is standard to take x-rays and to examine for any fractures, typically seen in the fibula or tibia. Often, an MRI is also ordered to identify the extent of the tear. Very rarely, surgery to repair the torn ligament is necessary.

The degree of severity can vary greatly. Due to the high incidence of associated injuries, it is difficult to outline the recovery time. Multiple studies have been done to determine the average recovery time. This can range from as low as 1 week to as high as 6 months. Studies have consistently showed that stage I and II ankle sprains on average have a faster recovery time than a syndesmotic sprain.

If an isolated syndesmotic sprain is identified with no other associated injuries than recovery time is very short. I feel comfortable saying that Peterson will be back on the field with the rest of the Vikings to finish the season. Unfortunately, with or without and injured Peterson, I don’t see them making it to the play offs.

New Jersy Nets Center Has Foot Surgery

2011-12-23T11:58:00.000-08:00

Brooks Lopez, the starting center for the New Jersey Nets, broke a bone in his foot and is having surgery to repair it today. He is expected to be out six weeks. The bone he broke is the fifth metatarsal and is located on the outside of the foot.

This is probably one of the most common foot fractures. It usually occurs when your foot rolls over. There is a tendon, called the peroneal brevis tendon that is under tension when you twist your ankle. This causes the tendon to pull on the bone and break a piece off. Sometimes, the piece is broken off in such a way that it needs to be put back surgically. Other times, the bone breaks but is not displaced, meaning it is a stable fracture and can be healed just by applying a cast.

There are three types of fractures in this location. The base of the fifth metatarsal fracture is called an avulsion fracture. This is because the tendon yanks or avulses the bone. This fracture is usally stable enough to be treated conservatively without surgery.

A second type is a stress fracture, which is not a through and through break and not displaced. They occur usually in young athletes that put a lot of strain on the bone, thus stressing the area.

The Jones fracture is located above the base (see above diagram) and is associated with poor healing. This fracture usually requires surgery and then non-weight bearing in a cast for six weeks. Surgery consists of putting in a screw to put the fracture back. We use intra-operative x-rays to make sure the screw and bone is in proper placement. The Jones fracture is in the area of good blood supply to this bone, thus, the nutrition to the bone is disrupted in this instance. This is the reason for the poor healing, unless it is surgically corrected.

However, in basketball players, or any athlete that is required to jump or pound on their foot for their sport, the best option is to surgically repair it just by using a screw. It takes about 6 weeks for the bone to heal and afterwards, Lopez will need to get back into playing shape. So, don’t expect him to be playing for about two months which is now almost the whole season, due to the shortened schedule.

2011-11-16T07:09:00.000-08:00

Matt Schaub, quarterback for the Houston Texans, has suffered a Lisfranc injury and is facing the possibility of being out for the rest of the season. A Lisfranc injury…like a hot dog? No, he didn’t suffer from hot dog poisoning, although you never really know what’s in those things. The name actually stems from the French doctor who first described this injury. Schaub suffered a painful fracture of his midfoot that could cause him to sit sidelined for the rest of the season.

A Lisfranc injury can come in different forms or be a mix of complex injuries in the foot. A Lisfranc injury could be a sprain, fracture or dislocation of the area in the middle of the foot including bones and ligaments. The Lisfranc joint is responsible for connecting the metatarsal bones and the tarsal bones.

This joint helps to support the foot by transferring the weight of a step from the heel to the padded forefoot. Although this condition is extremely rare, once you have a Lisfranc injury the recovery can be quite a battle. To determine the difference between a Lisfranc injury and a sprain check the following symptoms. Usually the top of the foot will be swollen and painful, and there could be noticeable bruising. Depending on the severity of the injury, the foot may not be able to handle any weight or pressure.

The treatment for a Lisfranc injury can include the following. First, it is recommended to try the RICE technique (rest, ice, compression, and elevation) to reduce swelling and bruising. If the pain persists you will need to see a podiatrist, who is specially trained to handle serious foot injuries. The doctor will need to take X-rays and possibly get an MRI of the foot to determine the status of the bones and make sure none are broken. In addition, a Lisfranc dislocation, where the joints are not aligned, has to be assessed. Then a person will be wearing a cast, non weight bearing for up to a few months. In the worst case scenarios the injury could require surgery for proper healing.

Although the injury is rare, once you have experienced a Lisfranc injury, your foot may be susceptible for further damage. For example, mobility would be a great concern, especially for an athlete. In addition, arthritis is common in those who have had this injury which could lead to less mobility. Aches, pains, and stiffness are also amongst the top complaints of Lisfranc injury sufferers.

The future of Matt Schaub’s season and career are yet to be determined. Sources connected with the athlete are trying to stay positive as the Texan’s quarterback travels from state to state gathering specialist’s opinions on the damage. Although Schaub is concerned to help his team and get back in the game, not treating the condition properly could lead to more serious problems down the road.

Q&A: The top 7 Questions about Ankle Fractures

2011-11-14T08:34:00.000-08:00

Breaking your ankle can be a very devastating injury which can involve significant time off your feet depending on the extent of your injury. The below question and answer format will give you much of the information you need to know about treatment if you or someone you know sustains a broken ankle.

FAQ (Frequently asked questions):

1. What should I do if I think I broke my ankle?
You should be treated immediately. If a local podiatric surgeon is not immediately available in his/her private office, a hospital emergency room is the best place to go. Pain medication will be administered and X-rays will be taken. If a fracture is confirmed and the fracture segments have moved apart significantly, pain medication will be given and a manual (closed) reduction to put the segments closer together will be attempted. If surgery isn’t needed, then an above or below the knee fiberglass cast will be applied and crutches, a walker and/or wheelchair will be given as no weight can be applied to the foot.

2. How do I know if I have a broken bone vs. a bad sprain?
There is no way of knowing whether you sprained your ankle instead of fracturing it without getting an X-ray. Blisters, swelling, pain, bruising and redness with either a fracture or a sprain may be present. Pain directly on the bones of the ankle with direct touch is a clinical test but often times even in a sprain there is pain everywhere even on the bone. X-rays are the only way of knowing for sure if you broke a bone. If you sustained a very intricate fracture, your doctor may also order a CAT scan.

3. Will I need surgery?
If the bones cannot be manually reduced or put back together, than surgery will be performed. This surgery for an ankle fracture is called an open reduction with internal fixation (ORIF).

4. How long does it take to recover?
Bony healing typically takes 6-8 weeks to occur. However depending on your overall health, other factors such as smoking, diabetes, poor nutrition and poor circulation can delay this process.

5. How long will I be in a cast?
Regardless of if you have surgery or not, a cast will be in place for at least 6-8 weeks in order to give the bone enough time to heal
.
6. When will I be able to walk normal again?
This depends on the severity of the fracture but typically one will be able to ambulate in a sneaker after 8-10 weeks. Even then, the ankle will still be somewhat swollen.

7. How long will I be out of work?
It depends on the type of work you do. If you have a very accommodating job and can sit most of the time, then you may be able to return as soon as 2-3 weeks after treatment. While at work you need to keep your foot elevated on another chair. You should keep ice applied for 20 minutes every hour when awake. Most people will need to take at least 4-6 weeks off from work, but if you have a job where you need to stand and walk, then you will need to take at least 3-4 months off from work. You may qualify for short-term disability or workman’s compensation (if the injury occurred at work).

SAQ (Should ask questions):
1. What bones are involved in an ankle fracture?
The ankle consists of the end of the tibia bone called the medial malleolus, the end of the fibula bone called the lateral malleolus and the bottom of the ankle called the talus bone.

2. Are certain people prone to breaking their ankle?
Oftentimes, an ankle fracture involves a simple, unintentional slip, fall or accident. Other times it involves a twisted ankle injury from someone who has frequently sprained his or her ankle in the past. These people have chronic ankle instability and have high arches that are unstable on uneven surfaces. This leads them to sprain their ankle a lot and even fracture it if the force of the sprain is high enough.

3. How can I prevent an ankle fracture if I am prone to this?
If you have high arches, have sprained your ankle in the past and feel unstable on uneven surfaces, you need the proper support to prevent not just another sprain but a fractured ankle. Good, sturdy shoes as well as a pair of functional customized orthotics (inserts) to straighten out the foot and offer stability are best to prevent a fracture or sprain.

4. What determines if I need surgery for the ankle break?
If the bony segments of the fracture are shifted enough more than 2mm and closed manual reduction cannot close the gap enough, you will need surgery/ORIF. Also surgical repair of the ligaments may be performed if the ligaments are torn as seen as a wide gap of the bones on X-ray.

5. Will I have long-term pain after the ankle is healed?
Just as in other joints, the ankle joint should be comprised of healthy cartilage that covers the bone to allow for up (dorsiflexion) and down (plantarflexion) motion. A break of the ankle usually involved a break or injury to the cartilage as well. Therefore and theoretically, someone who sustains an injury to the ankle joint (intra-articular fracture) may develop chronic ankle arthritis called osteoarthritis or degenerative joint disease. Arthritis involves cartilage damage where the bones rub together causing inflammation and pain. You might not have severe arthritis, but if the cartilage is slightly damaged you may have persistent but occasional pain and stiffness in cold or rainy weather.

6. Will I need physical therapy?
Yes, most patients whom are in a cast for 6-8 weeks will develop weakness and visible calf atrophy or a smaller calf. These muscles need to be strengthened and the ankle needs to be moved to increase ankle range of motion. A formal therapy program of 2-3 times per week for at least 1 month is needed at a therapy facility for optimal healing.

7. What is the difference between a podiatric surgeon and orthopedic surgeon? Who should I see for my ankle injury?
Seek treatment from a podiatric foot and ankle surgeon as they are uniquely qualified to not just perform the surgery but also to carry out the long-term care of patients by addressing the biomechanical conditions affecting the foot and ankle. Unlike orthopedists, a podiatric foot and ankle surgeon, in addition to the general medical training, focuses on the foot and ankle from the beginning of their medical training.

By Dana Waters, DPM
Podiatric Surgeon in Hillsborough and Piscataway, NJ

Charles Woodson: Clubfoot to Super Bowl

2011-10-31T13:18:00.000-07:00

Being born with a congenital deformity can be devastating. As a parent, you may struggle to understand why, how, and what should be done. It is incomprehensible to allow your child to suffer or struggle and you shouldn’t have to sit by and be helpless. When Charles Woodson was born with clubfoot, his parent probably never conceived that their son born with a foot deformity would someday be a successful football player. Clubfoot is a congenital foot deformity that occurs in about 1 in every 1,000 births and is twice as common in young boys as girls.

Clubfoot can be identified at birth and the foot will have an appearance of turning inward. The medical name for the deformity is Talipes Equinovarus. The exact cause of clubfoot is still widely debated and unknown. No genetic component has been discovered but statistics show that children whose parents or siblings have clubfoot are twice as likely to be born with club foot.

The child does not experience any pain, but if left untreated, the ability of the child to ambulate in the future is very limited. Disability would be inevitable. Over the last 25 years the treatment protocols have been debated. The current standard of treatment involves a series of casting starting shortly after birth. This treatment method is referred to as the Ponsseti technique. The cast is changed by a trained physician weekly and a series of manipulations and stretching are performed. Casting can be as few as 4 weeks but the amount of time taken correct the deformity is dependent on the complexity of the deformity. Most children also need their achillies tendon lengthened, a minor procedure done through a minimal incision. Fallowing correction of the deformity, the child will need to be in a series of braces that help maintain the correction. Less than 20 percent of children treated by casting will need surgery in the future to correct any residual deformity.

Though the child is bound to braces and continued foot care up the age of four, the deformity and treatment has little effect on the child’s development. By the time the patients is gearing up to ambulate, the braces are worn minimally, mostly while the child is asleep. Most children go on to have a normal childhood with few, if any, limitation. Often the only residual defect is the clubfoot having a slightly smaller size than the normal foot. If treatment is delayed, children may be subject to more invasive surgery and longer recovery times but surgical procedures for clubfoot have been well studied and discussed in the literature with good success.

From Clubfoot to athlete, there have been many professions who were born with the congenital deformity who grew up to be successful athletes. Charles Woodson is a Super Bowl Champion. Kristi Yamaguchi is a gold medal figure-skater. From MVP baseball players to star soccer players, people born with clubfeet have proven to overcome their congenital deformities.

As Does Ryan Howard’s Achilles Tendon Goes Pop, so Does the Phillies Season

2011-10-08T11:38:00.000-07:00

The favorite Philadelphia Phillies lost their playoff series last night to the St. Louis Cardinals. On the very last play, Ryan Howard, the Phillies first baseman, was running out a ground ball. On the way to first base, Howard crumbled to the ground. “I heard my Achilles Tendon pop,” he said.

That pop that Howard describes is a sign of an Achilles Tendon tear. You might say well, he has all off season to recover, but Achilles Tendon ruptures are not to be taken lightly. Since the Achilles is the largest and the strongest tendon, it is also the hardest tendon to heal after an injury. The tendon attaches the big calf muscle to the back of the heel bone, also known as the calcaneus. When the calf muscle contracts, the tendon allows you to point your foot and stand tiptoe. The tendon is necessary to run, walk and put your foot down.

How does the Achilles Tendon Tear?

Tears are really not that common and usually occur in Men over 40 or in athletes who perform a ballistic movement, like Dan Marino did several years ago, when he pushed off his foot to throw a pass. The athlete pivots, jumps or runs in a very quick fashion.

The injury can also happen in these situations.

1) You make a forceful push-off with your foot while your knee is straightened by the powerful thigh muscles. One example might be starting a foot race or jumping.

2)You suddenly trip or stumble, and your foot is thrust in front to break a fall, forcefully overstretching the tendon.

3)You fall from a significant height.
When the injury occurs, a loud pop sound usually happens. It is sometimes sounds like a gun shot went off. Sometimes the tendon doesn’t fully tear, and you get a partial rupture. Partial tears can lead to a full blown rupture if left untreated. In young athletes, surgery is usually needed to repair the tendon if it was fully ruptured. Partial tears can be treated with initial immobilization and physical therapy.

Rehabilitation after surgery can be from 3-6 months. Most professional athletes, like Ryan Howard, would need about three-four months before being ready to play their sport.

Another way to get a tear of the tendon is to ignore pain in the area. It is very common to develop Achilles Tendinitis, which is a swelling along the tendon. If one ignores this pain and continues to stay very active, the inflamed tendon can tear. So, it is very important to see your podiatrist if this happens.

Sprained Ankles Raising the Cost of ER Visits!

2011-08-31T07:36:00.000-07:00

There is nothing cheap about healthcare and going to the ER can cost you an astonishing amount of money! In 2008 the average Emergency room bill was $1,265. What can you do when it is an emergency? How do you tell when you actually need to go to the emergency room and what can wait for an appointment?

A recent study published in Clinical Orthapaedics and Related Research took a closer look at lower extremity emergency room visits. They analyzed a total of 119,815 patient visits in 2009 and the most common injury was not an emergency! According to the study the most common diagnosis in the ER for the lower extremity is strains and sprains. This accounted for 36% percent of these visits. An ankle sprain was the most common injury with an incidence of 206 per 100,000 visits. But how do you know the difference between a sprain and a fracture?

Ankle sprains can be very painful and lead many to question: “Did I break something?” Ankle sprains are most common in young individuals with teenagers having the highest ER visits with such injuries than any other age group. Parents are often the ones making the critical decision if the injury warrants the visit to the ER. And If moms are still like my wonderful mom, they are better safe than sorry. The incidence of an ankle fracture is 49 per 100,000, much less than an ankle sprain. The symptoms are extremely similar consisting of pain and swelling and often an audible pop will be heard. Some like to use weight bearing as a guideline but I have seen both ankle fractures walk through the door and I’ve also seen ankle sprains unable to bear weight.

A team of doctors took up the challenge of differentiating between fractures and sprains in Ottawa, Canada and devised the Ottawa Radiograph Rules. They found that only 15% of foot and ankle x-rays in the ER revealed fractures. After implantation of their guidelines, they reduced the number of x-rays by 35%. These rules help determine when x-rays are necessary because of a highly suspected fracture, and when x-rays were unnecessary due to certainty of a simple sprain injury. In simplest terms the guidelines include bone tenderness and inability to bear weight.

The lesson here is that you don’t need to go to the ER to be diagnosed with a sprain or even an ankle fracture. Many specialties have time built into their schedule for emergency visits and many practices even have weekend hours. Depending on your insurance, you may not need a referral to see a foot and ankle specialist and you will cut your cost significantly by avoiding the costly ER. Nearly all podiatric practices have immediate access to x-ray in the office to make the appropriate diagnosis. Injuries can be painful and scary and it is always better to be safe than sorry but you don’t have to go the ER and get charged an arm and leg.

Is Shaq’s 3 Month Achillies Recover Normal?

2011-05-11T08:12:00.000-07:00

At 39 years old, Shaquille O’Neal has had quite the basketball career. This year, he has fallen on hard times. In February he suffered an achillies tendon injury and in April only 2 quarters after returning to the game, he goes out with a calf muscle injury. Is this the beginning of the end for the famous Shaq? Three months after the original injury and the Celtics are still Shaq-less.

The Achillies tendon is the largest and strongest tendon in the body and attaches the calf muscles to the heel. There are a few different achillies tendon injuries. First, the most minor injury is tendonitis. This is typically the result of overuse. Basketball players are extremely susceptible to such injuries since they frequently push off and jump off their toes. Thus, there Achillies is much over used. An achillies tendon can also become torn or completely ruptured. This is another injury commonly seen in basketball. This occurs when one pushes off or contact is made with an already contracted muscle. The tendon will tear in the weakest spot and if the force is strong enough, the tendon will completely rupture.

Since the achillies is the largest and the strongest tendon, it is also the hardest tendon to heal after an injury. Even tendonitis, the most minor achillies injury can sometimes lead to surgery! Statistics show that over 25% of all those with chronic achillies tendonitis go on to have surgery. For acute injuries, rest is the key. For low grade tendonitis, a 1-2 week rest is recommended. For higher grade injuries, a month of rest in needed for recovery. After the rest period, a slow progression back to your activities in recommended. Relative rest does not mean a break from all physical activity, but rather cease in activities that have high impact on the achillies and supplementing activities with appropriate bracing. Depending on the degree of injury will determine the level of rest needed for repair. Achillies tendon tears or ruptures often need surgical repair or a series of casting.

It is most typical for achillies tendon injuries to occur in men in their 40s. Weekend warriors commonly injure their achillies when they pick up a game of basketball after weeks, months or years of a less active lifestyle. Unfortunately, the recovery time with achillies tendon injuries is very cumbersome. Many spend a length of time in casts or in walking boots. A change of activities is necessary. This drives many crazy and anxious to get back to their activities. Many often rush the recovery and what was originally an acute tendonitis or a partial tear becomes a chronic problem.

Shaq is the oldest player in the NBA and may be now considering retirement. Achillies tendon injuries cripple a player’s season and for Shaq being near the end of his career, this may be the injury that fades him out of the basketball scene.

Wendy Williams Loses Because of her Feet!

2011-04-20T12:23:00.000-07:00

I am not a Dancing with the Stars nut but I did get a chance to see Wendy Williams’ feet and I must say they do not look good. With bunions, blisters, and swelling I am not sure how she managed to put her feet in stilettos and put on a show. That in itself is talent. Still, she was voted off and her dancing didn’t make the cut.

I haven’t done any professional dancing but I can respect the intense work it does on your entire body and on your feet. Spinning, stepping, dipping, swaying all push your body to use it in ways you are not used to and it also puts increased stress and strain on your feet. It is no secret that podiatrist do not promote heel wearing. Surely we wouldn’t promote heel wearing while spinning, stepping, dipping, and swaying across a glossy dance floor right? Well entertainment is entertainment. No one is going to line up to see a beautiful ballroom dance with sweeping elegant gown and well supportive athletic shoes. Seriously!!!!

I’ve worked with ballerinas and other professional dancers and it is just devastating what happens to a professional dancer’s feet. What they endure is unbelievable. There are things to keep your feet healthy if you are a dancer or are pursing to take up dancing as a new hobby. First, you have to know your feet. Are you prone to ankle sprains? Do you have a flat foot or a foot with a high arch? There are general precautions and taping techniques to prevent you from injuries depending on your foot type. Second, know your shoes. Not all heels are created equal. Most importantly, flip them over and take a look at the bottom. Dance floors are made slightly slick to help the dancer glide along the floor. Paired with the wrong shoe, the dancer may be gliding across the floor on their bum. Lastly, know when to stop. Your feet are a part of your body. You can push them too hard and do too much damage. They hurt for a reason! Your body is trying to tell you something.

When you are a non-dancer who goes to dancing 7 days week like Wendy Williams, there is no way you will make it without blisters, bleeding, and stiffness. The biggest mistake is going to long too soon. Dancing is like running. You have to take baby steps and work yourself up to the long hours and the advanced moves. Blisters go away with time, but some injuries will change how your foot functions.

Is Japan’s Radiation in our Hospitals?

2011-04-15T12:02:00.000-07:00

As we watch the devastation in Japan unfold, we are becoming more aware of the dangers of radiation. Remembering Chernobyl, many of us recall the nuclear disaster that affected much of Russian and Western Europe. These are serious nuclear accidents, but can we be exposed to radiation every day? How much is too much and what is it doing to our body?

Radiation is everywhere. Bananas, pistachios, and kitchenware all have radioactive particles. You cannot avoid being exposed to some levels of radiation every day. The amount is so small that it is not harmful to your body. Radiation exposure is measure in sierverts. Death is the result of exposure of 5,000 mSv and radiation poisoning is secondary to about 1,000 mSv. A banana contains 0.0001mSv. Smoking 1.5 packs a day exposes you to 13mSv/ year. The limit for nuclear power plant workers is 20mSv/year. The lowest clearly carcinogenic level is 100 mSv/year.

That is your everyday life but what about the hospital. X-rays and CT scans are sources of radiation. They are important diagnostic tools that allow physicians to see inside of your body without cutting you open. I take x-rays of most of my patients to better understand the biomechanical structure of their foot. X-rays are also an important tool during foot surgery. Am I putting my patients in radiation danger? An extremity x-ray exposes a patient to about 0.001 mSv. This is equivalent to the radiation you are exposed to in 3 hours of a normal day. A CT scan can be potentially more dangerous with exposures about 10 mSv. Some studies suggest about 2% of all cancers can be linked to over exposure due to multiple CT scans.

What should you do? It is important to understand that these diagnostic tests are often necessary to make appropriate diagnoses and treatments. These tests are safe when used properly. An MRI has no radiation exposure. Though there are more contraindication with use of an MRI because it can disrupt a pacemaker and the picture is distorted if metal implants are near the area of interest. If you are having a bad year and are seem to be in and out of the doctor’s office and having many tests, you should have a conversation with your doctors about radiation exposure. When you start to have multiple CT scans a year, there is a concern of excess radiation exposure. Very few people fall into this category.

Knowing the dangers of radiation, many safely protocols are set in place to limit exposure. In the hospital and in our daily lives, our radiation exposure is kept to a minimum. Unfortunately, nuclear disasters do happen. As danger lingers, our thoughts are with Japan.

Foot Surgery Nearly Kills Serena Williams???

2011-03-11T12:16:00.000-08:00

Less than a year ago, Serena Williams underwent foot surgery. She was in cast, walking boots and crutches for some time after the injury. She recently underwent surgery for a life threatening condition. Did her foot surgery have anything to do with her blood clot?

Pulmonary Embolisms are most often the result of a blood clot that has traveled from the blood vessels through the heart and then to the arteries of the lung. The blockage causes shortness of breath, chest pain, and can be life threatening. The clot typically originates in the deep veins of the leg. These clots are also known as a DVT. Blood clots can form in anyone, but are most likely to occur after immobilization, in the elderly, or those that have a family history of blood clots. Those who smoke, are overweight or take birth control are also at an increased risk. The risk of having a pulmonary embolism is greater in high risk large orthopedic cases such as hip surgery. The risks of a DVT after foot surgery is less than 1% and the risk of a pulmonary embolism is even less.

Why is there a risk of a DVT or pulmonary embolism after foot surgery? It is common to be immobilized after foot surgery. While in a casts, surgical boots and crutches, your lower leg is generally inactive. The calf muscles are an internal pump to move blood back to the heart. If the leg is immobile, the body has to work harder to move the blood. If there is an insufficiency in blood movement, there is a higher risk of a blood clot. Not only did Serena have recent surgery, but she has also been doing a lot of traveling. Sitting on a plane for hours will only worsen a blood clot.

Linking the surgery to Serena William’s blood clot is hard to do. The surgery was some time ago and there may be other risk factors that we are unaware of. It does demonstrate that even healthy, young individuals may be at risk of a blood clot. It is important to take certain precautions to prevent clots before they happen. If you are at high risk of a blood clot, your doctor may prescribe medication after foot surgery to help prevent blood clots and pulmonary embolism. The risk is still very low, below 1%, but the results can be serious if not treated promptly.

Jennifer Grey Has Foot Surgery

2011-02-15T06:25:00.000-08:00

Jennifer Grey of Dirty Dancing and Dancing with the Stars Fame just had surgery to remove a neuroma. If you remember, she consistently complained of foot pain during the show. Neuromas are very common in dancers.

A neuroma is a thickening of a nerve and can occur anywhere in the body, even the foot. Morton’s neuroma describes a neuroma of a specific location in the foot, between the third and fourth metatarsals. This is located on the balls of foot between the third and fourth toes. Clinicians may refer to this benign growth as a tumor. In medical terms this is a correct description but this is not an indication of cancer. The enlarged nerve is benign meaning it will not become invasive or become cancerous. In essence, a neuroma in the foot is really a pinched nerve, where the adjacent bones press on the nerve. Thus, the nerve gets inflamed and very painful. Dancing on the balls of your feet is definitely a cause for this type of neuroma.

Though a morton’s neuroma is not a medical emergency, it can cause severe pain and impede on your daily life. Some patients describe the pain as walking on a marble, but the most often complaint is a burning, sharp pain. Tingling and numbness is also common.

It is thought that the nerve becomes enlarged due to repetitive irritation or pressure. Over time, this irritation leads to a neuroma and pain. Wearing shoes that are tight, too small, or with a heel can aggravate the pain because it causes increased irritation. The pain may also be caused by running or other sports. Flexing and relaxing your toes causes compression on the nerve, and the balls of your foot takes on the most weight during walking or running. Since this is the area where the neuroma is located, doing such activities can elicit a lot of pain.
The podiatric physician will take x-rays of a patient with such pain to rule out a fracture or other foot disorders. The doctor will also attempt to elicit the pain by squeezing the foot. This will not only cause pain, but there the doctor will also hear a clicking sound due to the neuroma shifting between the bones.

There treatment ranges from conservative treatments to surgery. Like all treatment plans, surgery should be a last resort for when all other treatments fail. The pain may be greatly reduced by changing shoe gear, but this is often not enough. It is very common for your podiatric physician to prescribe a custom orthotic. Many patients find relief by not only wearing orthotics but also wearing a pad under the balls of their foot. A podiatric physician can properly fit and provide such padding. Non-steroid anti-inflammatory drugs, such as Advil, can also be used to help reduce the pain but should not be used long term. Your doctor may also suggest a steroid injection which has a greater effect on relieving the pain. Stretching, massages, and icing has also shown to relieve pain.

In addition, cyrotherapy, a prodedure that freezes the nerve, and allows the patient to immediately ambulate in their regular shoes, is a very effective method to eliminate the pain from a neuroma. In most cases today, surgical removal is not necessary because of this procedure

If the pain has increased due to physical activity, it is suggested to take some time off from the activity to allow your foot to rest and heal. It may be better to take on activities that cause less impact on the foot. Excises’ such as swimming or bicycling may be good alternatives.

Neuromas are not life threatening, but they do cause alterations in your life. You should consider wide toed shoes with plenty of room for your toes to wiggle. The pain most often subsides with conservative treatment, but in rare cases surgery is necessary. Unfortunately, the procedure removes the entire nerve and will leave numbness of the effected toes. Thus, you and your podiatric physician should try to avoid surgery if possible.

Smoking Costs Dollars, Legs, and Now Your Job!

2011-02-14T07:14:00.000-08:00

With the economy slowly recovering, every smoker is faced with the financial burden of their bad habit. Many still push out the dollar signs for their nicotine. Others are paying a different price for the many cigarette breaks. Smokers are 16 times more likely to have peripheral vascular disease or PVD. This disease leads to decreased blood flow, painful limbs, chronic ulcers, and amputations. But wait there is more. The job market is a little smaller for smokers as many companies are adopting anti-smoking policies.

Hospitals and medical businesses are turning away smokers. Part of the interview is screening your smoking habits and some go as far as instituting a nicotine urine test. Why the crackdown on smokers in the workplace? With health care dollars a growing concern for many employers, they are trying to cut their losses anywhere possible. It is estimated that the average smoker cost greater than $3,000 more to employ than the non-smoking counterpart. This is attributed to the higher health care costs and the lost productivity due to those many cigarette breaks.

29 states, with the help of strong lobbies, have adopted laws that prohibit smoking discrimination. Still many large health institutions have adopted the policy. The Cleveland Clinic has been hiring non-smokers since 2007. Also not hiring smokers is the American Lung Association, The American Cancer Society, and the World Health Organization.

Do you need any more reasons to stop smoking! Smoking continues to be leading cause of preventable death. One in five Americans still smoke. We have all heard the dangers of smoking from cancer to cardiovascular disease, but did you know smoking is bad for your feet? I hesitate doing any surgery on smokers. Got a bunion? If you smoke, you are at higher risk of non-healing, infection, and many other complications. Nicotine causes your blood vessels to constrict and decreases the amount of oxygen and nutrients delivered to your tissues. Years of smoking causes years of damage to your feet and legs.

Too many of my patients come in with ulcers due to poor circulation A number of my patients are missing toes because the blood flow was so poor it could not keep the toes alive. Smokers have thinning skin and are on the verge of losing their legs. Cigarettes will cost you your pocket book, cost you your legs, and now may cost you your job. Quit while you are ahead, because it will get worse the longer you puff.

Is Rex Ryan a Frustrated Podiatrist?

2010-12-22T16:38:00.000-08:00

A video was just released showing Rex Ryan, the NY Jets football coach and his wife, depicting Rex of having a foot fetish. It is this video that made me think of the endless times I get asked, “Dr. Wishnie, why did you become a podiatrist? Do you have a foot fetish?”

Let me first answer that as simply as, absolutely not. I usually tell my patient, “Do you think a gastroenterologist has a butt fetish?” Then I ask, “What body part is beautiful? At least the foot is an external appendage that I don’t have to go digging into any holes.”

Well, why did I become a podiatrist? Podiatrists see many different types of patients. We see patients ranging from the age of infancy to the geriatric. On one day I can see both an 18 month old baby and a 104 year geriatric. I can see patients with sports injuries, like ankle sprains, Achilles tendinitis, fractures and dislocations. I see runners who don’t want to stop running, no matter how bad their foot hurts. Then I see little old ladies who remind me of my grandmother.

As you can see, I love the diversity that podiatry offers. I also love the fact that I can usually get people feeling better immediately. See, when you are not feeling well and you go to your family physician, they say, “Take this pill and you will feel better in a week.” Then the patient asks, “Hey doc, what happens if I don’t take the pill.” The doctor answers. “Then you will feel better in seven days.”

A lot of people are afraid of going to the doctors. They are afraid of the pain that might be inflicted upon them. Then what happens if they delay in making an appointment? The pain and the problem usually worsen. In podiatry, we can treat a problem many different ways. If a child comes in with a plantar’s wart, we usually use a topical medication to kill this virus. We usually don’t have to use any needles or do any cutting. If you have a corn, which is dead skin on a toe due to a deformity called a hammertoe, we can trim it painlessly. The patient leaves the office immediately feeling better. If you suffer from heel pain, we can tape the foot and give medication to relieve the pain. Many times we need to give an injection but then the patient is walking out the office feeling ten times better.

Getting patients better quickly and seeing almost immediate results is very satisfying. Podiatry is a wonderful profession and with millions of active baby boomers turning 65 on a daily basis, podiatrists will be very busy and will be an extremely necessary profession for many years to come.

Hey Rex, if this football coaching doesn’t work out, I can help you get in touch with my podiatry school professors.

Dr. Wishnie is Finally Legal!

2010-12-05T08:48:00.000-08:00

Today Marks the 21st Anniversary for

Family Foot & Ankle Specialists

We would like to thank all of our incredible patients as we celebrate our 21st anniversary! We have met so many amazing people through the years, many of which were patients when we first started. We have seen each other through a lot; marriages, children, grandchilren, birthdays and more. You are more than just patients to us, you are considered a special part of our family!

We hope you continue to grow with us for many years to come. Wishing everyone a safe holiday season,

The Doctors & Staff Of Family Foot & Ankle Specialists

Roethlisberger’s Shoe Made Out of Steel After Foot Injury.

2010-12-03T12:57:00.000-08:00

The Pittsburgh Steelers will be taking a bit hit with Roesthlisberger’s foot. Originally reported as a foot sprained, some press releases are now reporting that the Steeler’s Quarterback has a broken bone in the foot. The official release from the Pittsburgh Stealers states that Roethlisberger injury is an aggravation of an old injury where scar tissue is present. So, is he going to play on Sunday?

It is believed that the Steeler’s Quarterback broke his fifth metatarsal bone. This bone is a long tubular bone located on the outside portion of the foot. The fifth metatarsal fractures are a highly researched topic and there are variable ways of treating this injury depending on the location. The majority of fractures in this bone can be treated conservatively with casting and rest. Occasionally, the fracture location or dislocation requires surgery and screw fixation.

Considering, that Ben has persisted that he will be playing on Sunday, we can assume this is a minor fracture that does not require surgery. He is currently ambulating in a walking boot and has been on light practice this week. The Steeler’s trainer stated that the Quarterback will be wearing a special shoe with metal plates protecting the injured area.

The fifth metatarsal is a common fracture site in athletes especially dancers. This is due to the extensive pivoting and jarring on the bone and surrounding tendons. Because of the bone’s location and soft tissue attachments, it does not take a traumatic event to break the bone. Simply landing on the foot wrong can cause such an injury. Recovery of most fractures in this area is easily treated with rest and decreased activity. Protection ambulation with a walking boot often all that is needed to make a full recovery.

When you are a professional athlete and have a record of 8-3, the rules of treatment are different than the average person’s. Winning games, egos, and pressure will push you in a direction that is not always the most beneficial for your body. It is probable that Roethlisberger’s foot break will not debilitate him or prevent him from throwing touchdown passes. It is also probable that his injury can worsen and the long term consequences of poor healing in the foot can mean chronic pain. Playing a a professional foot game in a metal shoe is not necessarily resting the injury.

Joints Under the Weather

2010-11-16T12:53:00.000-08:00

It is that time of year when the air gets crisp and you enjoy evening walks through the leaves. Unfortunately, it is also the time of year when arthritis pain flares up. After the rain, before the storm, and changes of temperature seem to have a poor relationship with our joints. Much like pollen aggravated seasonal allergies; the change in seasons aggravates joints. Is the weather really the cause of your joint pain?

Science has not been able to justify the theory. It is believe that the change in weather alters the pressure and changes the pressure threshold within your body. The tissues are able to expand or swell to a greater capacity. A number of large studies closely examined arthritis pain and compared it to temperature and air pressure. Unfortunately, the research has not given us any concrete answers. So many of my patients relate their joints are better weather predictors than the weather man and I can’t disagree with them.

Whether it is an old wise tale or the cold hard truth, joint pain can put a halt to your fall activities. Arthritis has a number of different causes. Most arthritis is causes by years of wear and tear that leads to damage in the cartilage. Cartilage provides a glossy, lubricated surface that allows for smooth pain free movement. As the cartilage degenerates bone comes in contact with bone and the joint loses its ability to move freely without causing irritation. Irritation leads to inflammation and inflammation leads to pain.

To treat arthritis, we start with trying to decrease the inflammation. This can be done with Non steroidal anti-inflammatory, and corticosteroids. Depending on the degree of arthritis, decreasing the inflammation to decrease pain is nearly impossible. In the foot and ankle, arthritis is very difficult to combat because we never give our feet time to relax. We are constantly up on our feet and push through pain because we have to. When conservative care fails, many patients ask for surgery.

There are generally two surgical options for foot and ankle arthritis. The joint can be replaced with an artificial joint made of titanium or stainless steel. The joint can also be fused, eliminating motion at the site. Not everyone or every joint is suitable for a joint replacement or a joint fusion. Many are turned off by the thought of having a joint fused, but in many cases it is very suitable for the condition and the patient can quickly adjust. The big toe is a joint that gets fused often and has a very high patient satisfaction rate.

Arthritis can be a very difficult and aggravating disease to combat. In our busy lives and our growing concerns on staying active and healthy, joint pain can really hinder the ability to live life to the fullest. You can however give the weather man a run for his money with those weather predicting joints!!!<

Is Brett Favre’s Ankle Serious

2010-10-30T10:28:00.000-07:00

The reason Favre is so enjoyable to watch is because you never know what is coming next. No one could have predicted the scene at Lambeau as the Green Bay Packers defeated their rival and hero, the Vikings with Bret Favre. Are you really a Hero when you play through injuries and avoid medical attention during a game?
I have read many articles trying to decipher this ankle injury, but the reports are vague only stating Favre suffers from two minor ankle fractures including a stress fracture and an avulsion fracture. I have also read a report that discusses a so called “heel” problems or injury. The reports say neither injury is severe and surgery is not necessary and the Vikings star is not practicing and resting in a controlled ankle motion boot (CAM Walker). Whether Favre will play on Sunday is still unknown.

I cannot predict or diagnose an injury without seeing them physically but here is what I know about Favre’s recovery time. Bone takes about 6 weeks to regain adequate strength after it breaks. Stress fractures heal faster since they are only hairline defects but still require a significant time of rest and decreased activity. Most stress fractures are secondary to overuse over time and not the result of a blunt trauma. Avulsion fractures result when ligaments or tendons pull off a piece of bone during a traumatic event. This injury most certainly happened after Favre was tackled. These injuries do not always need surgery, but they do require time to heal.

I find it interesting we nearly praise someone for playing through pain and injury when infarct they are only hurting themselves and their team. Ignoring an injury that is visibly impairing you can be very dangerous. I worry that many young men athletes think Favre’s actions are heroic. High school football injuries are getting a lot of attention this year. Many are suffering from damaging concussions and few have even died during a high school football game. Favre may be sending the wrong message to these young athletes. Your body does have a limit and ignoring a painful limp does not make you superhuman. It is after all just a game.

The future hall of famer, the Green Bay legend and the greatest quarterback of all time will always be remembered as a man who redefined the odds of the game and was at times above the game.

Today, we wonder if Childress and Favre are reading comic books or pretending to be Superman. You can’t play football with a broken ankle, a heel problem and tendonitis in your throwing arm. Well, Favre probably can but will he be any good? Favre has proven everything he possibly could on the field, now it is time to prove he can sit the bench. Not even Favre can go beyond his body’s limits.

Do You Suffer From Neuropathy?

2010-09-04T14:26:00.000-07:00

This is a great article by my friend and fellow podiatrist, Dr. Andrew Schneider. I use Neuremedy in the office and have gotten some great results. "http://www.facebook.com/#!/notes/andrew-schneider/can-a-can-a-medical-food-help-control-the-symptoms-of-peripheral-neuropathy/427051660996"

The Dangers of Lawn Mowers

2010-08-27T11:27:00.000-07:00

Some people enjoy cutting the lawn. Some give the job to their child or the neighbor. Who would think a common summer chore can be so dangerous? There are over 77,000 lawn mower injuries every year. Over 3,000 of them are in children. Some people even die after a lawn mower injury

I recently had a patient that lost part of his foot from a mower accident. It is devastating to see how much damage a blade can cause. After some research, I discovered exactly how much strength is behind the monster on wheels. Being hit by a mower blade is equivalent to being hit by a 21 pound object dropped from a height of 100 feet or 1.17 pounds traveling 232mph. This is three times the force of a 0.357 magnum gun!

Fortunately, these injuries are preventable, but we have to start taking our lawn mower chores more seriously. So many people choose to cut the grass bare foot. It feels good to have the grass between your toes but it is such a bad idea. First, there are a lot of things to step on especially in long grass where sharp object can be easily hiding. Secondly, the sharp mower blade can easily cut debris in the lawn into smaller sharper object. Though a shoe will not be strong enough to withstand the force of the blade, it will help decrease some severity of the injury.

Make sure you children understand the dangers of mowers. It is hard for a child to understand the complexity of a lawn mower. A push mower looks and sounds a lot like a vacuum. Since children are smaller, the injuries from a lawn mower are much more devastating than those seen adults. Adults will often lose toes or part of their foot, a child may lose their entire foot or part of their limb. Children are also more likely to put their hands near the blades and lose fingers, hands, and arms. There have also been many reports of accidentally running over children with the lawn mower. Remember to pay attention to what is behind you and tell your children they cannot come near you when you are cutting the grass.

These types of injuries are very prone to infections since the blade is so dirty. Luckily, early antibiotic treatments after such an injury cuts the rate of infection to a near minimum. If you suffer such an injury, it is imperative that you report to the ER immediately. The sooner you see a doctor, the less likely you will have complications from the injury.

My patient was lucky his injury was not more severe. He had 3 of his toes cut off with the blade and we then decided to remove his existing toes off to help him with ambulation and shoe fitting in the future. He is now walking normally; he is back to his normal job, and he is wearing normal shoes.

Knee Pain Is A Foot Problem

2010-07-04T12:57:00.000-07:00

Up to 75% of athletes have chronic knee pain. Is your knee pain driving you crazy? There are a million different reasons why so many people suffer from knee pain. Henry (Hank) Aaron, a home run king, is one of many professionals that suffer from arthritis in the knee. Is there anything you can do to treat or prevent these aches and pains in the knee?

All arthritides are irreversible. Once you have arthritis, you will always have arthritis. The first thing to identify is what is causing the arthritis. Weight is a very important factor. The heavier a person is the more stress and strain that is place on the knee.

Many people attribute activities to knee problems. Though high stress, pivoting, and jarring activities put a lot of stress on the knee, it does not always lead to arthritis. More importantly, a person’s biomechanics can cause chronic increased forces and instability that leads to damage and injuries. The knee is the most unstable joint in the body.

Most other joints have boney boarders that help stabilize the joint. The knee is simply two bones separated by cartilage and ligaments and surrounded by muscles, tendons, and ligaments. These are all soft tissue structures. The knee is surrounded by two more stable joints in the body, the hip and the ankle. However, small problems in these joints easily affect the unstable knee joint. Thus, if someone has chronic ankle or hip problems, it is not unlikely that they will also suffer from knee problems.

Since soft tissues are the major stabilizers of the joint, they can be strengthened with physical therapy, strength training, stretching and range of motion exercises. A biomechanical exam can be done to assess your ankle and hip range of motion, stability and muscle tightness that causes changes in joint function. Most people benefit from several different forms of physical therapy and other treatments gauged at correcting the mechanics of the joint, such as orthotics, custom shoe inserts made by a podiatarist.

Orthotics are not just for your foot pain! You may not have any foot pain and still benefit from orthotics. Many of my patients are extremely active in sports and running. From weekend warriors to obsessive marathon runners, I have heard patients say their orthotics helped their knees, hip, back and everything in between. Biomechanics is the application of mechanical principles to the human body and is studied extensively by podiatrists. Many of the basic concepts are also applied in physical therapy and sports training are biomechanical in nature. Orthotics are devices that enhance function and compensate for biomechanical problems in the leg. Changing joint positions and alignment in the foot and ankle have a direct effect on your knee and hip.
Not everyone needs orthotics, but many people benefit from them.

My clinical experience has me convinced me that orthotics are necessary treatment modalities for a number of musculoskeletal disorders in the lower extremity including arthritis.

My broken Ankle was Fixed, so Why does it Still Hurt?

2010-04-19T09:45:00.000-07:00

Some of us are very sensible and still end up in accidents. Some of us do foolish things and obviously end up in accidents. Whether it was a car accident, sport’s accident or a stupid accident, should we have to suffer for the rest of our lives? Ankle fractures are very painful and the surgery includes multiple screws and plates. The recovery period is long and hard. But one would think five, ten, twenty years down the road your ankle would be free from pain. For some, this is true. For others, and ankle fracture leads to lifelong arthritis and pain.

There are four bones that make up your ankle. The tibia, fibula, and the talus articulate with one another to make the ankle joint. Many ligaments surround the joint to stabilize the bones into proper alignment to provide optimal function. Typical ankle fractures involve the breaking of the tibia and fibula bones and damage to a number of ligaments.

To reestablish a competent joint, surgery is almost always necessary. The surgeon will realign the fragments and fixate them back into place using screws. Plates are also used to stabilize the injured area of bone. Essentially, the surgeon will reposition the bones as close as possible back to normal.

Unfortunately, many suffer long term effects from an ankle injury. When the bones break and the ligaments lose their integrity, the bones can slam into and damage the articluar cartilage. The talus, the other bone that makes up the ankle joint, has a thick layer of cartilage that is poorly vascularized. The poor blood flow to the cartilage and the extent of the damage can make it difficult for the body to self repair the injury. These injuries to the cartilage are difficult to assess during surgery. If a surgeon chooses to address these small and difficult injuries, it involves more studied, more procedures and more cost to the patient. Thus, many surgeons chose not to address the injury.

The majority of the time, the body does a sufficient job at repairing the cartilage damage. If the lesion is small, the body’s repair process works sufficiently. Occasionally the lesions are larger and lead to osteoarthritis or degenerative joint disease. It is believed that this may be the reason why some people have residual pain after an ankle fracture. Treating larger cartilage lesions is done by using grafts, preferably from the patients. They will take small pieces of cartilage from your knee or other joints. Some synthetic transplants can also be used. An ankle fracture surgery is already very complex and doctors are not certain treating the cartilage problem at the time of the ankle surgery is what is best for the patient. The longer a surgery takes, the higher the risk of complications.

Some are willing to accept that arthritis is an unfortunate side effect of ankle fractures, but many doctors are studying and researching ways to reduce the number of people living with pain after a fracture. Doctor’s want to make their patients feel better, but sometimes there are too many barriers to completely eradicate the pain. Please be assured that we are dedicated in helping you with your foot and ankle issues even if the battle seems impossible.

David Beckham’s Ruptured Tendon

2010-03-16T06:54:00.000-07:00

The Soccer king will be sitting on the bench through the world cup because of an Achilles tendon rupture. Though the achillies tendon is the largest tendon in the body, it is not uncommon for it to completely rupture! Athletes are at greater risk to experience such an injury, but it is also common in the weekend warriors who have tighter muscles and are taking part of a strenuous sport.

The Achilles tendon connects the calf muscle to the heel bone. This area of tendon is the most common to injure due to the least blood supply. This area is also referred to as the watershed and is located several centimeters above the heel bone. The Achilles tendon is used to point the toes and push off the ground and is used with every step. Thus, it is common after injury to feel unsteady or awkward walking.

When Beckham injured his tendon, he screamed “Its broken, its broken!!!” Complete rupture of the tendon can be very painful and is sometimes described as getting shot in the leg. Like Beckham, many will mistake the injury for a broken bone. There is often an audible pop accompanying the injury. With a complete rupture, one will be unable to stand on their toes or walk on the injured leg. Partial tears can also occur and will have similar symptoms but one will still be able to walk.
Men are five times more likely to rupture their Achilles tendon than woman. We all know David Beckham is a real man and he also plays a high risk sport that involves jarring movements and a lot of quick steps. He also falls into the correct age bracket. The most common age of those who suffer an Achilles rupture is between 30 and 40. Beckham may be rocking out a 20 year old body, but he is actually 34 years old.

It is important to seek a physician for treatment as early as possible. The longer treatment is delayed, the worse the outcomes will be for repairing the tendon. The most desired treatment is surgery. Ideally, the ends of the tendon are reattached to one another. Occasionally, the tendon has endured significant damage and a graft is used in the repair. If one is not a surgerical candidate, casting can be done and a full recovery can be reached, but the patient is at a significantly higher risk to reinjure the tendon than those who have had surgical repair.
Unfortunately, you do not have to emulate David Beckham to suffer from such a limiting injury. Some fluke injuries, such as falling down the stairs, can cause an Achilles rupture. The best way to prevent a rupture is to stay healthy and flexible. It can take four to six months to recover from an Achilles tendon rupture and it may cost you the world cup!

How Lysacek won Gold on an Injured Foot

2010-02-21T08:53:00.000-08:00

Winning an Olympic gold medal is the greatest accomplishment an athlete can have. All of the training, work and anticipation for the completion can be slammed into a halt if one suffers an injury near the games. Evan Lysacek has been struggling with a foot injury and was still able to put on a performance of a lifetime and win a gold medal.

Prior to the world championship, Lysacek suffered from a stress fracture in his foot. For this reason, he chose to remove the quadruple jump from his performance. After winning the competition, the champion spent time in a walking boot and had to rest from training in order to allow the fracture to heel. By the time the U.S. championship came around, Lysacek’s foot was back on track and he was fearless in performing a quadruple jump in his performance.

Stress fractures are small overuse fractures commonly seen in athletes. Unlike traumatic fractures, stress fractures are very small and thus referred to as a hairline fracture. These fractures can be very difficult to see on x-ray. Since the injury is so minor, the treatment is quite simple. Rest, rest and more rest is a straightforward treatment but a very difficult thing to do. Athletes have a very difficult time sustaining from their work out regimens; but if one does not rest, the stress fracture can progress to a complete fracture that would demands surgery.
Evan Lysacek was able to skate through his injury at the world championship, and then allowed himself to heal completely afterwards. Ignoring the injury or not allowing for proper healing, the fracture could have jeopardized his future in skating. After his quadruple jump at the U.S. championship, Lysacek started to feel similar foot pain all over again. He was not diagnosed with a stress fracture, but it was the wakeup call that he needed to focus on his training and performance techniques.

The quadruple jump is the most difficult trick a male ice skater can perform and only a few people in the world can execute it with grace and precision. Due to the difficulty, and the unnatural forces caused by the takeoff and landing of the jump, injuries can easily occur. Evan Lysacek knew his body’s limits and chose to discontinue training and performing quadruple jumps. This put him at a huge disadvantage in competitions, but this did not stop him from perfectly executing every element of his program.

All athletes, including the Olympic champions, YMCA junkies and weekend warriors need to pay closer attention to their body. You can only be a good as your body can handle. No one can be their best while injured. Lysacek dissected his body’s capabilities and was still able to walk away from Vancouver as a champion without the most prestigious element of an ice skating presentation. His performance had the world at the edge of their seats and he still kept his foot safe from reinjuring.

Being In Love May Reduce Foot Pain?

2010-02-13T07:57:00.000-08:00

The University of California Los Angeles recently did a study that showed thinking of a loved one decreased a person’s pain. While having heat applied to their forearm, 25 women were asked to rate their pain levels. When the women were shown pictures of their significant others or when they were allowed to hold their significant others hand their pain level consistently reduced.

Love is patient, love is kind, but is love an anti-pain medication? When one is suffering from a serious illness, it is obvious that having support from loved ones helps one get through the rollercoaster’s of pain and suffering. But, can love help with your everyday aches and pains? According to this study it can!

Medically, there is no definitive answer on why this may happen. Pain can only be measured by the person’s perception of the pain. Thus there is great variation in pain from one person to another. This is what we refer to as “pain threshold.” One may say they have a high pain tolerance, meaning it takes a lot before the pain “affects” them. I see this often in my clinic when I give a people injections. Some people are 100% calm, cool and collected and don’t even blink when I prick them with the needle. Others are jumping for the chandelier and screaming at the top of their lungs when all I am doing is putting a relatively small needle under their skin.

So can being in love increase your pain tolerance? Plantar fasciitis is one of the most common causes of heel pain. I see several patients a day with this common foot problem and when I ask the patients to rate their pain on a scale from 1-10, I can never predict their response. There is absolutely no consistency on how much pain this problem causes. The description is always the same “It hurts the most in the morning or after rest.” But since everyone perceives pain on a different threshold, not everyone rates it the same number. I have never dove into my patients personal lives to discover whether a pain rated a 10 actually means that they just lost the love of my life and as a result their foot hurts.

There is no doubt in my mind that having someone supportive in your life that makes you happy can help you deal with or handle your pain with slightly greater ease, but there is always a reason for the pain. .

Winter De-Feet

2010-01-18T17:02:00.000-08:00

Winter is knocking on our doors and bringing cold air to chill our bones. The cold air gives us so many reasons to snuggle up in bed or cozy up by the fire, but it also gives us so many reasons to enjoy the outdoors.

Skiing, ice-skating, snowshoeing, snowmobiling, and snowboarding are all common winter activities that expose our bodies to the cold. It is important to protect yourself from the cold weather. Many are unaware that you can still acquire cold injuries in weather above freezing! Sometimes we underestimate the weather, or sometimes we just don't have a pair of boots to go with our outfit. Whether on a ski hill or walking to work, you need to keep your feet protected from the cold.

Chilblains is an extremely common cold injury that does not involve freezing of the body's tissues. After exposure to cold weather, areas of the skin will be painful, red to purple, and swollen. The discomfort can last for days and eventually subsides. Occasionally, the affected area will permanently have an increased sensitive to cold Trench Foot occurs after the foot is exposed to cold and wet conditions. This was a common injury in soldiers of WWII. As in Chiliblains, none of the body's tissues are freezing but the cold weather does cause damage. The foot will be very painful, red, and blotchy. Depending on how long the foot was exposed and how cold the foot got, determines the severity. In rare cases, trench foot can lead to gangrene and the need of an amputation.

Frostbite is the actual freezing of the affected area and is the most severe of cold induced injuries. Ice crystals form and damage the surrounding tissues due to the lack of blood flow and heat. The longer the body is exposed or the colder the air, the more severe the injury. The skin may appear, pale, blue, red and will be extremely painful. Eventually the injury will cause nerve damage and loss of sensation. Blisters may form shortly after the injury.

The prognosis varies from mild complications to amputations. Those who are more susceptible to cold injures are children and elderly. Children have very small toes and fingers and therefore it is easier for these small areas to become cold. The elderly tend to have poor circulation and less mobility. Blood flow helps keep our extremities warm, thus anybody with poor circulation is at a greater risk for cold injuries. If you know you are going to be exposed to cold weather, make sure to dress for the occasion. Wear layers but make sure no area is too tight. Tight clothes can restrict circulation. Bring extra clothes and stay dry. If you have sweaty feet, try changing your socks as often as possible. Avoid drinking alcohol or using illicit drugs since these products can alter your perception of the weather. Take some time to warm up when you are getting cold. Going indoors and enjoying a cup of hot chocolate is sometimes the best part of playing outdoors!

A Painful Foot Tattoo

2010-01-16T11:51:00.000-08:00

You can get a tattoo just about anywhere of anything. Surprisingly, the foot has become a tattoo hot spot. Young and old tattoo enthusiasts are racing to get their foot art. Even though the feet are one of the most painful areas to get a tattoo, their popularity is growing! Is it safe for anyone to get a tattoo on their foot?

The foot has many tendons, ligaments, bones, blood vessels, and nerves. The bottom part of the foot is nicely cushioned with fat, but the top of the foot has a very thin layer of skin and fat. Thus, there is very little protecting the delicate structures underneath. The less fat an area has, the more painful the tattoo sight. The skin is basically made up of three parts called the epidermis, dermis, and hypodermis. The epidermis is the skin that regularly flakes off on a daily basis. The dermis is deeper and is the layer that tattoo ink is injected into. The tattoo needle injecting the ink is not intended to go into the hypodermis that contains larger blood vessels and nerves. There are tiny nerve endings in the dermis and thus the tattoo procedure will be very painful. One reason that foot tattoos are extremely painful and tedious is due the fact that the skin is thinner on the top of the foot and there is little space between the layers.

In simple terms, a tattoo is a wound with a dye injection. The skin which is a protective barrier to bacteria is broken and a foreign object, the dye, is injected into the sight. The body reacts to the dye and “walls it off” to protect the rest of the body from this foreign object. As a result, a permanent tattoo is formed. Most tattoos do not lead to serious complications, but occasionally a foot tattoo can go sour. It is important to keep the tattoo sight clean and protected after the procedure. Unfortunately the foot is often in socks and shoes that can harbor bacteria. The foot also bears a lot of weight and can put stress on the structures surrounding the tattoo and the tattoo itself. Many have to resort to flip flops or other non-supportive shoes for days to weeks before returning to their normal shoes. If your feet are not used to being in unsupportive foot gear, this may lead to generalized or focal foot pain. Still, it is more important to keep the tattoo sight clean since the complication is much more severe than not wearing proper shoe gear. Once the tattoo sight has healed, one should go back to wearing socks and supportive shoes during regular day activities.

Since tattoos are wounds, there is a population that should avoid getting a tattoo on the lower extremity and especially the foot. Peripheral Arterial Disease (PAD) is an extremely common disease among diabetics, and all people over 50 years old. It is the aging of the arteries that causes the vessels to be narrower than normal and thus decreases the blood supply to the feet. Wounds need blood and oxygen to heel. Remember, a tattoo is a wound and it also needs blood and oxygen to heel. Thus, if you have diabetes or PAD, your wound could turn into an ulcer that is limb threatening. People with lymphatic diseases and those who are have lost feeling in their feet are also at increased risk for developing an ulcer.

If you are interested in expressing body art on your feet, make sure your feet are healthy! Visit your podiatrist to have a foot exam to evaluate the health of your feet. If you have decreased pulses or sensation, your cool foot statement could lead to a not so beautiful wound or even an amputation!

Aaron Rodgers and Brett Favre: The Foot Comparison!

2010-01-06T12:30:00.000-08:00

You cannot watch football this season without hearing about Brett Favre and Aaron Rodgers. They have been over analyzed in every way possible. So much attention surrounds the legend and the rising star who replaced him. They have faced each other twice already this season, both with a Favre victory, yet the discussions don't seem to subside for a moment. So, to add on to this intense analysis, let us explore the foot injuries of the two athletes!

Prior to the Viking and Packer game, Favre had his first report on the Viking's injury list with foot pain. Nothing more was said about the issue other than that he had a sore foot. The irony of the situation is that after the game, Rodgers suffered from a foot and a toe sprain. Is this the beginning of the end? Did Favre get the last word through foot injuries?

A sprain describes an injury in which a ligament between two bones is stretched, damaged or torn. A Grade 1 injury is fairly mild with only minor damage to the ligament. A Grade 2 injury is a partially torn ligament and a Grade 3 is a ligament that is completely torn. With a grade 1 injury, the recovery time is short with very few possible complications.

On the other hand, a grade 3 can takes months to heal and is often extremely painful. Foot sprains are rare in the general population, but are common in sports that put the foot in abnormal twisting positions. Such injuries usually result in a grade 1 or grade 2 damage and complete recovery can be seen within the season with much improvement in only weeks.

Treatment consists of rest, icing, strapping, and anti-inflammatory drugs. A sprained big toe is better known as turf toe. This usually results when the big toe is abnormally hyper-extended. This injury can often be more debilitating than a foot sprain because of the important role the big toe plays in pushing off the ground when running. The grading system is the same as a foot sprain with Grade 1 being a minor injury and grade 3 being more severe.

To prevent further damage with the ability to continue activities, taping techniques have been proven quite effective. The severity of the foot injuries of Favre and Rodgers has been downplayed and seeing their continued performance on the field allows us to assume they are minor.

Still, these injuries can be very painful and increases the risk for a more severe injury. To prevent further injuries, both players should be undergoing physical therapy and switch to a more stable shoe gear. The cleats and the flexibility of football shoes increase the chance that the foot will be twisted in a position that could worsen the injury.

Rodgers' first line of treatment should be to have more protection on the field. It is likely that the injury resulted after one of his many sacks this season. Favre, has age working against him. Younger athletes tend to recover better and faster than older athletes, but Favre has proven that age does not define his ability to play football. Only time will tell if these injuries will advance to a more serious problem that will take them off the field.

The likelihood of these injuries progressing is unlikely since they seem to be only presenting with minor symptoms. Thus, the live football drama series of Favre versus Rodgers will continue.

The Ankle Sprain that Doesn’t Improve

2009-10-28T14:52:00.000-07:00

25% of all musculoskeletal injuries are ankle sprains! What does spraining the ankle actually mean? The ankle joint is made up of three bones: the tibia, fibula and talus. These bones are held into proper position by a number of ligaments. The soft tissues surrounding the joint help stabilize the bones so they do not move too much in the wrong directions. Sprains usually occur during athletic activities but sometimes we step down or trip on a rug and put abnormal pressures on our ankle. Most often, a sprain occurs when the foot gets tilted inward or inverted. These abnormal forces causes stretching or tears to the ligaments that stabilize the joint.

The injured ligaments will lead to swelling, inflammation, and pain. If the injury is severe, there may be a fracture present. It is standard for doctors to order x-rays and do multiple different maneuvers to the foot and ankle to asses which ligaments are damaged and if any of the bones are broken. When no bones are involved, rest, ice, compression, elevation, and anti-inflammatory medication usually does the trick. When a fracture occurs there may be need for surgical intervention.

Many people recover from ankle sprains with no problems, but about 10% of ankle sprains do not improve with traditional therapy. In these patients, the ankle sprain was only part of the problem. Below the ankle is another joint between the talus and the calcaneus called the subtalar joint. Thus the talus bone is connected to both the ankle and the subtalar joint. You can imagine that if abnormal forces are put on the talus there will sometimes be damage to the ankle joint and the subtalar joint. Just as ligaments are torn or damaged at the ankle joint, ligaments can be damaged at the subtalar joint.

Unfortunately, it is nearly impossible to tell the difference between ankle instability and subtalar joint instability by physical evaluation. To evaluate the damage, radiographs have to be carefully evaluated and some non-traditional evaluations should be utilized. Placing the foot in specific forced positions is necessary to open up the joint spaces to assess the damage. These can be very painful and a local anesthetic may be necessary in order to complete the exam. Ultrasound has shown to be a great way to evaluate injuries, but not all medical care centers have this modality available. If this injury is caught early , the treatment is mostly non-surgical. Different immobilization devices and physical therapy can usually strengthen the ligaments. Occasionally the injury will become a chronic problem that requires surgery.

Since this injury is hard to assess and difficult to differentiate from ankle joint injuries, your doctor may have a difficult time recognizing the issue. It is important to communicate your symptoms and pain as thorough as possible. Knowing how the injury occurred and the position your foot was in when the injury occurred can be very useful information for your doctor to determine what ligaments were injured. If you had an ankle sprain that doesn’t seem to be getting better, it may be an unstable subtalar joint that is the root of your problems.

Child Limping May be Sign of Bone Infection!

2009-10-14T18:12:00.001-07:00

Child Limping May be Sign of Bone Infection!

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Here a Cankle, There a Cankle, Everywhere a Cankle Ankle!

2009-10-14T17:42:00.000-07:00

We’ve all heard the term “cankle” but do we really know what it means? Media harps on Hillary Clinton’s cankles and other famous celebrities such as Kelly Clarkson and Katherine Hepburn. Cankle is a non-medical slang word to describe the absence of a defined ankle. The calf seems to extend strait down into the foot. As if the word did not have enough body parts to over criticize, we have not moved on to obsess over the size and appearance of our ankles!

A cankle a fully functional ankle and the so called “deformity” has no medical relevance other than self-esteem issues. The cause of cankles is merely due to a focal increase in adipose tissue or fat. It is thus largely associated with overweight individuals, but it is also widely seen in those who are physically fit. There is always that one part of your body that is really hard slim down. While some focus on the abs, thighs, or arms, some athletic individuals have discovered their cankles to be the problems area when trying to slim down.
Did my mom give me cankles? There does seem to be a family predisposition for the cankle syndrome. Just as some families have big noses or wide ears, some people have the genes for fat ankles. There is no medical proof that supports these claims but ask any cankle syndrome survivor and they can tell you their heart filled story on how cankles has stricken their family to wearing long wide-legged pants.

With the recent cankle phenomenon sweeping the nation, gyms and plastic surgeon have developed workouts and treatments to maximize your ankle appearance. The trick with you working out your cankle is to burn fat and thus a high cardio regimen is essential in the work out plan. In addition, defining your leg muscle will also decrease the appearance of the large ankle. Many people admit that the gym does not bring them close to their wanted appearance and have thus taken the road of liposuction.

Podiatrists, surgeons of the foot and ankle, do not recognize cankle as a medical term but take an increase of ankle size as a very serious matter. If your ankles seem to increase in size throughout the day or you feel as though your lower leg is swelling, this may be a sign of a more serious condition. Cardiovascular, and lymphatic diseases can cause increase swelling in the ankles. Trauma or injuries to the ligaments of the joint can also cause local changes to the ankle. The ankle is a very influential joint in ambulation and pain in this area should never be ignored. If you are worried your ankle size is secondary to a more serious issue, seeking medical attention is not unwarranted.

Got cankles? Be reassured that there are millions across the world battling the fatty ankle. Though you may feel like the only girl in the world who is self conscious about her ankle size, you are among many who avoid short skirts, high heels, and skinny jeans. You may want to discuss possible causes of edema in the lower extremities with your doctor if your ankle size has been increasing over time.

Summer Bumming Hard on Your Feet!

2009-08-16T13:37:00.000-07:00

Though it is hard to admit in a heat wave, summer is coming to a halt. It won’t be long until the kids are at school, and pumpkin picking, football games, and turkey dinners will be on the agenda! Thankfully there is still a good month of sandals and barbeque left! But, are your feet still up for the summer challenge or has summer gotten the best of them already. You may need to pay special attention to your feet on the last stretch of fun in the sun!

Complaint: My feet are dry and cracked. My feet are itchy, red, and sometimes have blisters.
Cause: Believe it or not, both of these complaints will often root from the same problem! Warm, dark, humid environments create a delightful home for fungus! Dry feet are a sign of sweaty feet and sweaty feet are a precursor to fungal feet.
Prevention: The number one thing to avoid is going barefoot in public. Wear sandals around the pool, in the locker room, and in public showers. When possible wear sandals over shoes to allow your feet to breath. Wear dry shoes, change socks often and inspect your feet on a regular basis.

Complaint: I have calluses or corns making my feet ugly. I have thick skin on my foot and it hurts.
Cause: The summer shoe selection can be referred to as the podiatrist’s best resource for job security. Too often men and women put their feet in shoes or sandals that are nowhere near the shape of their foot. This causes the foot to rub against the shoe. Friction causes a buildup of skin that can become painful or unsightly.
Prevention: Wearing wide toed shoes or just properly fitting shoes can help with this problem! Over the counter creams and lotions can help soften the skin, but be careful with corn pads. They often make the problem worse over time. If the callus or corn is continuously painful see a podiatric physician to properly remove the ailment.

Complaint: I have warts. I have a hard, flat, bump on the bottom of my foot.
Cause: Warts are caused by the human papilloma virus. It only takes a small cut or opening in the skin to allow the virus into your skin. These opening are often unseen by the naked eye. Some people are more susceptible to getting warts and need to take extra precautions to avoid the virus.
Preventions: Avoid walking around barefoot, even in your own home! If your family members have warts, you can all get warts! Avoid at home or over the counter treatments. Picking at the wart or improperly removing them can make the wart spread and what started out as one wart can quickly multiply creating a mosaic of many warts.

So as summer comes to an end make sure you keep your feet healthy and safe. If you have any
questions or concerns about your foot health or other summer threats to your feet, seek medical help
from a foot and ankle specialist also referred as a podiatrist. They are trained to treat all foot ailments of children and adults.

Sending Your Child's Feet to College

2009-08-16T13:32:00.000-07:00

Some of you have been dreading this day since the day he/she was born. Some of you have been waiting anxiously since he/she became a teenager. Your bundle of joy is all grown up and on their way to college. Parents across the world are preparing their lectures on sex, drugs, and alcohol. There is so much they have to learn on their first adventure with independence. What parents often overlook at this vulnerable time in their child’s life is the “foot talk.”
Hear me out before you think I’m crazy. I don’t want to undermine the importance about talking to your child about sex, drugs, and alcohol, but there are other important conversations to have. Young adults can be afflicted with a magnitude of foot disorders that can be very embarrassing and socially limiting.
Sweaty, Smelly Feet!

How on earth will your son your daughters make any friends if they have the smelly feet dorm room! If you think your child’s feet stink, imagine confining all of their dirty socks and shoes and their feet in a small poorly ventilated, overheated dorm room. It may not seem like a big deal now, but it is a major problem that can lead to athletes foot and toenail fungus. In your 20s with a fungus farm growing on your feet… good luck meeting your life partner!

Bare feet among fungus, bacteria, and who knows what!

We have all heard the importance about wearing sandals in public showers, but what about public areas in general. How often do the hallways of the dorm or your child’s dorm room floors actually get cleaned? It is college, so we can only imagine what is on the carpet. All you need is a tiny cut or skin opening to get infections. Plantar warts can be very common among college students because the virus can easily transfer from person to person when everyone is walking around barefoot in their new home called the dorms!

Ladies are walking home barefoot because their feet hurt!

If you’re a woman, you know the pain induced by wearing cute shoes. After spending all night in those high heels at a party (I mean “library”), the girls’ kick off their heels to relieve their feet on the walk home. What’s on the sidewalks in a college town? The most dangerous is glass! I recently went to surgery for a young lady who had a piece of glass lodged in her foot for 3 months! This lucky girl avoided a severe infection, but that is not always the case.

Pedicure day with the girlfriends!

Whether your daughter is familiar with getting pedicures or not, the girls will hang out and do girly things like pedicures. Don’t forget your college driven child is broke, thus they are always looking for a good deal whether it is penny beer pitchers or affordable pedicures. A pedicure can be disastrous if the tools are not cleaned properly, the spa chairs are not flushed properly, and the pedicurist does not use proper precautions to not cross contaminate. Remember, people with foot fungus or bacterial infections get pedicures too. Now I’m not saying the more expensive the pedicure the safer it is, but remind your child to ask about the cleaning techniques of the pedicure instruments.

So if you don’t have enough to worry about sending your child off to college, here some more things to add to your list. If your child has sweaty feet, see a podiatric physician before all possible friends are running away from the odor. Remind your children to watch their feet and take note of any changes. Don’t wait 3 months before you seek medical help for glass lodged into the foot, toenails changing color, or flaky, itchy athlete’s foot.

Why See a Foot Doctor?

2009-08-02T05:08:00.000-07:00

It is interesting to me how many people ignore foot and ankle problems. My feet hurt. My toe looks funny. My foot doesn’t feel right. My ankle is sore. I can’t run because of foot pain. My ankle gives out. This should warrant one to suspect a problem but most turn a blind eye to their foot problems. When you have a tooth ache, you go to the dentist. When you can’t see well, you go to the eye doctor. When your child has a fever, you go to your family doctor. So, when you have foot and ankle pain, shouldn’t you see a foot and ankle doctor?
For whatever reason, people have become to believe that sore feet are a part of life. Instead of seeking medical help, we adjust our activities to avoid the pain. I can’t tell you how many people I have met that have halted their favorite hobbies because they thought they didn’t have the feet to do it anymore.
Sandy, a dear patient of mine once told me she was an avid runner in her youth, but after college she stopped running because her feet couldn’t “handle” it anymore. She never did anything about her foot pain except decreased her activities and wore “ugly shoes.” As a result of her new found sedentary lifestyle, she gained quite a bit of weight and is now suffering from type 2 diabetes. Her primary care doctor referred her to me to monitor her foot health, which now is in great jeopardy due to her diabetes. It breaks my heart that Sandy, not only gave up something she loved but also put her heath at risk because of treatable foot pain. Since Sandy’s first visit with me 1 year ago, we have eliminated her foot pain, greatly decreased her chance of diabetic foot complications, and Sandy has taken up more physical activities and lost almost 100Ib.
Just yesterday, I had a patient who recently returned from a family vacation in Walt Disney World. Jim was upset because after the first day his feet hurt so badly, he spent most of the time sitting on benches as the rest of his family toured the park. I hear similar stories all the time. He admitted to suffering from moderate heel pain prior to the trip, but had a desk job so he never noticed the pain except when he went golfing, a hobby he practically gave up because of his busy schedule. Thus, since he only rarely had foot pain, he didn’t think it was a big deal. The full day of walking through Disney World flared up his condition, and his heel pain became unbearable for the remainder of the trip. Once again this could have been prevented if he would have gone to a podiatric physician about his foot pain.
I told Jim, “If you have difficulty seeing while driving in the dark, you go to the eye doctor and get glasses even though you are not suffering from a problem all day long. If your feet hurt with activity, you should go to the foot doctor (podiatrist), and receive treatment even if your pain is not all day or every day.”
If you find yourself adjusting your daily activities or avoiding hobbies because of your feet, call your foot doctor today! No matter your age, your feet should not limit the way you live your life, but rather be walking you up and down every hill and through every garden life has to offer. Take care of your feet!

Ingrown Nails Got You Hanging?

2009-08-01T09:17:00.001-07:00

If you have an ingrown toenail, you can relate when I say the pain and discomfort is beyond aggravating. Trying to find comfortable shoes is sometime impossible. But what do you do about an ingrown toenail? Do you try to cut it out with a toenail clipper? Will it be there forever? Some people are scared to seek medical attention because they think they will have to get their nail removed. Though sometimes this is necessary, it is rare that it one will have to lose their entire nail.
An ingrown toenail is a nail that digs into the skin and cause pain, swelling, redness, and sometimes infections. It can be cause by genetics, trauma, or improper trimming. Stubbing your toe or dropping an object on your toe may result in an ingrown toenail. Many people cut their nails too short. This encourages the skin to surround the nail and the nail can then pinch the close confiding skin.
When you first notice the problem, there are some at home treatments to reduce the inflammation and pain. Soaking your foot in luke warm water with Epson salt may reduce some of the symptoms. Wearing wider shoes that decreases the pressure applied to the area will also help with the pain. It is highly discouraged to try to remove the ingrown portion of the nail yourself. Continuously cutting the nail inappropriately will worsen the condition. These areas are highly susceptible to infection. Thus at-home surgeries of the nail can be very dangerous. If you continuously feel discomfort from your toenail, it is recommended to see a foot and ankle doctor, also referred to as a podiatrist.
A podiatric physician can do a simple in office procedure to remove the offending nail border. The nail will continuously grow to be ingrown unless the matrix or the root of the nail is destroyed. When only the outside border is causing problems, the doctor can remove that portion of the nail and only kill the root of that area of the nail. Thus you will still have a nail but a small portion will be removed and will not grow back. Those concerned with cosmetics will be happy to know that the removal of the border of a nail often goes unnoticed by others when the condition is minor. If there is a serious infection present, the root of the nail will not be killed due to the reaction of the chemicals used with the infectious tissue. The nail boarder is removed and the injury is allowed to heal until the tissue is healthy to undergo chemical insult.
Though some need to undergo more invasive surgeries to remove the matrix, most have their problems solved by a simple 15 minute visit to the doctor. The most important thing to do is to keep your hands off your toenails. Do not try to pick at it or cut it because a small problem can become a big problem if you do not remove of it correctly.

Ingrown Nails Got You Hanging?

2009-08-01T09:17:00.000-07:00

If you have an ingrown toenail, you can relate when I say the pain and discomfort is beyond aggravating. Trying to find comfortable shoes is sometimes impossible. But what do you do about an ingrown toenail? Do you try to cut it out with a toenail clipper? Will it be there forever? Some people are scared to seek medical attention because they think they will have to get their nail removed. Though sometimes this is necessary, it is rare that it one will have to lose their entire nail.
An ingrown toenail is a nail that digs into the skin and cause pain, swelling, redness, and sometimes infections. It can be cause by genetics, trauma, or improper trimming. Stubbing your toe or dropping an object on your toe may result in an ingrown toenail. Many people cut their nails too short. This encourages the skin to surround the nail and the nail can then pinch the close confiding skin.
When you first notice the problem, there are some at home treatments to reduce the inflammation and pain. Soaking your foot in luke warm water with Epson salt may reduce some of the symptoms. Wearing wider shoes that decreases the pressure applied to the area will also help with the pain. It is highly discouraged to try to remove the ingrown portion of the nail yourself. Continuously cutting the nail inappropriately will worsen the condition. These areas are highly susceptible to infection. Thus at-home surgeries of the nail can be very dangerous. If you continuously feel discomfort from your toenail, it is recommended to see a foot and ankle doctor, also referred to as a podiatrist.
A podiatric physician can do a simple in office procedure to remove the offending nail border. The nail will continuously grow to be ingrown unless the matrix or the root of the nail is destroyed. When only the outside border is causing problems, the doctor can remove that portion of the nail and only kill the root of that area of the nail. Thus you will still have a nail but a small portion will be removed and will not grow back. Those concerned with cosmetics will be happy to know that the removal of the border of a nail often goes unnoticed by others when the condition is minor. If there is a serious infection present, the root of the nail will not be killed due to the reaction of the chemicals used with the infectious tissue. The nail border is removed and the injury is allowed to heal until the tissue is healthy to undergo chemical insult.
Though some need to undergo more invasive surgeries to remove the matrix, most have their problems solved by a simple 15 minute visit to the doctor. The most important thing to do is to keep your hands off your toenails. Do not try to pick at it or cut it because a small problem can become a big problem if you do not remove of it correctly.

Why See a Foot Doctor?

2009-08-01T09:11:00.000-07:00

Back to School Shoe Shopping

2009-08-01T09:01:00.000-07:00

If my kid doesn’t complain about sore feet, do I need to worry about what I put on his feet? Some children spend most of their days running around the yard barefoot all day and never complain about a thing until they step on a nail or thorn. Other children will wine all day about their feet hurting. So what do you need to be looking for when you are shopping for new shoes for the new school year?

My kid never complains!
Wow! Can we trade? Alright lets be serious all kids complain but not all kids complain about their feet. It is best to actively ask the child, “Do your feet hurt? Do you feel pain in your feet when you are out playing?” Some children ignore the pain because they are having so much fun. Think about how awesome it is to be on the soccer team or play in the park with your best buddies… You wouldn’t stop unless you had to. How many kids pee in their pants because they don’t want to stop playing?

There no special accommodation, devices, or exercises that are required for healthy foot living. There is a level of common sense that needs to come into play though… for some this is difficult. Kids shoes can be trendy, inappropriate, and can lead to pain.

Stay away from the following
· Pointy toes
· Platforms
· Flip flops
· Stilettos—Teenagers love to sacrifice comfort for style!
Standard Shoes for Back-to-School
· Good Athletic Shoes (light colors are preferred for the gym and will decrease sweating)
· A wide toe box for dress shoes

My Kid Does Complain about Their Feet!
It is not uncommon for children to have foot and ankle problems. The good news is that these are highly treatable! If your child is complaining about foot pain, seeing a podiatric physician will help prevent complicated problems in your child’s future. Common problems can range from flat feet to ingrown toenails. Treatment is often non-invasive and conservative. Children can be prescribed special insoles known as orthoses and physical therapy to help strengthen the weak or ill-working muscles, joints, and ligaments. Children tend to be extremely active, so podiatric physicians can work around sport schedules and care for their feet to optimized their performance and enjoyment of their preferred after school activities.
Save your child from grandma’s bunions and dad’s recurring ankle sprains. Seek consultation on your child’s foot pain from a medical professional such as a podiatric physician. Even if your child is not experiencing pain, remember to use common sense when shopping for this year’s new shoes!

Feet Fit for Moon Walking

2009-07-09T18:44:00.000-07:00

His dance moves defined gravity. There was no performance that did not leave the entire audience speechless. Michael Jackson even designed and patented a shoe to successfully pull off one of his memorable dance moves. But even Michael Jackson suffered from foot and ankle injuries. Shortly before being inducted in the Rock n’ Roll Hall of Fame, Jackson suffered a foot injury that kept him from moon walking his way into history. Dancing, like many sports, puts your foot and ankle at high risk for injury. So how does a professional or amateur dancer prevent such injuries? Here are some helpfull suggestions.

The most common dancing injuries are sprains, fractures, tendonitis, blisters, toenail injures, and bruises. The first step to prevent these injuries is to inspect your shoe gear. Depending on what type of dancer you are, will determine what types of shoes are most appropriate. Unfortunately, many dances require shoes that are not healthy for your feet. Such as many ballroom dances that requires women to wear high heels. Heels can cause instability and compression issues. When shoes are not your friend on the dance floor, there are other common practices that you should become familiar with to prevent injury.

A thorough warm up is always necessary to get your muscles warm and loose. This will greatly decrease the likelihood of strains and sprains. Paying attention to your pains is also extremely important. Pain and discomfort can indicate an underlying problem that may be treatable. Seeing a podiatrist to examine your foot and ankle prior to increasing your dancing regimen can greatly reduce the risk of injury. A trained podiatric physician can asses risk factor for foot and ankle injuries and provide treatment and therapies to improve your foot function.

Children are also at great risk of suffering from foot and ankle injuries while dancing. The bones in the foot are still developing late into childhood. For some dances, it is necessary for the child to be examined before being allowed to do certain moves. For an example, going up onto Pointe can be very dangerous and damaging to the foot if done prior to the growth plate closure. The only way to be certain that the growth plates are closed is through x-rays.

Before you jump on the dance floor, take time to watch the moves carefully so you fully comprehend the demands on your body. Understanding your bodies’ limitations is key. Learning taping and padding techniques can help you accommodate your ailments and further prevent future injures.

If you are dreaming about being the next Michael Jackson, you need to be prepared to deal with foot and ankle issues. Luckily, these ailments are often temporary and treatable, but they often take time and rest.

Super-Pregant Feet

2009-07-05T05:52:00.001-07:00

It was recently announce that Ariana Lima and her basketball star husband are expecting their first baby. This Victoria Secret Supermodel is not along. Heidi Klum also recently announced she too is pregnant. When supermodels are pregnant they still find a way to uphold their image. We see them on TV strutting their stuff in high heels and designer gowns. Unable to drink or drug, how do celebrities keep the smile on their face with all the extra weight and tight shoes? The secret: Good Actresses! So, how does the real woman deal with the aches and pains of pregnancy?

My Feet Have Swollen and They Won’t Deflate!
The most common complaint among the child bearing is foot swelling. During the nine months, your baby grows into a healthy young baby and your feet grow about a half a size! Your feet swell because of the weight and position of the baby in its temporary home. This along with the added weight cause stretching of many of the tendons and ligaments in your foot. Thus, your foot gets bigger. For some, once the swelling subsides, they can go back to their old shoes. For many, their pre-baby shoes are off to the donation box. To cut down on the swelling, the most effective treatment is compressive stockings. Other treatment options are to rest with your feet elevated, stretch, and of course make sure that your shoes fit you properly. You never know when your feet are going to go on a growth spurt!

No Pain; No Gain!
In the process of nurturing a gift of joy in the womb, your body takes a severe beating. Pregnancy can be very traumatic on the expecting mother’s feet and will cause pain, pain, and more pain. As the pregnancy progresses, the feet are taking on an increasing amount of weight. This extra weight changes how we walk and move our body. To compensate for these changes, the foot tilts inward and the arch is decreased. This causes increases stress on the plantar fascia that helps support the arch. Plantar Fasciitis is inflammation of this fascia and is the cause horrible heel pain. Though the pain usually subsides after the pregnancy, the pain is often unbearable. To address the pain, women are advised to wear shoe inserts to support the foot and ice the painful areas. It is often recommended to get custom made orthoses prior or early in the pregnancy to prevent future foot aches and pains.

Cramping your Style!
As one would expect when a life is growing in another, there is an increase in blood volume. In order to prevent hypertension, the body dilates the vessels to decrease the flow and pressure. This may lead to a decrease in oxygen delivery to muscles far away from the heart and lungs because it takes longer for fresh blood to get to the sight. A lack in oxygen supply is what often causes leg and foot cramps. To relieve the cramping, one should increase the blood flow. Thus, it is best to walk this one out!

At the end of the day, there is no big secret to pregnancy and comfort. All women experience the ups and downs of bringing life into the world. Foot pain is one of the many road bumps along the way. I wish I could say it was the worse, but the teen years will probably give you more pain and heartache than the 9 months and 12 years prior combined.

Ped Egg Over-Easy

2009-05-15T11:57:00.000-07:00

Isn’t it great that you can buy cheese pre-grated. I had to grate cheese for dinner last night and I realized how awkward and difficult it was to use a cheese grater. If only the grater fit nicely in your hand like those Ped Eggs I see on commercials. Maybe that is what I’ll do next time; use a ped egg to grate my cheese because I surely wouldn’t be caught dead taking that device to my body.

It seems like every time you turn on the TV or walk through the pharmacy there is a Peg Egg waiting to be bought. With over 75% of the population suffering from foot problems, almost everyone is looking for a foot product to fix their problems. Is Peg Egg the answer to all of our problems? Personally, I think this gadget is better suited in the kitchen rather than the medicine cabinet.

Many people suffer from calluses and they can be very unsightly and very painful. For years, my patients have asked me advice on lotions and pumice stones, but now I’m frequently being asked about the Ped Egg. My answer: It is not safe! The Ped Egg is made up of sharp metal blades that literally cuts or shaves your skin off. Why would that ever be a good idea? Calluses are accumulation of dead hard skin. If painful, the callus can be reduced by medical professionals using a scalpel. This involves a delicate technique to prevent open lesions, bleeding, and infections. This type of callus is a sign of improper foot structure or gait. To treat, the doctor not only takes down the callus with instruments but also treats the patient with devices and or therapy to correct the underlying problem. The fact that patients may be self treating these problems with a glorified cheese grater is downright scary!

Most people experience rough dry skin because of improper shoe gear. This problem is easy to treat with specific lotions, stones and a change in shoes. The dry dead skin should be sloughed off to remove the dead skin and not any of the live, healthy skin underneath. Imagine if you had an old piece of furniture and the paint was chipping off. To remove the paint but save the chair, you would use a sander to just take off the top damaged layer. You would never think to take a chain saw, a chisel, or ax to the chair unless you wanted to completely destroy it. If you want to lose your foot then the Ped Egg is right up there with the chain saw. If you actually want to save your foot and have it look all nice and pretty than stay away from the fancy cheese grater.

With all jokes aside, the Ped Egg can be very dangerous for people with diabetes, peripheral vascular disease or any other disease that compromise the healing process or the immune system. Sometimes it only takes a tiny cut for some to get a devastating infection. Any product that has the potential of cutting the skin should be used with severe caution or not at all.

Testing the Foot

2009-05-08T09:35:00.000-07:00

How to test the Foot
As you sit in the doctor’s office, you may notice pamphlets on all sorts of different complications and treatments. You may also come across information on diagnostic testing such as Magnetic Resonance Imaging, Computed Tomography, and Ultrasound. What do these words mean? Do you really need to have these tests done?

When seeing a podiatric physician for the first time, they almost always take x-rays. Weather you have toe pain or ankle pain, an x-ray can give the doctor valuable information. Since doctors are human, they cannot see what is happening inside of your body. X-rays are a rather inexpensive way to take a glance underneath the skin and screen for any issues. Often, x-rays tell the doctor enough to confirm a diagnosis and treatment plan but sometime the x-ray cannot provide a clear diagnosis. The doctor must then order some more advanced studies.

Computed Tomography (CT scan) is a more advanced form of traditional x-ray. A CT scan takes digital technology and combines it with x-ray to create cross sectional images of the body or foot. Imagine cutting your foot with an egg slicer and being able to visualize the bones and soft tissue layer by layer. This is exactly what is done with a CT scan. This allows the physician to more precisely examine the size and location of the issue or complication. With a better understanding of the issue, the doctor can then better treat the issue.

Magnetic Resonance Imaging (MRI) is a very popular diagnostic test. Rather than using x-rays, MRI uses a magnetic field and radiofrequencies to produce images of the body. Unlike x-rays or CT scans, MRIs do not emit any radiation. A MRI is often used to evaluate soft tissue injuries or suspected problems. Since the MRI functions via a magnet there are some limitations for patients with pacemakers, artificial valves or other foreign artifacts in the body.

Ultrasound is a very popular diagnostic test because it is real time imaging. This means that the test can be performed in the office and the results are seen immediately. The device looks much like the ultrasound used on pregnant women but they are not quite the same. Ultrasound used on the foot is done at a different frequency to better capture the structures in the foot rather than the uterus. In general the ultrasound sends out sound waves that, depending on the tissue, get absorbed or bounced back to the probe. The information collected from the hand held probe is transformed into an image on the computer.

Though there are many other tests available, these are the three most popular advanced imaging test utilized by podiatric physicians. Remember that your foot is attached to your body. There are many different pathologies that can arise. Everything from a tumor to a neuroma can appear in the foot. It is important that a podiatrist fully evaluates every condition to rule out some very serious conditions. These tests also help to evaluate the severity of common conditions which leads to more appropriate treatment.

Why Do My Legs Hurt?

2009-05-08T09:32:00.000-07:00

Peripheral arterial disease (PAD) is becoming more and more prevalent in America. Our love of fast food and convenience has lead to almost 10 million Americans to be diagnosed with PAD. Our body naturally starts forming plaques in our arteries. This is part of the aging process. Unhealthy lifestyles though cause abnormal increases in plaque and as we get older, these high levels of plaque hardens and causes narrowing of the blood vessels. Arteries supply the body with blood rich in oxygen. If the vessels narrow, the body is not getting the appropriate amount of oxygen to the organs and muscles. Thus, those with PAD are four times more likely to have a heart attack and almost three times more likely to have a stroke.

Who is at Risk? Those with diabetes have a significant risk in developing PAD. So much so, that the American Diabetes Association recommend everyone with diabetes over the age of 50 should be tested. Other high risk factors are high blood pressure, high cholesterol, family history of heart disease, or being overweight. Smoking will also increase your likelihood of developing PADS by four times.

The first signs and symptoms of PAD are often first seen in the legs and feet. This is why we highly encourage high risk patients to pay close attention to pain, discomfort or open lesions in the legs and feet. One will often feel like their legs get tired or painful when walking or climbing exercise. When experiencing this pain, it will go away with rest. This is termed intermittent claudicating and is a sign that your muscles are not getting enough oxygen. One may also feel numbness or tingling, coldness, changes in color, hair loss on the legs and feet. These are all be signs of a serious problem, but some people who have PAD do not appear with any of these symptoms. Thus it is very important to still get tested if you are at risk.

How to get tested? If you are experiencing any of symptoms above or are at high risk of getting PAD, you should consult a health care provider. Testing for PAD is noninvasive, pain free, quick and easy! The examiner will either use a standardized machine or manually take your blood pressure on your arm, ankle and other areas on your leg. Significant changes in your blood pressure in your legs and or ankle is diagnostic of PAD.

What to do if you have PAD. It is important to take the steps to adjust your lifestyle to prevent the progression of the disease. It is advised that patients stop smoking, lose weight, and exercise to improve blood flow. All treatment plans should be thoroughly discussed with your doctor to know what options are right for your body. The doctor may prescribe blood pressure medication, encourage physical therapy, and in critical conditions, surgery may be necessary.

Those suffering from PAD are at an increased risk of having several foot issues including non-healing ulcers. PAD patients should visit a podiatrist regularly for foot screenings and management of foot and ankle problems. A growing number of the American population are having foot and leg amputations due to the effects of diabetes and PAD. Many of these amputations are highly preventable when people take the appropriate steps to care for their feet and consult a podiatric physician when suffering from any foot and leg pain or abnormalities.

Keeping the Elderly Walking

2009-04-21T16:13:00.000-07:00

As we get older, our health continues to weaken. Every time we take a trip to the doctor’s office we pray nothing new comes up. Time and time again we hear the same old story, “you need to make sure you exercise to stay healthy.” Whether you have hypertension, diabetes, or high cholesterol, your doctor is going to prescribe exercise! So how does an elderly person stay fit? Walking is everyone’s favorite activity! It is often the safest and easiest type of physical activity to participate as we age. Here are a few tips to help you stay healthy and safe while walking.

Walking Tip #1: Warm up and Cool down

It may seem silly and useless, but taking time to warm up and cool down before walking is very important. It allows an increase of blood flow to your muscles. This increases the oxygen levels available to your muscles. As you exercise, your muscles use the oxygen to create energy. If the oxygen is depleted, your body creates lactic acid which causes pain and your muscles to get tired faster. A warm up will help prevent this from happening. Stretching is an import part of a warm up and cool down. Having tight muscles can cause many different problems and can be painful. Stretching can also help prevent injuries.

Walking Tip #2: Buy a good pair of shoes that fits!

We all want to watch our budget, but walking shoes is not a place to cut corners. You should shop for your shoes in the afternoon. Your feet will swell throughout the day; thus, to ensure you have a properly fitted shoes you should avoid buying them in the mornings. Also make sure you have ample space in the toe box. You should be able to wiggle your toes around in your shoes. Try on several different brands and different sizes and walk around with them on both feet. This is the only way to find a comfortable shoe!

Walking Tip #3: Your feet should not hurt!

You may experience some pain when you begin your new walking schedule. You should pay close attention because this is not a normal occurrence. Self treatment may lead to more significant problem. You should contact a podiatric physician who will be able to accurately asses your pain and treatment options.

Walking Tip #4: Walk on softer surfaces!

As we get older, we lose our protective fat pad on the bottom of our feet. This increases the pressure on our bones and may lead to stress fractures. These types of injuries are more common in women but can also occur in men. Try to walk on grass, or dirt paths rather than hard cement if possible. Through softer ground may be better for stress fractures, make sure the ground is even to prevent ankle sprains or falls.

Walking Tip #5: Make a plan and get a friend!

Changing your lifestyle to include exercise is a huge undertaking. It is not easy to always stay motivated. It works best to build a plan and schedule that you can adhere to the best. Talk over your plan with your doctor to make sure it is appropriate for your health concerns. Find a friend or local walking groups to join. This will make the experience more enjoyable and rewarding!

Are Your Feet Overstressed?

2009-04-21T15:53:00.000-07:00

A stress fracture is a tiny crack in the bone caused by overuse. Most stress fractures occur on your metatarsal bones in your foot but they can occur in any part of the body. Stress fractures develop over a long period of time and are often initially unnoticed. Your bones naturally break down bone and rebuild bone on a continual basis. If too much force in repeatedly applied to the bone, then the breaking down of bone will exceeds the rebuilding of bone. The bone is insufficiently repairing itself. This is called bone fatigue. Over time the bone becomes weaker and eventually cracks. The fracture is very small and is often unapparent on x-rays.

Physical activity is always encouraged, but working out too hard too fast puts your body at risk for injury. When starting to work out or changing your workout routine, make sure you give your body time to adjust to the new stresses. It takes time for your muscles and bones gain the strength necessary to absorb the impact of running, jumping, and jarring. When your muscles fatigue, they no longer distribute the forces along the entire bone and the bone has to carry an increase of load. This will lead to fractures. Sometimes even changing the surface you run on can lead to injuries. If you are used to running on the grass or a softer surface, changing to cement or concrete surfaces will force your body to absorb more of the impact. You may not notice the bone fatigue initially but over time, you may develop a small crack in the bone or stress fracture.
Stress fracture pain is usually experienced with increased activity. Therefore, one may notice the pain to get worse the more they work out. The pain also occurs earlier in the workout as the fracture progresses. Initially the pain will subside with rest, but as the fracture increases in size the pain will become more constant. The pain may also be elicited by palpating the area over the fracture. Sometime a doctor may use a tuning fork to elicit the pain. The fork causes vibrations in your bone, and if a fracture is present it will cause pain. If no fracture is present, the tuning fork will not cause pain. Your podiatric physician will also take x-rays to rule out any other complications. The stress fracture will often be unapparent on a x-ray because the crack is so small. Therefore, the physician may need to order an MRI or bone scan to further assess the injury.

The best treatment for a stress fracture is rest. Chen Lu, a professional figure skater, missed the Olympics due to a stress fracture, Scott Neidemayer missed his Hockey All Star Game, and Yao Ming had to sit out a large portion of the season to nurse his stress fracture. Whether you are a professional athlete or have sport hobbies, you need to rest if you have a stress fracture. The only way to fully recover and prevent the injury is to slow down and allow your body to heal. Changing your workout to less impact sports and slowly increasing your body’s demands is highly recommended. Athletic shoes lose their shock absorptive properties and should be replaced at least every 6 months. NSAIDS can be taken to reduce the pain but should not be taken for long periods of time. If you are experience any foot pain that is continually getting worse, you should see a podiatric physician to assess the injury.

Can You Buy Foot Products From a Catalogue?

2009-03-19T14:08:00.000-07:00

While flying home from a medical conference, I noticed that airplane shopping magazines have everything. You can buy jackknife watches, home acupuncture kits, and even the world’s largest crossword puzzle. Amazing! You may notice that the magazine is full of advertisements for healthcare products. You can buy hearing aids, back adjusters and tons of different foot products. All while flying thousands of miles above your doctor’s office. So how reliable are these products?

Almost everyone has achy feet. Studies have shown that 75% of the American population has at least one foot problem. What a great market! Though we all have achy feet, there are thousands of reasons why our feet hurt. Do these products address your problem? If you have achy feet and have not yet seen a podiatric physician then I highly recommend that you refrain from wasting your money on products. If you have heel pain, it is not always planter fasciitis. Unless you have a diagnosis from your podiatric physician, you should not be using products to treat any foot disorder.

What if you have a diagnosis? When a doctor diagnosis’s you with a disorder, they develop a treatment plan that treats you and your specific conditions. Podiatric physicians know more about the foot and ankle than any other profession. With a combination of education and experience, podiatric physicians can map out a step by step process that will give you the best road to recovery. If you use products that are not a part of their treatment plan, you may interfere with your own healing! Talk to your doctor before trying something new. It may hurt you more than it will help you. Also, make sure to talk to your doctor about products you have used in the past. This is valuable information for the doctor because it may be the reason you are still or again experiencing problems.

What if your doctor already talked to you about using a product? Your doctor should discuss their treatment plan with you. High in the air, you see a devise that looks just like the one he showed you in the office. Should you take advantage of the low prices in the sky? Just because two products look the same, does not mean they are made the same. There is constantly being new products developed and researched but not all foot products have reliable studies to back up their claims. Many of the products that podiatric physicians provide are only found in physician offices and often a special licenses and education is needed to provide such products. These products always have legitimate studies that approves their use, but only someone who has training can really determine if it is the right product for you. Your foot is very complex and the devices and products provided in the doctor’s office are made with your foot’s anatomy and biomechanics in mind. Many of the products you find outside of the office are made with your pocketbook in mind.

Here are some helpful hints to guide you through the foot mall. Shoes should be made to support your feet not to fit in your back pocket. If you can fold the shoe or sandal up to a compactable size it is probably not going to support your foot well. There is a country song that says “Shoes don’t stretch and men don’t change.” Maybe you forgot but shoes come in multiple sizes. If they don’t fit buy the next size up. Let that “I’ll change for you” boy buy the shoe stretcher. Check your doctor’s website for products. Your podiatric physician can provide you with products approved by the American Podiatric Medical Association. Your physician is not there to take advantage of you; they are there to make you feel better. They provide you with a product because it is in their treatment plan to make you better. Most other places do not care if get better as long as you buy.

The Effect of Ankle Injuries on Your March Madness Office Pool

2009-03-19T09:07:00.000-07:00

There are two things for which March is known: green beer and basketball. This week, Americans are enjoying both. Whether you are a twelve year old boy or a grandma involved in the nursing home pool, it seems like everyone is talking about March madness. But did you know that just the last week there were five foot or ankle injuries among the players competing in the NCAA tournament. Before you turn in your bracket, you may want to take some of these injuries into consideration.
Robert Sacre, Gonzaga Bulldogs; Liam mcMorrow,Marquette Golden Eagles; Ty Lawson, North Carolina Tar Heels; Teondre Williams, Oregon Ducks; and Jonnie West, West Virginia Mountaineers have all had foot or ankle injuries within the last week and all of their teams have advanced into the tournament. Whether or not these injuries will affect the teams is questionable, but what we should be asking is why these injuries are happening so late in the season. At this point, the athletes should be at their prime strength, so why are the falling apart?
Basketball, like all sports, puts significant stress on your body especially your foot. Running causes an increase in forces on your foot and ankle three to six times your body weight. When a forward goes up for a rebound, they come down to contact the ground with a forces six times their body weight. Our body is designed to compromise and adjust for these forces, but if we do them too fast, we can cause damage to our body. This is why athletes go through training. Even with the best training, such as that provided to college athletes, your body can still get injured!
Ankle sprains are the injury seen most often on the court. Once an athlete has one ankle sprain, they are much more likely to have another one because the ligaments are weekend. Ligaments are small fibrous bands of tissue that connect bones to other bones. This along with muscles allows the skeletal system to have a considerable amount of stability. If a ligament gets stretched or injured, it will never recover to have the same amount of strength that it did before the injury. Therefore, once you have an ankle injury, you are much more prone to have one in the future.

So why aren’t athletes spraining their ankles every day.
Physical Therapy helps your body regain as much strength and function as possible. Since muscles also contribute to stability, a physical therapist will adjust the patient’s exercises to strengthen the muscles in the areas prone to injury. This type of therapy is the most beneficial and is why your podiatrist often suggests physical therapy for most types of injuries.
Basketball shoes are quite a bit different than the cross trainers or running shoes we all have stashed away in our closets. Basketball shoes or high tops come up higher to give your ankle more support. You put a lot of stress on your body jarring back and forth, running up and down the court and jumping up for the rebound. Simply changing your shoe gear can do wonders to reducing injuries on the court.
In addition, some people are more prone to ankle sprains due to biomechanical weaknesses, or simply put, the way their foot and ankle moves when they walk or run. This can innate weakness can be eliminated with a properly made custom orthotic that controls excessive foot motion.
Though the NCAA offers some of the best training and resources to their athletes, some injuries are inevitable. If you ever roll your ankle, take a stumble, or hear a POP, make sure to contact your podiatric physician as soon as possible. The earlier you seek medical attention by a highly trained doctor in the foot and ankle or a podiatrist, the better the outcome of your injury will be.

What is That Tingling, Burning Feeling in My Feet?

2009-01-21T13:56:00.000-08:00

Morton’s Neuroma

A neuroma is a thickening of a nerve and can occur anywhere in the body, even the foot. Morton’s neuroma describes a neuroma of a specific location in the foot, between the third and fourth metatarsals. This is located on the balls of foot between the third and fourth toes. Clinicians may refer to this benign growth as a tumor. In medical terms this is a correct description but this is not an indication of cancer. The enlarged nerve is benign, meaning it will not become invasive or become cancerous.

Though a morton’s neuroma is not a medical emergency, it can cause severe pain and impede on your daily life. Some patients describe the pain as walking on a marble, but the most often complaint is a burning, sharp pain. Tingling and numbness is also common.

It is thought that the nerve becomes enlarged due to repetitive irritation or pressure. Over time, this irritation leads to a neuroma and pain. Wearing shoes that are tight, too small, or with a heel can aggravate the pain because it causes increased irritation. The pain may also be caused by running or other sports. Flexing and relaxing your toes causes compression on the nerve, and the balls of your foot takes on the most weight during walking or running. Since this is the area where the neuroma is located, doing such activities can elicit a lot of pain.

The podiatric physician will take x-rays of a patient with such pain to rule out a fracture or other foot disorders. The doctor will also attempt to elicit the pain by squeezing the foot. This will not only cause pain, but there the doctor will also hear a clicking sound due to the neuroma shifting between the bones.

There treatment ranges from conservative treatments to surgery. Like all treatment plans, surgery should be a last resort for when all other treatments fail. The pain may be greatly reduced by changing shoe gear, but this is often not enough. It is very common for your podiatric physician to prescribe a custom orthotic. Many patients find relief by not only wearing orthotics but also wearing a pad under the balls of their foot. A podiatric physician can properly fit and provide such padding. Non-steroid anti-inflammatory drugs, such as Advil, can also be used to help reduce the pain but should not be used long term. Your doctor may also suggest a steroid injection which has a greater effect on relieving the pain. Stretching, massages, and icing has also shown to relieve pain.

If the pain has increased due to physical activity, it is suggested to take some time off from the activity to allow your foot to rest and heal. It may be better to take on activities that cause less impact on the foot. Excises’ such as swimming or bicycling may be good alternatives.
Neuromas are not life threatening, but they do cause alterations in your life. You should consider wide toed shoes with plenty of room for your toes to wiggle. The pain most often subsides with conservative treatment, but in rare cases surgery is necessary. Unfortunately, the procedure removes the entire nerve and will leave numbness of the effected toes. Thus, you and your podiatric physician should try to avoid surgery if possible.