As the end of the year winds down (already?!), once again, unless you have foot pain, our tooties are the last things we focus on. Turkey, trips, tantrums and those terrifically terrible relatives are of more importance! So I challenge all of you to take this moment to make those simple changes that will keep our feet happy for a long, long time to come.
A resolution and a fresh foot start for the new year! Let’s get started!
Feet tend to swell more in the afternoon. Shop for shoes in the afternoon so you aren’t stuck with a pair you can’t get off at the end of the day! Be sure they feel good in the store. Shoes are not meant to be “broken in”. And if you are shopping for your children, bring them with you. They may feel something wearing the shoe you couldn’t possibly know without them putting them on!
If you have to wear a heel, stick to one that is no more than 1 ½ inches. Over that, you greatly change the dynamics of foot function putting 75% of your weight on the ball of your foot. Save the stilettos for short distances, not shopping trips if you can’t part with them altogether!
It is a good habit to powder up those feet with a powder that has corn starch before putting your socks on. This will help keep them dry. Moisture causes foot odor and althete’s foot. If you don’t want the powder in a sandal, pick up some Summer Soles at www.summersoles.com. This is a paper thin inlay for sandals and shoes that wick the sweat right off your feet so your feet don’t slosh and slide on it!
Avoid trimming your nails too short. This can cause an ingrown. Keep your nails trimmed so there is still a little “white” showing on the end. Round the corners with a file so they don’t dig in.
Get your pedicures at a place where you see them physically take the nail packets out of an autoclave (the device that sterilizes them). Now is not the time to skimp on nail care. The cheaper the place, the less they want to put into the cost of sterility. And if you don’t know how difficult it is to get rid of a fungus, here’s a pearl: over-the-counter topical nail solutions are only about 12% effective and less! And that is after you use it consistently for a year without painting your nails that entire time!!
Here’s an extra tip because I simply could not stop at 5!! Visit us if you have any type of foot pain that does not go away within a few days of TLC on your part. A chronic foot problem is so much harder to get rid of even with our help!
Remember, feet are our friends until they hurt! Let’s keep them on our good side!
Sunday, December 6, 2009
Monday, November 2, 2009
Painful Lump In Your Arch? Could Be Plantar Fibromatosis
Plantar Fibromatosis. Wow, that's a mouthful! What is it? A lump in your arch that is firm and doesn't move. They usually start out as a very small pea sized nodule that increases in size over time. Most people don't even notice them until they get big enough to be annoying in your shoes or when walking barefoot. They can happen to anyone, but are most commonly seen in middle-aged to older patients and are much more common in men than woman. It is also more common in the Caucasian population than other ethnicities.
Most people come into the office complaining of a painful lump in their arch and are very concerned it is cancer. It is actually just an exuberant growth in the plantar fascia (a.k.a. the ligament that holds up your arch) or extra fibrous tissue. We really don't know why they occur, but it is thought that some kind of trauma plays a role in the formation of the nodules. I often see them in pilots and runners who have constant repetitive trauma to this area. Family history is also a factor. As many as 50% of patient with plantar fibromas also have nodules in the palm of their hands known as Dupuytren's contractures. There has been some correlation with medications like beta-blockers and anti-seizure medications. One study even linked an excessive amount of vitamin C with fibrous disorders. Patients with a history of chronic liver problems, diabetes, seizures and alcohol abuse seem to have a higher rate of plantar fibromas.
Treatments vary, but fall into three categories:
1. Do nothing: the nodules are annoying but usually self-limiting. They do not grow indefinitely, so if you can put them down as life's minor annoyance, most patients choose to just leave them alone.
2. Conservative or Non-invasive: Vigorous stretching, accommodative orthotics, physical therapy, and topical transderamal Verapamil.
3. Surgery: injections with a corticosteroid can be helpful to decrease the inflammation around the nodule, but if they are large and painful; most go on to surgical excision.
What should you do? A personal question, that only you with the help of your doctor can answer. In my opinion, if the nodule is small, leave it alone. If it is increasing in size, then it should be addressed. If the nodule is of moderate size, with no intrasubstance calcifications on x-ray, and is annoying; a three to six month trial of transdermal verapamil coupled with an accommodative orthotic and physical therapy can be helpful. If it meets these criteria and is a little soft, then a steroid injection may also help decrease the size. If the lesion is large, painful, or has intrasubstance calcifications on x-ray; then excision is most likely your best option. Simple excision is not enough with these lesions, removal of not only the lesion, but a large margin is necessary to decrease recurrence rates.
If you have a painful lump in your arch, seek the advice of your podiatrist. Help is only a phone call or mouse-click away!
Most people come into the office complaining of a painful lump in their arch and are very concerned it is cancer. It is actually just an exuberant growth in the plantar fascia (a.k.a. the ligament that holds up your arch) or extra fibrous tissue. We really don't know why they occur, but it is thought that some kind of trauma plays a role in the formation of the nodules. I often see them in pilots and runners who have constant repetitive trauma to this area. Family history is also a factor. As many as 50% of patient with plantar fibromas also have nodules in the palm of their hands known as Dupuytren's contractures. There has been some correlation with medications like beta-blockers and anti-seizure medications. One study even linked an excessive amount of vitamin C with fibrous disorders. Patients with a history of chronic liver problems, diabetes, seizures and alcohol abuse seem to have a higher rate of plantar fibromas.
Treatments vary, but fall into three categories:
1. Do nothing: the nodules are annoying but usually self-limiting. They do not grow indefinitely, so if you can put them down as life's minor annoyance, most patients choose to just leave them alone.
2. Conservative or Non-invasive: Vigorous stretching, accommodative orthotics, physical therapy, and topical transderamal Verapamil.
3. Surgery: injections with a corticosteroid can be helpful to decrease the inflammation around the nodule, but if they are large and painful; most go on to surgical excision.
What should you do? A personal question, that only you with the help of your doctor can answer. In my opinion, if the nodule is small, leave it alone. If it is increasing in size, then it should be addressed. If the nodule is of moderate size, with no intrasubstance calcifications on x-ray, and is annoying; a three to six month trial of transdermal verapamil coupled with an accommodative orthotic and physical therapy can be helpful. If it meets these criteria and is a little soft, then a steroid injection may also help decrease the size. If the lesion is large, painful, or has intrasubstance calcifications on x-ray; then excision is most likely your best option. Simple excision is not enough with these lesions, removal of not only the lesion, but a large margin is necessary to decrease recurrence rates.
If you have a painful lump in your arch, seek the advice of your podiatrist. Help is only a phone call or mouse-click away!
Wednesday, October 28, 2009
Here a Cankle, There a Cankle, Everywhere a Cankle Ankle?
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, foot and ankle surgeons, 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.
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, foot and ankle surgeons, 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.
Tuesday, September 22, 2009
What is a "Sausage Toe"?
A patient came in the other day with a swollen tip of her second toe. She also had a funny looking, thick toenail and really thought that was the cause of her pain and swelling. She related that she had been experiencing throbbing pain, redness and swelling for several months in just the tip of the toe. It had never spread or gotten much worse. She had never experienced drainage or infection symptoms around the toenail. She was unable to wear a closed in shoe and was to the point that she wanted her toe amputated. She had been treated with topical anti-fungals and antibiotics without much result. She was sent to me for another opinion after taking two months of oral anti-fungals and having no change in the nail or toe appearance. What a strange presentation….or is it?
Sausage toe is a whimsical term used to describe a red, hot swollen toe often seen in psoriatic arthritis. It can also be seen in Reiter’s syndrome and other seronegative arthropathies. In English, a non-rheumatoid type arthritis. Sausage toe is inflammation of the distal interphalangeal joints (tip of your toe and adjacent knuckle) that looks like a sausage or lollipop. In psoriatic arthritis, it is often accompanied by nail changes that mimic onychomycosis or a fungus in the nails. The nails can be pitted, yellow, thickened, fragmented, and lifting from the tip of the toe. Psoriatic arthritic can occur without the typical skin changes seen in psoriasis, but most patients have some skin lesions.
Sausage toes should be treated aggressively to decrease the inflammation and joint destruction. Long term inflammation can lead to erosive changes and permanent joint pain and stiffness. Joint ankylosis (complete fusion of the joint) can occur in severe cases. Basic treatment starts with nonsteroidal anti-inflammatory drugs, exercise, physical therapy and education. Patient should be taught the “move it or lose it” principal of arthritis management. Exercise and mobilization of the joints, but not overuse and abuse, should be reinforced. Some patients need more aggressive treatment, and this should be part of a comprehensive treatment plan by a rheumatologist.
Sausage toes should not be ignored. They can be caused by many factors such as trauma, infection, osteomyelitis (infection of the bone), and many different rheumatologic disorders as discussed. If you experience a painful, red, swollen toe that just seems to persist; seek the opinion of your podiatrist. Treated early, sausage toe can just be part of a whimsical story instead of a long term disability.
Sausage toe is a whimsical term used to describe a red, hot swollen toe often seen in psoriatic arthritis. It can also be seen in Reiter’s syndrome and other seronegative arthropathies. In English, a non-rheumatoid type arthritis. Sausage toe is inflammation of the distal interphalangeal joints (tip of your toe and adjacent knuckle) that looks like a sausage or lollipop. In psoriatic arthritis, it is often accompanied by nail changes that mimic onychomycosis or a fungus in the nails. The nails can be pitted, yellow, thickened, fragmented, and lifting from the tip of the toe. Psoriatic arthritic can occur without the typical skin changes seen in psoriasis, but most patients have some skin lesions.
Sausage toes should be treated aggressively to decrease the inflammation and joint destruction. Long term inflammation can lead to erosive changes and permanent joint pain and stiffness. Joint ankylosis (complete fusion of the joint) can occur in severe cases. Basic treatment starts with nonsteroidal anti-inflammatory drugs, exercise, physical therapy and education. Patient should be taught the “move it or lose it” principal of arthritis management. Exercise and mobilization of the joints, but not overuse and abuse, should be reinforced. Some patients need more aggressive treatment, and this should be part of a comprehensive treatment plan by a rheumatologist.
Sausage toes should not be ignored. They can be caused by many factors such as trauma, infection, osteomyelitis (infection of the bone), and many different rheumatologic disorders as discussed. If you experience a painful, red, swollen toe that just seems to persist; seek the opinion of your podiatrist. Treated early, sausage toe can just be part of a whimsical story instead of a long term disability.
Tuesday, September 15, 2009
Why Do Some Younger People Get Arthritis in their Ankles?
Younger patients can experience arthritis in their ankles. There is no age limit, young or old, for this painful disorder. Some people have arthritis caused by a systemic disorder like juvenile rheumatoid arthritis. Most have a more traumatic type of arthritis caused by an injury.
In the majority of younger patients with ankle arthritis, their arthritis is usually a secondary effect from too many ankle sprains. Most can relate a twisting type of injury which caused a deep cartilage injury that is often called osteochondritis dissicans. This has been seen to occur with no obvious trauma, but most can relate a history of severe sprain. Over time, the injured cartilage starts to deteriorate, then flake and finally many patients have bone on bone contact which is extremely painful.
Osteochondritis often causes significant pain, swelling and stiffness in the ankle. Patients come in several months after experiencing a bad sprain complaining of continued popping, instability, stiffness and pain. Some complain of severe discomfort, but most relate a chronic annoying ache.
Ankle sprains should not be ignored, because many lead to chronic instability and eventual arthritis. A physical examination by your podiatrist is usually followed by x-rays. If plain film x-rays are negative, and you have had pain for more than 2 months from an ankle sprain; an MRI is indicated to rule out a cartilage injury of the talar dome. This MRI can evaluate the cartilage of the talar dome for obvious flaps and for subchondral injury to the underlying bone. A chip fracture can be quite painful and feel like a clicking every time you move your ankle.
Conservative therapy for osteochondritis includes bracing, physical therapy, anti-inflammatories and rest. Many people do well with just conservative therapy and maintain their joints by working on their proprioception and strength.
Unfortunately, surgical intervention of ankle arthriscopy is often needed to remove the cartilage fragments and place tiny drill holes in the deficit to encourage the formation of fibrocartilage or scar tissue. Severe defects may require cartilage grafting.
So, for all you young sports stars out there: Remember that ignoring multiple ankle sprains and ankle instability is usually a prescription for long term arthritis. Osteochondiritis leads to good old fashion osteoarthritis. Arthritis pain can be treated with anti-inflammatories, bracing, and in severe cases; an ankle fusion of joint replacement. In the end, most people wish they had consulted their doctor for their ankle sprains early on and avoided long term arthritic pain.
In the majority of younger patients with ankle arthritis, their arthritis is usually a secondary effect from too many ankle sprains. Most can relate a twisting type of injury which caused a deep cartilage injury that is often called osteochondritis dissicans. This has been seen to occur with no obvious trauma, but most can relate a history of severe sprain. Over time, the injured cartilage starts to deteriorate, then flake and finally many patients have bone on bone contact which is extremely painful.
Osteochondritis often causes significant pain, swelling and stiffness in the ankle. Patients come in several months after experiencing a bad sprain complaining of continued popping, instability, stiffness and pain. Some complain of severe discomfort, but most relate a chronic annoying ache.
Ankle sprains should not be ignored, because many lead to chronic instability and eventual arthritis. A physical examination by your podiatrist is usually followed by x-rays. If plain film x-rays are negative, and you have had pain for more than 2 months from an ankle sprain; an MRI is indicated to rule out a cartilage injury of the talar dome. This MRI can evaluate the cartilage of the talar dome for obvious flaps and for subchondral injury to the underlying bone. A chip fracture can be quite painful and feel like a clicking every time you move your ankle.
Conservative therapy for osteochondritis includes bracing, physical therapy, anti-inflammatories and rest. Many people do well with just conservative therapy and maintain their joints by working on their proprioception and strength.
Unfortunately, surgical intervention of ankle arthriscopy is often needed to remove the cartilage fragments and place tiny drill holes in the deficit to encourage the formation of fibrocartilage or scar tissue. Severe defects may require cartilage grafting.
So, for all you young sports stars out there: Remember that ignoring multiple ankle sprains and ankle instability is usually a prescription for long term arthritis. Osteochondiritis leads to good old fashion osteoarthritis. Arthritis pain can be treated with anti-inflammatories, bracing, and in severe cases; an ankle fusion of joint replacement. In the end, most people wish they had consulted their doctor for their ankle sprains early on and avoided long term arthritic pain.
Sunday, September 13, 2009
My Big Toe Joint Hurts! The Arthritis You Never Knew!
Have you ever suspected you have arthritis in your big toe joint? It is one of those conditions that slowly creeps up on you. You may be going about your business only to notice that your big toe joint hurts! You may end up limping around for an hour or even a few days and then it disappears only to reappear when you least expect it! What’s up with this? Well, it may be plain ol’arthitis!
Arthritis in the big toe (aka: hallux) joint is known as “Hallux Limitus” or Hallux Rigidus” depending on whether it the motion in your toe is limited or not moving at all (rigid). Basically, how much arthritis you have puts you in either one of those categories. So here it how it works. Over the years, all of your joints wear down to some extent. We start to lose the cartilage, (this is the stuff covering the bones at the joint so the joint can glide smoothly). Once we have worn down enough cartilage, the bones at the joint start making bone on bone contact instead of cartilage on cartilage contact, and this causes pain. This bone on bone rubbing is not as smooth either and it limits the amount of movement at the joint. This is arthritis. As the amount of arthritis in the joint increases, the amount of pain in that joint increases as well!
How does it all start? I tell my patient that simply stubbing your toe, which most of us have done at some point or other, can accelerate the wearing down process. Many times, arthritis in the big toe joint shows up in people with other foot conditions, such as bunions, or flat feet or high arched feet simply because of how our bones line up in the feet. If they are not perfectly aligned, that joint will wear down quicker because it was not meant to work in that position.
What can be done about the pain? Once you have been diagnosed, your podiatrist will be able to tell you just how severe the arthritis in your big toe joint is and treatment will be based on that. Treatment could include anti-inflammatories, custom inserts, physical therapy, shoe alterations, padding, cortisone injections, and in the worst of cases, surgery. That being said, the sooner you see us about your big toe pain, the quicker we can slow down the damage being done to that joint and keep you moving!
Arthritis in the big toe (aka: hallux) joint is known as “Hallux Limitus” or Hallux Rigidus” depending on whether it the motion in your toe is limited or not moving at all (rigid). Basically, how much arthritis you have puts you in either one of those categories. So here it how it works. Over the years, all of your joints wear down to some extent. We start to lose the cartilage, (this is the stuff covering the bones at the joint so the joint can glide smoothly). Once we have worn down enough cartilage, the bones at the joint start making bone on bone contact instead of cartilage on cartilage contact, and this causes pain. This bone on bone rubbing is not as smooth either and it limits the amount of movement at the joint. This is arthritis. As the amount of arthritis in the joint increases, the amount of pain in that joint increases as well!
How does it all start? I tell my patient that simply stubbing your toe, which most of us have done at some point or other, can accelerate the wearing down process. Many times, arthritis in the big toe joint shows up in people with other foot conditions, such as bunions, or flat feet or high arched feet simply because of how our bones line up in the feet. If they are not perfectly aligned, that joint will wear down quicker because it was not meant to work in that position.
What can be done about the pain? Once you have been diagnosed, your podiatrist will be able to tell you just how severe the arthritis in your big toe joint is and treatment will be based on that. Treatment could include anti-inflammatories, custom inserts, physical therapy, shoe alterations, padding, cortisone injections, and in the worst of cases, surgery. That being said, the sooner you see us about your big toe pain, the quicker we can slow down the damage being done to that joint and keep you moving!
Tuesday, September 8, 2009
My toes are starting to curl!!
I first noticed it when I wore a pair of heels the other night(that were maybe a little to pointy). I figured that the 2-3 hours that I wore them wouldn't kill me, but my goodness... By the end of night I had severe pain in my feet, right on the top of my toes.
Today I was looking at my toes and I noticed a small area of redness on the top of my toe right where it is starting to curl. It is sort of hard and painful to the touch, and truthfully a little ugly.. I think it is a corn.
If you are suffering from anything similar to this you may have hammertoes. Hammertoes are a contracture of a joint in the toes, that usually start off flexible and may progress to a more rigid deformity. The more rigid they become the more they will interfere with your ambulation and may lead to corns, or even worse an open sore.
What causes Hammertoes? Hammertoes are a mechanical imbalance of the tendons in the toes. The tendons on top of the foot gain control over other tendons and start to contract and curl your toes. Why does it happen?
1.Can be caused by biomechanics (your foot structure and the way you walk)
2.The wrong shoes (high heels, pointy shoes)
3.Neuromuscular condition
4.Broken toe or trauma to the toe (jamming)
Treatments for Hammertoes:
Treatments usually include accomodative padding, different shoe gear, trimming of corns, anti-inflammatories, injection therapy and surgery. Orthotic devices may also help control abnormal biomechanics.
If you are suffering from any of these symptoms talk to your podiatrist. There are many advances in the treatment of these silly toes!
I first noticed it when I wore a pair of heels the other night(that were maybe a little to pointy). I figured that the 2-3 hours that I wore them wouldn't kill me, but my goodness... By the end of night I had severe pain in my feet, right on the top of my toes.
Today I was looking at my toes and I noticed a small area of redness on the top of my toe right where it is starting to curl. It is sort of hard and painful to the touch, and truthfully a little ugly.. I think it is a corn.
If you are suffering from anything similar to this you may have hammertoes. Hammertoes are a contracture of a joint in the toes, that usually start off flexible and may progress to a more rigid deformity. The more rigid they become the more they will interfere with your ambulation and may lead to corns, or even worse an open sore.
What causes Hammertoes? Hammertoes are a mechanical imbalance of the tendons in the toes. The tendons on top of the foot gain control over other tendons and start to contract and curl your toes. Why does it happen?
1.Can be caused by biomechanics (your foot structure and the way you walk)
2.The wrong shoes (high heels, pointy shoes)
3.Neuromuscular condition
4.Broken toe or trauma to the toe (jamming)
Treatments for Hammertoes:
Treatments usually include accomodative padding, different shoe gear, trimming of corns, anti-inflammatories, injection therapy and surgery. Orthotic devices may also help control abnormal biomechanics.
If you are suffering from any of these symptoms talk to your podiatrist. There are many advances in the treatment of these silly toes!
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