Easy and Effective Winter Foot Care Tips

One of the best feelings in the world might be warm, fuzzy socks on cold feet. When your feet are cold, it's likely your body will be cold as well. Your head and feet are the two biggest outlets of heat on your body. If you keep them warm and cozy, the rest of your body will likely feel the same way.

The cold months of winter can wreak havoc on your feet. It's especially important to keep your feet warm and protected during the winter in order to keep them...and the rest of your body safe. In the article below, Dr. Robert Kosofsky, a podiatrist in Piscataway, NJ at Family Foot & Ankle Specialists explains some easy and effective tips to keeping your feet healthy and happy. He explains it is especially important for children and seniors are they are more susceptible to illness and injury.

For example,

• Always keep a change of socks
• Wear weather appropriate socks
• Children & babies need to wear extra blankets or protection
• Seniors need to regularly visit their healthcare professionals

Click here to learn how to keep your feet happy, dry and COZY all winter long!

Do you have a rash on your leg?

 I once had a woman come to me as a patient for an evaluation of a dark rash on the front of her right leg with mild swelling.  She says the rash always stays the same but the swelling is worse at the end of the day.  The key to her story is that she has almost no swelling when she wakes up in the morning.  She saw a dermatologist who prescribed some antifungal creams for this rash but it never cleared up.  She was very frustrated.  What was this rash?   

The official diagnosis was venous stasis dermatitis from venous insufficiency.  Well to break it down, this is a circulation issue.  Not the arteries.  She had good pulses in her feet (pedal pulses) so the arteries were bringing the oxygenated blood to the feet.  This is the most important part of foot health – the arterial circulation.  You must have good arterial circulation to literally keep your feet but that is another topic.  

This patient had insufficient venous circulation.  It is easier for the arteries to bring blood down to the feet with the help of gravity but the veins have to bring the deoxygenated blood back up to the heart and lungs against gravity.  So to help this venous blood to travel up, there are valves in the veins that push this blood up.  Over time, sometimes these valves get damaged, become insufficient and cannot do a good job at this so the venous blood pools in the legs and the legs increasingly swell.  Superficial and deep varicose veins develop and the venous purplish blood deposits some of its contents called hemosiderin deposits.  

This is what is responsible for the “rash” on this patient’s legs.  This is called venous stasis dermatitis.  So that is why the antifungal did not work as it is not a fungus nor did the steroids work as it doesn’t help the venous blood travel up the leg.  If this persists, venousstasis ulceration can develop with the increased swelling as the fluid has nowhere to go but out and the skin breaks opens.  

Increased age, smoking, genetics, obesity, trauma and pregnancy are all risk factors of venous insufficiency.  Compression stockings (support hose), pneumatic compression devices, weight loss, elevation and exercise can all help manage this condition.  Wound care is needed for an open wound (ulceration) and sometimes if severe enough, referral to a vascular specialist is necessary.

New NJ Podiatrist

 Introducing Dr. Amit Kalra!!

 Dr. Amit Kalra joins Family Foot & Ankle Specialists, in Hillsborough and Piscataway, NJ. 

As an athlete myself I know what it is like to have a foot/ankle injury. My mission here at Family Foot and Ankle is to make sure we give you the best and most up to date treatment for whatever issue you may have; Welcome!” 

Extensive Education “I pride myself on the education I have received to date and the years it took to get me to where I am today. By educating myself, I am able to provide my patients with the best and highest quality care imaginable.” 

• Bachelor of Science in Nutritional Sciences, Cornell University, Ithaca, NY Class of 2003 
• Masters of Science in Exercise Physiology, Ithaca College, Ithaca, NY Class of 2005 
• Doctor of Podiatric Medicine, Scholl School of Podiatry at Rosalind Franklin University Medical Center, North Chicago, IL Class of 2009 
• Residency in Foot & Ankle Surgery, Long island Jewish Medical Center/NSLIJ Health systems, Long Island, NY Class of 2012 

Highly Qualified “By continually educating myself and attending local and national seminars, workshops and conferences I stay abreast of new therapies to help my patients in all aspects of Foot and Ankle care.” 

• Board Qualified in Foot Surgery by the American Board of Podiatric Surgeons 
• Board Eligible in Reconstructive Rearfoot & Ankle Surgery 
• Member, American College of Foot and Ankle Surgeons 
• Certified, Foot and Ankle Arthroscopy

Dr. Dana Waters a podiatrist in Hillsborough and Piscataway, NJ explains how to treat ankle sprains at home. There are different treatments you can do at home, but if the pain persists you need to see a podiatrist.

How You Walk Shows Early Signs of Dementia and Alzheimer’s

The elderly population is booming and more than ever, people are living longer.  This is causing great energy in the medical community to explore diseases affecting our aging population.   Though we expect our bodies to age, it often troubles us to see ourselves or our loved ones have a decline in cognitive ability.  Alzheimer’s disease and Dementia can be a very painful disease for all involved.  New ways of detecting these diseases are being developed rapidly and now researchers are watching the way we walk to gain insight into our aging cognitive ability. 

The study of gait as it relates to medical pathology has been an increasing interest since the 1970’s.  You may notice that your podiatrist, orthopedist, physical therapist, or other health professionals take special interest in the way you walk.  Some offices now have gait labs that use state of the art technology to gain information about your walking patterns.  The way you walk gives great insight to a podiatrist on the cause or effect of different foot and ankle pathologies.  Gait analysis can be used to help train professional athletes to improve their performance, detect postural related pathology or injuries, and identify stroke patterns or other neuromuscular ailments.  Now science is discovering that our gait may give great insight into our cognitive ability.

In recent studies exploring gait patterns in the elderly population a correlation was found between a person’s gait pattern and their overall cognitive, memory, and executive function.   It appears that a person’s gait becomes slower and more variable as their cognitive function declines.  One study also evaluated brain atrophy using an MRI and found atrophy of the entorhinal cortex related to a decrease in gait velocity.  This portion of the brain functions as the center for a widespread network for memory and navigation.   Those patients with Dementia and Alzheimer’s disease showed measurable variations in gait compared to healthy individuals and as the severity of the disease increased.

Though it may seem logical that as we age we move slower, but these studies demonstrate gait to be much more dynamic than a simple, automatic, motor activity.  Gait is dependent on our cognitive ability and with cognitive decline, our ability to walk within normal parameters declines.  As the science of gait continues to evolve it may become common to have a doctor study your movements as you walk into the treatment room.  Examination of your gait may become as common as taking a blood pressure

Click here to have your gait analyzed by podiatrist in order to learn your chances of developing Alzheimer's Disease or Dementia. 

Peroneal Tendonitis: A Common Missed Problem in an Ankle Sprain

Below the outside ankle bone there are two tendons that can be easily injured during an ankle sprain.  These tendons are called the peroneals.  The longer tendon is called the peroneus longus and the shorter one, the peroneus brevis.

The function of these tendons is to turn the foot outward.  Most anklesprains occur when the foot and ankle roll inward causing an excessive amountof tension on these tendons.  The brevis tendon attaches to a bone on the outside of the foot, called the fifth metatarsal.  Due to this, it is very common to have the tendon pull off a piece of bone during a sprain.  When one sprains his ankle, most emergency room physicians will order only an ankle x-ray.  A foot x-ray is also needed to diagnose this fracture.

Ankle sprains are not the only cause of peroneal tendon injuries.  Feet with severe high arches will cause excessive strain on thetendon.  This is because the foot is naturally severely inverted (turned in).  Another culprit of peroneal tendonitis is direct trauma, so anything that hits or rubs against the tendon.  Besides the above causes, improper or abnormal shoe wear is a huge reason people get pain along these tendons.  Flip-flops allow the foot to move in all directions without any support and can cause a myriad of problems.  In addition, shoes with worn out sides cannot support the foot or ankle. 

When you have pain in this region, the doctor will first get an x-ray to rule-out a fracture. The next step is to treat this problem with the RICE method.  This is rest, ice, compression and elevation.  Depending on the severity of the pain or injury, you will either have a removable compression sleeve or a soft cast and a walking boot for a week or two.  If there is a fracture, then a hard cast and crutches might be necessary for 4-6weeks.  In really severe fractures, where the bone is displaced, surgical intervention is required.

Once the initial inflammation calms down, an injection of a steroid (anti-inflammatory) might be needed, as well as physical therapy to strengthen the area as well as to increase mobility and decrease swelling.  The final treatment would be a custom orthotic, which is an insert, made specifically for your foot, which will control the foot’s poor function. Family Foot & Ankle Specialists in Piscataway and Hillsborough NJ also offers a painless FDA approved laser to not only treat the pain but to help in the healing process of the tendon.   In very rare instances, the tendon is bogged down with scar tissue, and surgical intervention is needed to clean it out. 

As you can see, peroneal tendonitis is not something you want to ignore.  If you are suffering with this condition, go see your local podiatrist as soon as possible.  Remember, the faster you treat this, the quicker it will heal and get you back into the game. 

Yankees Pitcher, Andy Pettittte, Out With Ankle Fracture

Andy Pettitte, the 40 year old pitching star of the New York Yankees, was hit by a battered ball on his left ankle. The result was a fractured fibula, the outside bone of the ankle. Pettite will miss at least six weeks due to this injury.

 Pettitte was lucky that the fracture was at the fibula and not along the inside ankle bone, the tibia. This is because the fibula is a non-weight bearing bone as compared to the tibia, which is the larger of the two lower leg bones. As long as the fibula fracture is not displaced, surgery is usually not necessary and in most cases, the patient only needs to be in a walking boot.

Besides a direct blow to the fibula, other causes of this fracture are landing from a jump, or spraining the ankle. Fibula fractures are common in sports that require a quick change of direction such as, football, soccer and basketball.

If one sprains their ankle, or lands funny after a jump, a fibula fracture must be ruled out. The patient will usually limp or be unable to put any weight on the associated foot. We have seen severe displaced fractures of the fibula, where the bone is protruding out of the skin. Obviously, in this case, the fracture has to be repaired surgically. X-rays are used to diagnose this fracture and in some cases, an MRI or CT scan might be required.

For a non-displaced fibula fracture, such as the one Pettitte has, treatment usually is walking with a protective boot and/or the use of crutches for six weeks. The fracture is evaluated periodically to assess healing via radiographs. Once healing has occurred, the patient has physical therapy to get the ankle moving.

The patient must avoid all strenuous activities that might put a strain on the fibula. If the patient ignores the pain, the fracture can worsen, and then might require surgical correction. If the fracture is treated properly and quickly, the patient will heal to a full recovery and will be able to resume all activities within a couple of months.

It is most likely that Pettitte will not pitch until September, since it takes about 6 weeks for the bone to heal and then he will need a couple of weeks of therapy as well as time to strengthen his arm again.

Is Foot Plastic Surgery Safe?

Last week it was chin implants and this week it is toe tucks.  Butt, boobs, tummy, nose, and thighs are only a few common “problem” areas.  Plastic surgery has become nearly mainstream.   From 2000 to 2006, cosmetic surgeries performed increased by 48 percent and Americans spent over 11 billion dollars a year to better their looks under the knife.  At one time it was the rich and famous who got the occasional tuck and tighten but now it seems like everyone is getting their dose of Botox and surgical “touch ups.”  I now have patients coming in asking for cosmetic foot surgery. 

More popular in Hollywood and New York, podiatric plastic surgery has become the rage among women who have to wear the towering heels.  Why buy a more comfortable pair of shoes when you can get your foot reshaped to fit into the fancy shoes you love!  Clearly justifying their decision with fashion over logic, many are subjecting themselves to the knife, removing bones and sometimes complete toes.  Yes, complete toes.  Amputation of the fifth toe is now a procedure women are asking for so they can better squeeze their feet in the highly unreasonable shoes.  Are there any serious risks to these cosmetic foot surgeries?

Every surgical procedure carries risks.  Even the best surgeon in world has had a complication.  Some are unavoidable, unpredictable or even untreatable without devastating results.  Simply said, stuff happens.  In 2009, former Miss Argentina died after butt enhancing surgery.  This young, healthy, celebrity died of a pulmonary embolism.  Blood clots that traveled to the lungs are uncommon complications after surgery and in foot surgery it occurs in less than 1%.  Still, it does happen and it can be fatal.  This is of course the worst case scenario.  Less fatal but possibly equally devastating are post operative infections.  In young healthy patients, these can typically be treated successfully with antibiotics.  Occasionally, the infection is more severe requiring more surgery, and possible amputation.   Other complications consist of nerve damage, chronic pain, recurrence of deformity, and worsening appearance.  Currently the American Podiatric Medical Association and the American Orthopedic Foot and Ankle Society both denounce cosmetic surgery to the foot due to the inherent risks of surgery far outweighing the benefits.  Many people need foot surgery but such surgical procedures are reserved for people experiencing pain or a chronic deformity.  

We have all been there.   A gorgeous pair of shoes on sale just begging you to buy them,  but they are just a size too small.  If only your foot were a little smaller, a little narrower, if you had one less toe or less toe cleavage, you could make this perfect pair of shoes fit!  Unfortunately a toe tuck or a foot facelift is not the answer.  There are some shoes you just have to walk away from.  If the shoe hurts, it doesn’t fit!!!  It’s better to find a shoe to fit the foot than make a foot that fits the shoe. 

Will I Need Pins in my Toes after Surgery?

It may look and sound crazy but pins sticking out of toes are normal!  You can imagine the disbelief on a person’s face when I tell them they may wake up from surgery with pins sticking out of their feet.  “Don’t worry, I’ll remove them in my office and you won’t feel a thing.”  It sounds crazy but I’m being serious!  Kirschner wire or k-wire is a small pin commonly used in foot and ankle surgery and is routinely used in toesurgery.

A hammertoe is a dreadful toe deformity that can cause pain, discomfort, difficulty fitting in shoe gear and appear unsightly.  Few people can ignore the annoyance of hammertoes because they often progressively get worse over time.  I’ve seen patients have to completely dismember their shoes, cutting holes to allow their toes to fit in the shoe box.  The cause can be complex and is largely attributed to a tendon imbalance caused by an abnormal foot type. The result is bones buckling up on one another causing the knuckle of the toe to stick up in the air.  Most people complain of the knucklerubbing on the shoe and forming corns.  Another common complaint is pain at the tip of the toe that is now bearing more weight.  Pain around the nail can also occurrence because the nail will often rub against neighboring toes. 

Unfortunately, little can be done to treat hammertoes conservatively.  A wider shoe with alarge toe box is the best advice.  Tapingor padding around the toes can help to relieve symptoms periodically but does not treat nor reverse the deformity.  Hammertoe is a common surgical procedure with some variability.  Depending on the flexibility of the toe, sometimes it is only necessary to remove a small part of bone to straighten the toe.  Often, it is necessary to fuse the bones to ensure the toe remains strait.  Toe surgery is performed in a step wise fashion and until the toe is strait.  First the bone is cut to allow more space in the joint.  This is then followed by surrounding soft tissue procedures to completely straiten the toe.  There are several different implants that can be placed in the bone at the joint to fuse the two bones.  These have become more popular over the years and k-wires are being used less, but still k-wires remain the gold standard of treatment.  The k-wire is drilled through the toe to keep it strait during the healing process to ensure a better recover and appearance of the toe after surgery.  The pin is pulled several weeks after surgery and is completely painless.  

It probably still sounds a little funny and maybe a bit scary, but nothing abnormal about waking up from toe surgery with some external hardware.  As I described before, toe surgery is done in a step wise fashion until the toe is strait.  Not all toes surgery needs a k-wire or joint implant.  This depends on the severity of the deformity . 

My Toes are Always Cold!

When a patients comes to my office complaining of cold or numb toes there a three things that instantly pop into my head; diabetes, vascular disease, or Raynaud’s phenomenon. Now before you get all excited and start self diagnosing, many people just have cold feet because it is cold! We may think it is a new problem or it has gotten worse, but we must also take note that the temperature is dropping, our floors are colder and it has been months since our feet have seen this weather. Still, persistent coldness, numbness, or pain is not normal.

Why do diabetics have cold feet? Diabetes cause many changes in your body over time. One such change happens in the nerves. The elevated sugar levels in the blood damage the nerves and inhibit their ability to function properly. This is called peripheral neuropathy. Neuropathy can affect the foot in two ways. First it changes our perception of sensations and eventually progresses to loss of sensation. Most patients describe the process as burning and tingling that eventually leads to numbness, but I have heard many different descriptions. Just yesterday a gentlemen with neuropathy said, “It felt like was standing in ice cold water and my toes eventually froze with no feeling.” Secondly, neuropathy changes the way nerves reacts to stimuli. The nerves in the feet do not communicate well with the rest of the body. For example when we are warm the blood vessels dilate, this explains why we get rosy cheeks. But with diabetes the nerves in the foot don’t always get the message and the vessels stay constricted and less warm blood is getting the toes.

Are cold feet a sign of vascular disease? Our body produces heat in many different ways but a major facilitator to maintain body temperature is our blood. Blood vessels enlarge when we are warm and get smaller when we are cold. It is more important to keep our organs at a certain temperature than our hands, so our body naturally adjusts blood flow to facilitate the demands. With vascular disease, our vessels are damaged or clogged and either blood is not traveling where it needs to be fast enough or it is has trouble getting back to the heart to get re-warmed and refilled with oxygen. In the most simplistic terms: less blood moving means less warmth moving through our hands and feet.

Are cold feet a disease in itself? Actually, there is a disease that causes cold, numb feet! Raynaud’s disease is a condition in which your body over-reacts to cold stimuli. As I mentioned before, our blood vessels get smaller when we are cold. They can also get small when we are stressed or excited so our heart and brain get the most blood in demanding situations. With Raynaud’s our body blows the situation out of proportion and the vessels go into vasospasms. The toe(s) and or finger(s) will turn white due to the lack of blood flow, and then purple due to the increase in venous blood flow, finally when the toe is re-warmed it will turn red due to the return of blood flow. More often Raynaud’s occurs with other conditions such as Lupus, rheumatoid arthritis, or many other systemic diseases.

I cannot count the number of times I have heard the complaint about having cold feet. We have all had them and know the pure agony of freezing toes. Occasional coldness with changes in weather is normal. Struggling every day with cold feet is not normal.

Losing Weight Workouts without Foot Pain

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 area. 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.

Losing Weight Workouts without Foot Pain

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 area. 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

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.