Kobe Bryant Tears Achilles Tendon

Could This be the End of His Career?

During the fourth quarter of yesterday’s Los Angeles Lakers game, Kobe Bryant suffered a probable Achilles tendon tear in his left leg.  Probable, because he will undergo an MRI to confirm the diagnosis.

However, a complete tear is easily diagnosed by clinical examination. A doctor will perform what is called the Thompson’s test, whereby the patient is lying on his stomach and the doctor will squeeze the calf muscle.  The foot should move up and down if the Achilles is not ruptured.  If it is, the foot will not move.

The Achilles tendon attaches the calf muscle to the back of the heel bone.  It is a very thick and strong tendon and not easy to tear, but it is still a common injury. Causes of Achilles tendon tears can be caused by overuse, such as in sports, when one does too much, too fast, and too soon.  Combine that with lack of stretching, then you have a great recipe that can lead to this type of injury.

In addition, the injury is common in professional athletes because of the tremendous force that is applied to this tendon while playing their sport.  It usually occurs as the foot is planted on the ground and then there is a quick rotation of the leg and ankle.  So, in Kobe Bryant’s case, as he planted his left foot, he quickly turned his body, causing the tendon to snap.

Bryant is 34 years old and has played more minutes per game during the month of April then in any other time during his prodigious NBA career.  This has definitely caused a lot of wear and tear on his body.

Other causes for this type of injury is wearing high heels, which causes a lot of stress on the tendon, as well as trauma to the tendon, such as a blow to the area.

Bryant will need surgery to repair this tendon, and recovery will be anywhere from 6 months to a year.  This type of injury ended careers of Dan Marino and Charles Barkley.  Hopefully, this is not the end for Kobe.

If you are having pain at the back of your heel, you should see your podiatrist.  AtFamily Foot & Ankle Specialists in Piscataway and Hillsborough, NJ, 
we see and treat a lot of athletes with this sort of injury. 

To get more information on foot and ankle injuries, get our free book, "Stop Foot Pain Fast: A User's Guide to Foot and Ankle Health.

If you are experiencing foot or ankle pain, call to get a FREE appointment at our Piscataway podiatrist office.

Dr. Wishnie is Finally Legal!

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

Is Brett Favre’s Ankle Serious

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.

Knee Pain Is A Foot Problem

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.

How Lysacek won Gold on an Injured Foot

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?

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

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

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!

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

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.

Summer Bumming Hard on Your Feet!

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.

Why See a Foot Doctor?

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?

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?

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?

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!

Ped Egg Over-Easy

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

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?

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.

Can You Buy Foot Products From a Catalogue?

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

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.