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!
Wednesday, September 2, 2009
Toenail Disorders Due to Chemotherapy:
I am training to walk the Susan G Komen Breast Cancer Walk Dallas of 2009. During my training I have met a lot of great women. Some are walking as survivors, and others are walking because someone close to them is suffering from the disease, or have lost someone they love.
As you can probably imagine there is a lot of talking during these long training walks. I happen to be a podiatrist, so I commonly have people asking me questions about their feet, proper shoe gear, how to prevent injuries, and most commonly their toenails! Most will say they have either lost toenails or they have turned colors due to the chemotherapy.
Alot of the survivors agree that when undergoing chemo, most of the time they are not warned on what to expect their toenails to begin to look like. No one tells them that their toenails will most likely fall off, turn colors, get thick, have skin attached to them and possibly smell.
When undergoing Chemotherapy the drugs that are commonly used; (Adriamycin, Taxol, 5-Fluorouracil) cause damage and attack the tissue that keeps the toenail in place. This is called onycholysis. It is common for the nail to loose its attachment to the entire nail bed or sometimes only half of the nail bed. Either way when a nail looses its attachment it allows dermatophytes( the bugs that cause fungus) to get under the toenail, also known as onychomycosis.
Tips to Keeping your Toenails Looking There Very Best:
1. Clip toenails straight across and keep them short, this prevents splitting and breakage of the toenail.
2. Keep toenails clean and moisturized. If getting a pedicure make sure all instruments have been sterilized.
3.Cut away any loose cuticles, do not pick or pull at them. This can cause bleeding which can easily lead to an infection.
4. Try to avoid injuries to your toes and toenails, they will bruise easily. Wear wider shoes that have plenty of room in the toe box. Wider shoes will also allow for more circulation to the toes and toenails.
If your nails become infected, inflamed or painful you may need to see a doctor. There are some over the counter treatments that may be fine for your type of infection or you may need a doctor to prescribe a medication to help combat the problem. There are some very advanced treatments that are now available including topical treatments, oral pills and laser treatments.
I am training to walk the Susan G Komen Breast Cancer Walk Dallas of 2009. During my training I have met a lot of great women. Some are walking as survivors, and others are walking because someone close to them is suffering from the disease, or have lost someone they love.
As you can probably imagine there is a lot of talking during these long training walks. I happen to be a podiatrist, so I commonly have people asking me questions about their feet, proper shoe gear, how to prevent injuries, and most commonly their toenails! Most will say they have either lost toenails or they have turned colors due to the chemotherapy.
Alot of the survivors agree that when undergoing chemo, most of the time they are not warned on what to expect their toenails to begin to look like. No one tells them that their toenails will most likely fall off, turn colors, get thick, have skin attached to them and possibly smell.
When undergoing Chemotherapy the drugs that are commonly used; (Adriamycin, Taxol, 5-Fluorouracil) cause damage and attack the tissue that keeps the toenail in place. This is called onycholysis. It is common for the nail to loose its attachment to the entire nail bed or sometimes only half of the nail bed. Either way when a nail looses its attachment it allows dermatophytes( the bugs that cause fungus) to get under the toenail, also known as onychomycosis.
Tips to Keeping your Toenails Looking There Very Best:
1. Clip toenails straight across and keep them short, this prevents splitting and breakage of the toenail.
2. Keep toenails clean and moisturized. If getting a pedicure make sure all instruments have been sterilized.
3.Cut away any loose cuticles, do not pick or pull at them. This can cause bleeding which can easily lead to an infection.
4. Try to avoid injuries to your toes and toenails, they will bruise easily. Wear wider shoes that have plenty of room in the toe box. Wider shoes will also allow for more circulation to the toes and toenails.
If your nails become infected, inflamed or painful you may need to see a doctor. There are some over the counter treatments that may be fine for your type of infection or you may need a doctor to prescribe a medication to help combat the problem. There are some very advanced treatments that are now available including topical treatments, oral pills and laser treatments.
Tuesday, September 1, 2009
“Mom, My Heels Hurt!”
It is that time of year again. Returning to school and those extra curricular activities. Kids are excited about sports and band practice, but this sudden increase in activity can cause them to have heel pain. Pediatric heel pain is nothing to ignore. It is not your typical adult heel pain caused by plantar fasciitis and will not go away with advil alone. It can be excruciating for some children to the point they cannot walk. So what is it really and why does it happen?
Calcaneal apophysitis is the medical term for inflammation of the growth plate in the heel caused by the pull of the plantar fascia below it and the Achilles tendon above it. As we grow, the bones in the legs get longer, but the muscles and tendons have to stretch to grow with them. If these structures are tight and have not reached the same length as the bones, then they pull much harder on the growth plates. This causes significant pain that usually occurs after activity and improves with rest. Other symptoms including swelling of the heels, pain with pressure and increased warmth.
Treating pediatric heel pain early is important. In our office, youf child will be fully evaluated including xrays to make sure that the growth plate is normal and the pain is not caused from other reasons like a stress fracture. Rest, ice and stretching are key factors in treating heel pain in children. Appropriate shoe gear, orthotics and physical therapy will also improve their pain and reduce recurrence. In severe cases, complete immobilization may be necessary.
If your child is complaining of heel pain, don’t ignore it. This pain can prevent them from participating in the activities they enjoy. At Foot and Ankle Associates of North Texas, we are here to get your children back in the game.
Calcaneal apophysitis is the medical term for inflammation of the growth plate in the heel caused by the pull of the plantar fascia below it and the Achilles tendon above it. As we grow, the bones in the legs get longer, but the muscles and tendons have to stretch to grow with them. If these structures are tight and have not reached the same length as the bones, then they pull much harder on the growth plates. This causes significant pain that usually occurs after activity and improves with rest. Other symptoms including swelling of the heels, pain with pressure and increased warmth.
Treating pediatric heel pain early is important. In our office, youf child will be fully evaluated including xrays to make sure that the growth plate is normal and the pain is not caused from other reasons like a stress fracture. Rest, ice and stretching are key factors in treating heel pain in children. Appropriate shoe gear, orthotics and physical therapy will also improve their pain and reduce recurrence. In severe cases, complete immobilization may be necessary.
If your child is complaining of heel pain, don’t ignore it. This pain can prevent them from participating in the activities they enjoy. At Foot and Ankle Associates of North Texas, we are here to get your children back in the game.
Monday, August 3, 2009
Why are my feet hurting now?
“I have never had a problem with my feet before. Why are they hurting now?” I have heard on so many occasions patients ask this question. I must admit, this is really a very good question! Why do your feet hurt now?
The easiest way I can get across to explain this phenomenon is that, unlike our teeth, which we make sure to brush several times a day, we completely and utterly seem to abuse our feet taking them completely for granted! We expect them to go on and on like the Energizer Bunny and never give out. Sure, we may moisturize them and pedicure them and soak them thinking this is how we are to care for them (and some of us do not even do that!). This does make them look on the outside and to a certain extent feel good. We also spend our years walking on them barefoot, without as much as a slipper for cushioning. We women strap strappy sandals and heels that force our feet to walk in no way God intended. Even if you don’t wear heels or strappy sandals, we too often put them into shoes with confined spaces and so very much UNlike the actual shape of our feet. This brand of torture does a whole lot of damage to the insides of our feet and ankles.
Now think about this. In our life time, we have walked around the earth several times!! That is a lot of mileage! Add the above mentioned abuse to our feet and Voila! Foot pain! I tell people we do more to take care of the tires on our cars than our own “tires”! No wonder at some point in our lives, we will all experience some form of foot pain! And when we do, oh, we will long for the days when we were able to walk without limping!
A reminder to all: Do not take your feet (or your podiatrist) for granted!! We will do all we can to get you dancing again. We only ask that you take our advice to help you take better care of those feet! You have so many more miles to go!!
The easiest way I can get across to explain this phenomenon is that, unlike our teeth, which we make sure to brush several times a day, we completely and utterly seem to abuse our feet taking them completely for granted! We expect them to go on and on like the Energizer Bunny and never give out. Sure, we may moisturize them and pedicure them and soak them thinking this is how we are to care for them (and some of us do not even do that!). This does make them look on the outside and to a certain extent feel good. We also spend our years walking on them barefoot, without as much as a slipper for cushioning. We women strap strappy sandals and heels that force our feet to walk in no way God intended. Even if you don’t wear heels or strappy sandals, we too often put them into shoes with confined spaces and so very much UNlike the actual shape of our feet. This brand of torture does a whole lot of damage to the insides of our feet and ankles.
Now think about this. In our life time, we have walked around the earth several times!! That is a lot of mileage! Add the above mentioned abuse to our feet and Voila! Foot pain! I tell people we do more to take care of the tires on our cars than our own “tires”! No wonder at some point in our lives, we will all experience some form of foot pain! And when we do, oh, we will long for the days when we were able to walk without limping!
A reminder to all: Do not take your feet (or your podiatrist) for granted!! We will do all we can to get you dancing again. We only ask that you take our advice to help you take better care of those feet! You have so many more miles to go!!
Am I Ready for Surgery Yet?
Am I ready for surgery yet? Seems like such an easy question to answer huh? Actually, unless it is something obvious like getting your foot stuck in a lawn mower or shattering your ankle putting up Christmas lights, this question is a little more challenging.
Some important questions to ask yourself:
Do I have pain nearly on a daily basis? Having pain more often than not is a red flag. If your answer is yes, that doesn’t necessarily mean you need surgery, but it does mean you may have let your condition drag out longer in hopes that it would get better on its own.
Is it difficult to find shoes that are comfortable? This is a “biggie” if the only shoes you can wear is a sandal and fall is quickly approaching!
Am I unable to perform my day to day activities because of the pain? A good example of this, and one I hear often, is not being able to exercise because of the pain. The lack of exercising causes weight gain and your foot or ankle pain gets worse because of it!
Have you ever seen anyone about your pain? It is surprising to me how many people I see on their first visit wondering when they can be scheduled for surgery without their ever having seen a podiatrist! Have you seen a podiatrist yet to even be evaluated? If you think you are ready, that is a most important step (no pun intended!). There are a number of conditions that we can treat conservatively. We will be able to tell you how serious your condition is and whether or not you can hold off from doing anything as drastic as surgery.
Is my pain severe enough that I am willing to risk the potential post-operative complications to have a chance of relief? This may be the hardest question to answer. There is no guarantee when it comes to surgery. You have to be willing to accept the risks involved. After you have run the gamut of conservative treatment options with your podiatrist and understand not only what your surgery would entail, but also what complications could occur post operatively, hopefully, this question will be easier to answer.
Unfortunately, we abuse our feet to no end. When they start to hurt, we should not ignore them hoping it will all go away. That is like hoping that cavity in your tooth will magically heal itself! The real message here is getting to your podiatrist before things get this bad.
Be assured that if surgery becomes our only answer, our goals for surgery are the same. We want to eliminate pain. We want to restore function. Simply stated, we want to make your feet happy again!
Some important questions to ask yourself:
Do I have pain nearly on a daily basis? Having pain more often than not is a red flag. If your answer is yes, that doesn’t necessarily mean you need surgery, but it does mean you may have let your condition drag out longer in hopes that it would get better on its own.
Is it difficult to find shoes that are comfortable? This is a “biggie” if the only shoes you can wear is a sandal and fall is quickly approaching!
Am I unable to perform my day to day activities because of the pain? A good example of this, and one I hear often, is not being able to exercise because of the pain. The lack of exercising causes weight gain and your foot or ankle pain gets worse because of it!
Have you ever seen anyone about your pain? It is surprising to me how many people I see on their first visit wondering when they can be scheduled for surgery without their ever having seen a podiatrist! Have you seen a podiatrist yet to even be evaluated? If you think you are ready, that is a most important step (no pun intended!). There are a number of conditions that we can treat conservatively. We will be able to tell you how serious your condition is and whether or not you can hold off from doing anything as drastic as surgery.
Is my pain severe enough that I am willing to risk the potential post-operative complications to have a chance of relief? This may be the hardest question to answer. There is no guarantee when it comes to surgery. You have to be willing to accept the risks involved. After you have run the gamut of conservative treatment options with your podiatrist and understand not only what your surgery would entail, but also what complications could occur post operatively, hopefully, this question will be easier to answer.
Unfortunately, we abuse our feet to no end. When they start to hurt, we should not ignore them hoping it will all go away. That is like hoping that cavity in your tooth will magically heal itself! The real message here is getting to your podiatrist before things get this bad.
Be assured that if surgery becomes our only answer, our goals for surgery are the same. We want to eliminate pain. We want to restore function. Simply stated, we want to make your feet happy again!
Friday, June 26, 2009
When is a Bunion Not a Bunion?
It happened again today in my office. A woman came in asking for bunion surgery. She had put up with the pain in her big toe for years and finally had had enough. Many years ago her family physician told her to wait until she couldn’t stand the pain in her foot before discussing surgery with a podiatrist. Like many physicians, she assumed any pain in the great toe accompanied by a bump was a “bunion” or Hallux Abducto Valgus. Unfortunately in this case, she was wrong. The patient actually has Hallux Limitis also known as osteoarthritis of the great toe joint. If she had sought treatment many years ago, her joint may have been salvaged. Now her joint was so destroyed that she needed a joint replacement or fusion. Not what she wanted to hear! In her mind, she came in the office asking for a simple bunionectomy and left needing a joint replacement. She regretted not seeking the advice of a podiatrist earlier.
So what’s the difference between Hallux valgus and Hallux limitis?
Hallux valgus is a crooked big toe joint. Over a period of years, the great toe becomes much friendlier with the second toe and drifts toward and eventually under or over the second toe. At the same time, the first metatarsal (long bone connected to the great toe) drifts towards the center of your body making the distinctive bump. This starts out as a minor annoyance, but then quickly becomes a shoe problem with rubbing on the bump. Most people seek the attention of a podiatrist when the bump is rubbing in their shoe and becomes painful. If the deformity is allowed to progress, the great toe joint can actually start to dislocate and you will start to experience joint pain and degeneration.
Hallux limitis is wear and tear arthritis or osteoarthritis of the great toe joint. Many people are predisposed to have this problem by the underlying biomechanical function of their joint. It becomes much worse after an injury or repetitive trauma from things like high heeled shoes, ballet or some sports. The symptoms are different than Hallux valgus. Hallux limitis usually starts with a feeling of stiffness of the joint. It can be accompanied by swelling and redness. This usually progresses to a decrease in range of motion, a distinctive crunching feeling when moving the joint and then a bump that forms usually more toward the top of the joint, not the side like Hallux valgus.
Hallux valgus and Hallux limitis can occur together in a more complex foot deformity. Usually the bunion deformity has progressed and then is injured by repetitive trauma or a distinctive injury. This starts the progression of the arthritis change. Bottom line: don’t ignore pain in your great toe joint. Treatment of Hallux limitis early can save you from needed a fusion or joint replacement!
Why is treatment of Hallux limitis so important in the early stages?
Once you have destroyed the cartilage in your joint, there is nothing a physician or surgeon can do to make more cartilage. Research is underway trying to replace or regrow cartilage, but we are many years from a solution. Hallux limitis in the early stages can be controlled with a functional shoe orthotic to control the biomechanics. A clean up procedure known as a cheilectomy can help remove all the debris from the joint and get rid of much of the crunching. This will slow down the progression. Some patients can really benefit from a surgical procedure to realign and shorten the metatarsal to give the joint better biomechanics and more joint space. Unaddressed Hallux limitis leads to complete joint destruction and the need for a fusion or joint replacement.
The flip side to this story is that patients with Hallux valgus or your tradition bunion can often delay treatment until they start to have pain. Bunions in the early stages are a cosmetic concern, but the joint is usually not damaged until the later stages. It is important to address Hallux valgus when it starts to hurt so the joint is not permanently injured, but a bump, in the absence, of pain can wait.
The take home message is to have your great toe pain examined by a podiatrist. A full examination including functional biomechanics and x-rays can determine whether your pain is from Hallux valgus, Hallux limitis or a combination. Only then can you make an informed decision on treatments for your foot deformity and pain. Waiting until you can’t stand it anymore is a recipe for unhappy outcomes! If you have great toe pain with or without a bump, don’t delay. See your podiatrist today!
So what’s the difference between Hallux valgus and Hallux limitis?
Hallux valgus is a crooked big toe joint. Over a period of years, the great toe becomes much friendlier with the second toe and drifts toward and eventually under or over the second toe. At the same time, the first metatarsal (long bone connected to the great toe) drifts towards the center of your body making the distinctive bump. This starts out as a minor annoyance, but then quickly becomes a shoe problem with rubbing on the bump. Most people seek the attention of a podiatrist when the bump is rubbing in their shoe and becomes painful. If the deformity is allowed to progress, the great toe joint can actually start to dislocate and you will start to experience joint pain and degeneration.
Hallux limitis is wear and tear arthritis or osteoarthritis of the great toe joint. Many people are predisposed to have this problem by the underlying biomechanical function of their joint. It becomes much worse after an injury or repetitive trauma from things like high heeled shoes, ballet or some sports. The symptoms are different than Hallux valgus. Hallux limitis usually starts with a feeling of stiffness of the joint. It can be accompanied by swelling and redness. This usually progresses to a decrease in range of motion, a distinctive crunching feeling when moving the joint and then a bump that forms usually more toward the top of the joint, not the side like Hallux valgus.
Hallux valgus and Hallux limitis can occur together in a more complex foot deformity. Usually the bunion deformity has progressed and then is injured by repetitive trauma or a distinctive injury. This starts the progression of the arthritis change. Bottom line: don’t ignore pain in your great toe joint. Treatment of Hallux limitis early can save you from needed a fusion or joint replacement!
Why is treatment of Hallux limitis so important in the early stages?
Once you have destroyed the cartilage in your joint, there is nothing a physician or surgeon can do to make more cartilage. Research is underway trying to replace or regrow cartilage, but we are many years from a solution. Hallux limitis in the early stages can be controlled with a functional shoe orthotic to control the biomechanics. A clean up procedure known as a cheilectomy can help remove all the debris from the joint and get rid of much of the crunching. This will slow down the progression. Some patients can really benefit from a surgical procedure to realign and shorten the metatarsal to give the joint better biomechanics and more joint space. Unaddressed Hallux limitis leads to complete joint destruction and the need for a fusion or joint replacement.
The flip side to this story is that patients with Hallux valgus or your tradition bunion can often delay treatment until they start to have pain. Bunions in the early stages are a cosmetic concern, but the joint is usually not damaged until the later stages. It is important to address Hallux valgus when it starts to hurt so the joint is not permanently injured, but a bump, in the absence, of pain can wait.
The take home message is to have your great toe pain examined by a podiatrist. A full examination including functional biomechanics and x-rays can determine whether your pain is from Hallux valgus, Hallux limitis or a combination. Only then can you make an informed decision on treatments for your foot deformity and pain. Waiting until you can’t stand it anymore is a recipe for unhappy outcomes! If you have great toe pain with or without a bump, don’t delay. See your podiatrist today!
Tuesday, June 2, 2009
Albert Pujols Twists His Ankle
“Ouch!” Did you see the replay of Albert Pujols twisting his ankle sliding into base? It actually looked much worse than it was in the instant replay. Looked terrible, but he toughed it out and stayed in the game. Boy, did it look like he was going to be in pain this morning! Over and over they played the tape on Sports Center!
What should you do if this happens to you or your child athlete? The trainer from the Cardinals was immediately evaluating Pujols, but most of us don’t have a trainer on standby!
If you have an ankle sprain, you should be evaluated by a sports medicine podiatric foot and ankle surgeon if you have localized pain, swelling and bruising, as well as inability to walk more than 5-7 steps comfortably. Many a foot fracture has been missed in the emergency room when x-rays were taken only of the ankle and not the foot. The fifth metatarsal is often broken with the same mechanism of injury of an ankle sprain, so the foot should be evaluated as well. If severe ligament injury is suspected, an MRI can evaluate the grade of injury. This is really what decides whether surgery is needed for full recovery.
Treatment for ankle sprains really depends on the degree of severity, which can only be determined by your doctor. Initial treatment always includes “R-I-C-E” therapy – Rest, Ice, Compression, and Elevation. Pain and edema is usually controlled with NSAID’s (non-steroidal anti-inflammatories) like ibuprofen. Bracing or casting coupled with non-weightbearing on crutches may be needed in more severe injuries to rest and stabilize the ankle while it heals. Return to pain-free ROM(What is ROM?) and stability is the goal. Surgery is only recommended in Grade 3 severe injuries in athletes or in those patients who have had multiple ankle sprains and suffer from chronic ankle instability. Long-term ankle instability can often be avoided with an aggressive physical therapy program. Bracing should only be used in the short-term during rehabilitation because long-term bracing actually causes atrophy and decreased ROM.
Physical therapy is needed for all ankle sprains. The goals of physical therapy should be to regain full ROM, strength and proprioception (where your brain thinks your ankle is in space). Regaining strength in the peroneal tendons as well as overall balance training are the keys to successful rehabilitation of an ankle sprain. A maintenance program of ankle strengthening, stretching, and proprioception exercises helps to decrease the risk of future ankle sprains, particularly in individuals with a history of multiple ankle sprains or of chronic instability.
Bottom line: if you happen to fall down and go “Boom”, have your ankle sprain evaluated by a podiatric foot and ankle surgeon. Delaying treatment and rehabilitation can lead to life-long instability.
For more information on ankle sprains and chronic instability, click here.
What should you do if this happens to you or your child athlete? The trainer from the Cardinals was immediately evaluating Pujols, but most of us don’t have a trainer on standby!
If you have an ankle sprain, you should be evaluated by a sports medicine podiatric foot and ankle surgeon if you have localized pain, swelling and bruising, as well as inability to walk more than 5-7 steps comfortably. Many a foot fracture has been missed in the emergency room when x-rays were taken only of the ankle and not the foot. The fifth metatarsal is often broken with the same mechanism of injury of an ankle sprain, so the foot should be evaluated as well. If severe ligament injury is suspected, an MRI can evaluate the grade of injury. This is really what decides whether surgery is needed for full recovery.
Treatment for ankle sprains really depends on the degree of severity, which can only be determined by your doctor. Initial treatment always includes “R-I-C-E” therapy – Rest, Ice, Compression, and Elevation. Pain and edema is usually controlled with NSAID’s (non-steroidal anti-inflammatories) like ibuprofen. Bracing or casting coupled with non-weightbearing on crutches may be needed in more severe injuries to rest and stabilize the ankle while it heals. Return to pain-free ROM(What is ROM?) and stability is the goal. Surgery is only recommended in Grade 3 severe injuries in athletes or in those patients who have had multiple ankle sprains and suffer from chronic ankle instability. Long-term ankle instability can often be avoided with an aggressive physical therapy program. Bracing should only be used in the short-term during rehabilitation because long-term bracing actually causes atrophy and decreased ROM.
Physical therapy is needed for all ankle sprains. The goals of physical therapy should be to regain full ROM, strength and proprioception (where your brain thinks your ankle is in space). Regaining strength in the peroneal tendons as well as overall balance training are the keys to successful rehabilitation of an ankle sprain. A maintenance program of ankle strengthening, stretching, and proprioception exercises helps to decrease the risk of future ankle sprains, particularly in individuals with a history of multiple ankle sprains or of chronic instability.
Bottom line: if you happen to fall down and go “Boom”, have your ankle sprain evaluated by a podiatric foot and ankle surgeon. Delaying treatment and rehabilitation can lead to life-long instability.
For more information on ankle sprains and chronic instability, click here.
Monday, June 1, 2009
Could it be Ringworm?
Rest easy, Ringworm is an infection of the skin caused by Fungus, not by actual worms. The types of fungi that cause ringworm are found on the superficial (top) layers of the skin. They grow best in warm, moist areas, such as locker rooms, swimming pools and in skin folds.
Ringworm is contagious, and spreads easily through skin to skin contact. It can also spread when you share towels, clothing, or sports equipment.
How do I know if it is Ringworm?
Symptoms of Ringworm usually include a very red itchy rash, it often makes the patttern of a ring. Your skin may be dry, scaly, and thickened in the areas of the rash. Ringworm of the feet may present between the toes and at the soles of the feet.
How is Ringworm treated?
Most times ringworm can be treated with a topical medicine (anti-fungal cream) that you can buy over the counter without a perscription. Make sure you use the cream till the rash is completly gone or you risk the rash coming back. It will take up to 2 weeks for the rash to clear up. If you do not treat the ringworm your skin could blister, have open sores and become infected with bacteria. If this happens you will need antibiotics.
Prevention of Ringworm:
Avoid walking barefoot in locker rooms and near swimming pools
Wash your hands often
Dont share pool towels with your friends
Wash clothes in hot water with fungicidal soap if suspected exposure occurs
If for some reason your rash does not go away with the use of the cream, medical attention is necessary.
Ringworm is contagious, and spreads easily through skin to skin contact. It can also spread when you share towels, clothing, or sports equipment.
How do I know if it is Ringworm?
Symptoms of Ringworm usually include a very red itchy rash, it often makes the patttern of a ring. Your skin may be dry, scaly, and thickened in the areas of the rash. Ringworm of the feet may present between the toes and at the soles of the feet.
How is Ringworm treated?
Most times ringworm can be treated with a topical medicine (anti-fungal cream) that you can buy over the counter without a perscription. Make sure you use the cream till the rash is completly gone or you risk the rash coming back. It will take up to 2 weeks for the rash to clear up. If you do not treat the ringworm your skin could blister, have open sores and become infected with bacteria. If this happens you will need antibiotics.
Prevention of Ringworm:
Avoid walking barefoot in locker rooms and near swimming pools
Wash your hands often
Dont share pool towels with your friends
Wash clothes in hot water with fungicidal soap if suspected exposure occurs
If for some reason your rash does not go away with the use of the cream, medical attention is necessary.
Monday, May 18, 2009
Dr. Giacalone Ponders Summer Shoes
Well, even your podiatrist isn’t immune to wanting and wearing those adorable, not-so-good-for-you shoes! This weekend I purchased a very comfortable pair of Fit Flops and of course, true to my style, covered with sequence. But I realized during my searching for summer shoes that I have an unfair advantage over the average shopper. I know what is good for my feet, what is not and what I can get away with.
So which shoes are good for you? All shoes with a thick supportive sole, full top and back or large strap over the arch will keep you from toe gripping while you walk. This reduces foot fatigue and will keep things like heel pain and ball of foot pain from occurring. If you are flat footed, you’ll want something with good arch support and a stiffer sole. If you have a high arch, think arch support, but a little softer. You need the shock absorption. For summer shoes, the best option is a sandal that has a strap over the arch and behind the heel. And don’t forget tennis shoes for activities requiring a lot of walking.
So what should you avoid? Obviously the new 7 inch heels are out! And the ballet slippers need to be passed by as well. Any heel height over 2 inches causes increased pressure to the ball of the foot leading to things like metatarsalgia and neuromas. They also shorten the Achilles tendon which can result in Achilles tendonitis. The ballet slippers are glorified socks. And when was the last time you went shopping in your socks alone?
So what about flip flops? Well, these fall into the “what can I get away with” category. Most of the time, you will hear us say, “don’t wear them”. But we know you are going to and here’s the reason we don’t like them. The only way you can keep a flip flop on your foot is to grip your big toe and second toe together. This is not natural and causes the smaller muscles in your foot to work harder leading to foot fatigue, arch strain and overall foot pain. For those with flat feet, they also cause the large tendon on the inside of your ankle to work harder as well, leading to posterior tibial tendonitis and ankle pain. If you have bunions, wearing flip flops on a regular basis only emphasizes the forces that can make the deformity worse. The thing about flip flops and any other shoe that may not be good for you is to think minimalist. Wear them only once a week or special occasions. And if the shoe hurts as soon as you put it on, don’t try to break it in. It should be comfortable from the very beginning.
If you are not sure what foot type you have or what shoes are good for you, our Certified Pedorthist, Janet Dixon is available to help you. She is located at Healthy Steps DFW and is available for one on one assistance with appointment or walk in. But if you are having any foot pain, our physicians would be happy to evaluate your condition and help get you back to summer fun.
So which shoes are good for you? All shoes with a thick supportive sole, full top and back or large strap over the arch will keep you from toe gripping while you walk. This reduces foot fatigue and will keep things like heel pain and ball of foot pain from occurring. If you are flat footed, you’ll want something with good arch support and a stiffer sole. If you have a high arch, think arch support, but a little softer. You need the shock absorption. For summer shoes, the best option is a sandal that has a strap over the arch and behind the heel. And don’t forget tennis shoes for activities requiring a lot of walking.
So what should you avoid? Obviously the new 7 inch heels are out! And the ballet slippers need to be passed by as well. Any heel height over 2 inches causes increased pressure to the ball of the foot leading to things like metatarsalgia and neuromas. They also shorten the Achilles tendon which can result in Achilles tendonitis. The ballet slippers are glorified socks. And when was the last time you went shopping in your socks alone?
So what about flip flops? Well, these fall into the “what can I get away with” category. Most of the time, you will hear us say, “don’t wear them”. But we know you are going to and here’s the reason we don’t like them. The only way you can keep a flip flop on your foot is to grip your big toe and second toe together. This is not natural and causes the smaller muscles in your foot to work harder leading to foot fatigue, arch strain and overall foot pain. For those with flat feet, they also cause the large tendon on the inside of your ankle to work harder as well, leading to posterior tibial tendonitis and ankle pain. If you have bunions, wearing flip flops on a regular basis only emphasizes the forces that can make the deformity worse. The thing about flip flops and any other shoe that may not be good for you is to think minimalist. Wear them only once a week or special occasions. And if the shoe hurts as soon as you put it on, don’t try to break it in. It should be comfortable from the very beginning.
If you are not sure what foot type you have or what shoes are good for you, our Certified Pedorthist, Janet Dixon is available to help you. She is located at Healthy Steps DFW and is available for one on one assistance with appointment or walk in. But if you are having any foot pain, our physicians would be happy to evaluate your condition and help get you back to summer fun.
Tuesday, May 5, 2009
Is Yoga Bad For My Feet?
I have always been curious about yoga. I have tried every possible form of exercise in my quest to find the perfect one for me (alas, I am still searching; aren’t we all?). The one form that I avoided was yoga. My mother was the one who finally convinced me to give it a try. She swore it to be the perfect form of exercise and swore it was relaxing at the same time! An oxymoron, I know!!
I avoided yoga because yoga is performed barefoot and the poses, I imagined, could put a great deal of stress on them. I could only imagine! The curse of being a podiatrist!! Seriously though, my curiosity was such that I had to see for myself just how much twisting and torque was involved.
On my first class, I used the thick mats provided by my gym. It had to be better than the flimsy mats some of the other people were coming in with right? Needless to say, I need to work on my core because I was working really hard to keep my balance and could not concentrate to keep the stretch! And I can tell you for a fact that the thicker the mat, the harder the tendons and ligaments in your feet are working along with your balance to keep you in check. It is very easy to develop a tendonitis or a muscle strain doing the required poses on a thick mat. So yes, the flimsy thin mats are better! Invest in the yoga mat if you have had a tendon or ligament injury or are prone to getting one. People with “extreme” foot types, the flatter foot type or the super high arch type are more prone to these potential yoga-induced tendon/ligament injuries.
The next week I bought this yoga mat. It is “stickier” so your feet do not have to grip as much and much thinner so you have better control of your movements. Over all, much less strain and stress. This is a trade off. If you have joint problems, the thinner mat could aggravate your pain just by the fact that there is less to cushion an aching joint. On the flip side, it can also aggravate tendon and ligament injuries for the same reason.
Beyond the mat are the poses. There are some pretty severe hyper extensions and pressure points going on here! Those “downward dogs” and “half-moons” and don’t get me started on some of the other ones I am no where near perfecting! Not for the light-footed! I can see how easy it is to cause some serious over-use injuries.
The conclusion to my curiosity is that you do not enter a yoga class thinking it will be easy because it doesn’t involve rapid movements. It needs to be approached as one would any exercise. Build your way into it slowly if you do not have foot problems to see if your feet can tolerate what is required of them. Modify the position of your feet if what the teacher is doing to her feet just doesn’t feel right to yours. I do not recommend the “standing” or “inversion” yoga poses to those of you who are trying to recover from a foot injury even though it is “non-impact” simply because of the lack of support it places. That being said, as resistant as I was to try it, I must say that, though it is not my “nirvana” form of exercise, it is now not one I will easily give up either! I have found harmony with yoga and my feet after all!
I avoided yoga because yoga is performed barefoot and the poses, I imagined, could put a great deal of stress on them. I could only imagine! The curse of being a podiatrist!! Seriously though, my curiosity was such that I had to see for myself just how much twisting and torque was involved.
On my first class, I used the thick mats provided by my gym. It had to be better than the flimsy mats some of the other people were coming in with right? Needless to say, I need to work on my core because I was working really hard to keep my balance and could not concentrate to keep the stretch! And I can tell you for a fact that the thicker the mat, the harder the tendons and ligaments in your feet are working along with your balance to keep you in check. It is very easy to develop a tendonitis or a muscle strain doing the required poses on a thick mat. So yes, the flimsy thin mats are better! Invest in the yoga mat if you have had a tendon or ligament injury or are prone to getting one. People with “extreme” foot types, the flatter foot type or the super high arch type are more prone to these potential yoga-induced tendon/ligament injuries.
The next week I bought this yoga mat. It is “stickier” so your feet do not have to grip as much and much thinner so you have better control of your movements. Over all, much less strain and stress. This is a trade off. If you have joint problems, the thinner mat could aggravate your pain just by the fact that there is less to cushion an aching joint. On the flip side, it can also aggravate tendon and ligament injuries for the same reason.
Beyond the mat are the poses. There are some pretty severe hyper extensions and pressure points going on here! Those “downward dogs” and “half-moons” and don’t get me started on some of the other ones I am no where near perfecting! Not for the light-footed! I can see how easy it is to cause some serious over-use injuries.
The conclusion to my curiosity is that you do not enter a yoga class thinking it will be easy because it doesn’t involve rapid movements. It needs to be approached as one would any exercise. Build your way into it slowly if you do not have foot problems to see if your feet can tolerate what is required of them. Modify the position of your feet if what the teacher is doing to her feet just doesn’t feel right to yours. I do not recommend the “standing” or “inversion” yoga poses to those of you who are trying to recover from a foot injury even though it is “non-impact” simply because of the lack of support it places. That being said, as resistant as I was to try it, I must say that, though it is not my “nirvana” form of exercise, it is now not one I will easily give up either! I have found harmony with yoga and my feet after all!
Wednesday, April 22, 2009
Be Careful of Those Spiders, They Are Not as Innocent as They Look.
Spring is here, the weather is warming up and we are finally able to wear those cute open toe sandals. With that being said, there are some new concerns to be aware of. All of the creepy crawlers that have been sleeping the winter months away are coming out of their favorite hiding places and we are all at risk for bug bites.
Brown Reculse Spiders are one of the more common spiders in the South part of Texas. They are yellowish-tan to dark brown in color, about the size of a half dollar. They measure around a half-inch in length.
The most common times for these spiders to bite are in the Summer Months. Spiders prefer dark, dry, undisturbed locations to live. Think garages, basements, under rocks, in piles of wood, and the attic.
How do I know if I was Bitten by a Spider? Or maybe it was just a Mosquito...
One of the first ways to tell if it was an actual spider bite:
1)It will be very painful, and the pain will not go away.
2)A central Blister may form around the bite site. The skin will often blanch(turn white in color) around the blister and the skin around that will become very red and irritated.
3)The redness will not be symmetric. We call this the "RED, WHITE, BLUE" sign. It is an excellent way of identifying a recluse spider bite.
What should I do if I think I was Bitten by a Spider?
1)Avoid exercise and avoid heat. Heat will spread the venom faster.
2)Elevation of the extremity.
3)Cold Compress
4)Cleansing of the wound
5)Topical and Oral antibiotics
6)Simple analgesics (tylenol for the pain)
7)Steroids
Typically these spider bites will heal in 1-3 weeks and the pain will usually reside in one week but, it is important to have the bite looked at by a professional. There have been studies that have shown these spider bites can cause necrosis of the skin, fever, nausea, and even renal failure. The best treatment is to avoid getting bitten at all. Learn to recognize the spider, patient awareness is the primary factor in making the correct diagnosis and forming an appropriate treatment plan.
Spring is here, the weather is warming up and we are finally able to wear those cute open toe sandals. With that being said, there are some new concerns to be aware of. All of the creepy crawlers that have been sleeping the winter months away are coming out of their favorite hiding places and we are all at risk for bug bites.
Brown Reculse Spiders are one of the more common spiders in the South part of Texas. They are yellowish-tan to dark brown in color, about the size of a half dollar. They measure around a half-inch in length.
The most common times for these spiders to bite are in the Summer Months. Spiders prefer dark, dry, undisturbed locations to live. Think garages, basements, under rocks, in piles of wood, and the attic.
How do I know if I was Bitten by a Spider? Or maybe it was just a Mosquito...
One of the first ways to tell if it was an actual spider bite:
1)It will be very painful, and the pain will not go away.
2)A central Blister may form around the bite site. The skin will often blanch(turn white in color) around the blister and the skin around that will become very red and irritated.
3)The redness will not be symmetric. We call this the "RED, WHITE, BLUE" sign. It is an excellent way of identifying a recluse spider bite.
What should I do if I think I was Bitten by a Spider?
1)Avoid exercise and avoid heat. Heat will spread the venom faster.
2)Elevation of the extremity.
3)Cold Compress
4)Cleansing of the wound
5)Topical and Oral antibiotics
6)Simple analgesics (tylenol for the pain)
7)Steroids
Typically these spider bites will heal in 1-3 weeks and the pain will usually reside in one week but, it is important to have the bite looked at by a professional. There have been studies that have shown these spider bites can cause necrosis of the skin, fever, nausea, and even renal failure. The best treatment is to avoid getting bitten at all. Learn to recognize the spider, patient awareness is the primary factor in making the correct diagnosis and forming an appropriate treatment plan.
Wednesday, March 25, 2009
Are Your Kid's Shoes Making Their Feet Deformed?
Children's Shoes Are Too Small and Causing Deformities, a New Study Finds
A new study of 250 children in Switzerland presented by the American Academy of Orthopaedic Surgeons (AAOS) found that a vast majority of young children are wearing shoes that are too small, increasing the risk of foot deformities. "The most striking finding was that more than 90 percent of children's shoes were too small," says Norman Espinosa, MD an orthopaedic surgeon at the University of Zurich. Overly-tight shoes are the leading cause of Hallux Valgus, a condition that occurs when the big toe begins to angle sideways in the direction of the second toe, causing a bump or bunion on the side of the foot.
For more information on juvenile Hallux valgus click here.
A new study of 250 children in Switzerland presented by the American Academy of Orthopaedic Surgeons (AAOS) found that a vast majority of young children are wearing shoes that are too small, increasing the risk of foot deformities. "The most striking finding was that more than 90 percent of children's shoes were too small," says Norman Espinosa, MD an orthopaedic surgeon at the University of Zurich. Overly-tight shoes are the leading cause of Hallux Valgus, a condition that occurs when the big toe begins to angle sideways in the direction of the second toe, causing a bump or bunion on the side of the foot.
For more information on juvenile Hallux valgus click here.
Tuesday, March 24, 2009
I Have a Neuroma.. Do I Need Surgery?
Neuromas can be very Irritating and Painful. A neuroma can prevent you from wanting to walk around and be active, and with summer around the corner who wants that?
Most of the time a neuroma will cause you to feel like you are walking on a pebble. It may cause shooting pain and tingling to the ball of your foot as well as to your toes, you may even experience numbness in your toes. Others might complain that it feels like they are walking on a rolled up sock in their shoes. All of these symptoms can be signs that you are suffering from a neuroma....
So what can we do to get rid of a neuroma??
There are many treatment options for neuromas.
1) Because neuromas are an inflammation and irritation of a nerve commonly from the bones in your feet, an injection into the area of the nerve can be helpful. It will calm down the inflammation and allow the nerve to become less irritated = less pain.
2) Accomodative Padding is another great option, by taking the pressure off the bones that are causing the nerve to become irritated, the nerve is able to relax and heal.
3) Custom Orthotics are another great treatment option. Nobody has a perfect foot and most people really will beefit from a custom device. An orthotic made specifically for your foot will allow a doctor to offload any areas in your foot that may be taking to much pressure.
4) Surgery is always an option once all conservative measures have been exhausted. Most of the time we are able to give patients a lot of relief from the other options listed above.
To learn more about neuromas click here.
Most of the time a neuroma will cause you to feel like you are walking on a pebble. It may cause shooting pain and tingling to the ball of your foot as well as to your toes, you may even experience numbness in your toes. Others might complain that it feels like they are walking on a rolled up sock in their shoes. All of these symptoms can be signs that you are suffering from a neuroma....
So what can we do to get rid of a neuroma??
There are many treatment options for neuromas.
1) Because neuromas are an inflammation and irritation of a nerve commonly from the bones in your feet, an injection into the area of the nerve can be helpful. It will calm down the inflammation and allow the nerve to become less irritated = less pain.
2) Accomodative Padding is another great option, by taking the pressure off the bones that are causing the nerve to become irritated, the nerve is able to relax and heal.
3) Custom Orthotics are another great treatment option. Nobody has a perfect foot and most people really will beefit from a custom device. An orthotic made specifically for your foot will allow a doctor to offload any areas in your foot that may be taking to much pressure.
4) Surgery is always an option once all conservative measures have been exhausted. Most of the time we are able to give patients a lot of relief from the other options listed above.
To learn more about neuromas click here.
Wednesday, March 18, 2009
Obesity Linked to Earlier Death!
Obesity has been show to shorten your life! New study shows similar effect as smoking on longevity
Obesity causes kidney disease, liver disease and several types of cancer, but the most common way it kills is by causing stroke and, most importantly, heart disease. Obesity causes heart disease by elevating blood pressure, by interfering with blood cholesterol levels, and by bringing on diabetes.
BMI is a calculation that expresses a relationship between height and weight. People are considered underweight if their BMI is less than 18.5, normal weight when the BMI is between 18.5 and 24.9, overweight when BMI is between 25 and 29.9, and obese when BMI is 30 or more, according to the U.S. National Heart, Lung, and Blood Institute.
People who are moderately obese with a BMI (body mass index) in the 30 to 35 range reduced their life span by two and four years. For those who are severely obese with BMIs between 40 and 45, their life span was reduced by eight to 10 years. That's very similar to the effects of smoking.
Of course, I would think that this a is a no-brainer! The fatter you are, the more likely you will die from chronic disease. This is common sense, but for all those peolpe in complete denial in the drive through at McDonalds, here is your wake up call!
Complete article is a must read!
Encourage your friends and family to start exercising and decrease their BMI! Add a few years to their life!
Obesity causes kidney disease, liver disease and several types of cancer, but the most common way it kills is by causing stroke and, most importantly, heart disease. Obesity causes heart disease by elevating blood pressure, by interfering with blood cholesterol levels, and by bringing on diabetes.
BMI is a calculation that expresses a relationship between height and weight. People are considered underweight if their BMI is less than 18.5, normal weight when the BMI is between 18.5 and 24.9, overweight when BMI is between 25 and 29.9, and obese when BMI is 30 or more, according to the U.S. National Heart, Lung, and Blood Institute.
People who are moderately obese with a BMI (body mass index) in the 30 to 35 range reduced their life span by two and four years. For those who are severely obese with BMIs between 40 and 45, their life span was reduced by eight to 10 years. That's very similar to the effects of smoking.
Of course, I would think that this a is a no-brainer! The fatter you are, the more likely you will die from chronic disease. This is common sense, but for all those peolpe in complete denial in the drive through at McDonalds, here is your wake up call!
Complete article is a must read!
Encourage your friends and family to start exercising and decrease their BMI! Add a few years to their life!
Wednesday, March 11, 2009
State-of-the-Art Treatments For Foot Pain
Let me start with the fact that foot pain is NEVER normal. If your feet or ankles hurt, there is usually a reason. Some common reasons may include poor shoes, infections, injuries or strained or torn tendons or ligaments. Understanding and fixing the cause of the pain, or making adjustments to alleviate the pain over time is often possible. What I want to discuss is a new treatment that allows correction of pain that is not alleviated through standard treatments.
Topaz Radiocoblation/Microdebridement treatment is a minimally invasive surgical procedure utilized to treat chronic foot pain from tendon or ligament abnormalities. For years, chronic pain to tendons or ligaments that didn't resolve with conservative treatments including rest, stretching, bracing, oral or topical medicine or injections often lead to aggressive surgical procedures with long periods of recovery.
Topaz Radiocoblation now provides a minimally invasive procedure that won't compromise the mechanical structures of the foot caused by traditional surgical techniques. Recovery is also quick and easy without the need for splints, casts, walking boots or physical therapy. In fact, a patient will usually return to shoes within 4-5 days, often with significant improvement of pain.
Topaz Radiocoblation is performed either through small incisions or through small "pin holes" (percutaneous) and often allows rapid return to regular shoegear and activities. This procedure utilizes a small wand that produces radiofrequency waves within the tendon or ligament to stimulate new blood vessel formation (neoangiogenesis), migration of growth factors, decreased inflammation, decreased pain and ligamentous or tendinous repair. This procedure is commonly performed on plantar fasciitis, peroneal tendonitis or Achilles tendonitis, and has been shown to be 80-90% effective at resolving pain from these entities.
The effectiveness of this procedure can also be improved through the addition of platelet-rich plasma injected locally. During the procedure, a small amount of blood can be drawn from the patient and concentrated to allow a large combination of proteins, growth factors, platelets and healing cells to be directly injected in treated tendons or ligaments to further speed the recovery process.
Platelet-rich plasma or PRP has been utilized for years to treat wounds and stimulate healing in areas that were previously difficult to heal. By adding this treatment to the already effective Topaz procedure, the probability of healing increases to 90% or above.
Theses results were not possible with previous treatment modalities.Although these treatments are state-of-the-art when it comes to foot pain treatment, they have been used for years by orthopedic surgeons in treating tendons elsewhere. They likewise found good success with these treatments.
So remember, your pain is not normal. You don't have to continue to suffer with foot pain, even when previous conservative treatments have failed. You now have a new technique to alleviate your pain and return you more quickly back to regular activities. You deserve to walk without pain. You deserve the opportunity to continue to enjoy life.
Topaz Radiocoblation/Microdebridement treatment is a minimally invasive surgical procedure utilized to treat chronic foot pain from tendon or ligament abnormalities. For years, chronic pain to tendons or ligaments that didn't resolve with conservative treatments including rest, stretching, bracing, oral or topical medicine or injections often lead to aggressive surgical procedures with long periods of recovery.
Topaz Radiocoblation now provides a minimally invasive procedure that won't compromise the mechanical structures of the foot caused by traditional surgical techniques. Recovery is also quick and easy without the need for splints, casts, walking boots or physical therapy. In fact, a patient will usually return to shoes within 4-5 days, often with significant improvement of pain.
Topaz Radiocoblation is performed either through small incisions or through small "pin holes" (percutaneous) and often allows rapid return to regular shoegear and activities. This procedure utilizes a small wand that produces radiofrequency waves within the tendon or ligament to stimulate new blood vessel formation (neoangiogenesis), migration of growth factors, decreased inflammation, decreased pain and ligamentous or tendinous repair. This procedure is commonly performed on plantar fasciitis, peroneal tendonitis or Achilles tendonitis, and has been shown to be 80-90% effective at resolving pain from these entities.
The effectiveness of this procedure can also be improved through the addition of platelet-rich plasma injected locally. During the procedure, a small amount of blood can be drawn from the patient and concentrated to allow a large combination of proteins, growth factors, platelets and healing cells to be directly injected in treated tendons or ligaments to further speed the recovery process.
Platelet-rich plasma or PRP has been utilized for years to treat wounds and stimulate healing in areas that were previously difficult to heal. By adding this treatment to the already effective Topaz procedure, the probability of healing increases to 90% or above.
Theses results were not possible with previous treatment modalities.Although these treatments are state-of-the-art when it comes to foot pain treatment, they have been used for years by orthopedic surgeons in treating tendons elsewhere. They likewise found good success with these treatments.
So remember, your pain is not normal. You don't have to continue to suffer with foot pain, even when previous conservative treatments have failed. You now have a new technique to alleviate your pain and return you more quickly back to regular activities. You deserve to walk without pain. You deserve the opportunity to continue to enjoy life.
Tuesday, February 24, 2009
How Long till I Heal Doc?
This is the age old question isn’t it? “Doc, so how long will it take for this thing to heal?”
Where to begin on this seemingly so easy a question? There are sooooo many factors to take into consideration. This explains why you will hear doctors say “on average…” or “typically…”. We know from experience, and what we’ve read in the mountains of medical literature, when things are suppose to heal. This is the easy part. Here is a very short list of when certain body parts heal:
Bone: 6-8 weeks
Tendons: 3-4 weeks
Ligaments: 3-4 weeks
Stitches: top of foot or leg: 2 weeks, bottom of the foot: 3 weeks
Simple huh! Now for the fun part; we add the human factor to the equation and suddenly, all this simplicity flies out the window! What most patients don’t understand is why they may not fall into these criteria! There is a LAUNDRY list of the reasons why things don’t heal when they should and the number ONE reason things don’t heal when they should is that many patients (yes, I could be talking to you!) say they are listening but they are not doing what they are told to do to get them better! They cheat! Not a lot (though there is that distinguished class of patients who do!), but just a little bit! Yes, that little bit over the weeks it could take sets you back even more weeks! I have heard every excuse in the book as to why people couldn’t follow through with what I asked from them and believe me sometimes there is good reason. But all too often the reason is not all that worthy. A sampling of my favorites so far: “I walked around school in a regular shoe because the boot is ugly, but I was really good at wearing it around the house!” or “I know you told me not to, but I walked on it because I just wanted to see if it was getting better and now it hurts worse!”
Let’s keep it real. There is no guarantee that anything will heal at all much less in the intended time frame. But by not following instructions, you are just plain sabotaging your healing. We are a very small part of the healing equation. YOU MUST DO YOUR PART! Regardless of the reasons why you think you can’t, if you don’t, it will take you longer to get back to doing what you want to do in the first place! Do your part and at least give your body the chance it needs to work the miracle of healing. It really is trying and us “Docs” are really trying too!
Where to begin on this seemingly so easy a question? There are sooooo many factors to take into consideration. This explains why you will hear doctors say “on average…” or “typically…”. We know from experience, and what we’ve read in the mountains of medical literature, when things are suppose to heal. This is the easy part. Here is a very short list of when certain body parts heal:
Bone: 6-8 weeks
Tendons: 3-4 weeks
Ligaments: 3-4 weeks
Stitches: top of foot or leg: 2 weeks, bottom of the foot: 3 weeks
Simple huh! Now for the fun part; we add the human factor to the equation and suddenly, all this simplicity flies out the window! What most patients don’t understand is why they may not fall into these criteria! There is a LAUNDRY list of the reasons why things don’t heal when they should and the number ONE reason things don’t heal when they should is that many patients (yes, I could be talking to you!) say they are listening but they are not doing what they are told to do to get them better! They cheat! Not a lot (though there is that distinguished class of patients who do!), but just a little bit! Yes, that little bit over the weeks it could take sets you back even more weeks! I have heard every excuse in the book as to why people couldn’t follow through with what I asked from them and believe me sometimes there is good reason. But all too often the reason is not all that worthy. A sampling of my favorites so far: “I walked around school in a regular shoe because the boot is ugly, but I was really good at wearing it around the house!” or “I know you told me not to, but I walked on it because I just wanted to see if it was getting better and now it hurts worse!”
Let’s keep it real. There is no guarantee that anything will heal at all much less in the intended time frame. But by not following instructions, you are just plain sabotaging your healing. We are a very small part of the healing equation. YOU MUST DO YOUR PART! Regardless of the reasons why you think you can’t, if you don’t, it will take you longer to get back to doing what you want to do in the first place! Do your part and at least give your body the chance it needs to work the miracle of healing. It really is trying and us “Docs” are really trying too!
Sunday, February 15, 2009
Got Toenail Fungus? Laser Can Help!
My nails are thick, yellow and seem to have something growing underneath them. I’m not a dirty person, how did this happen?
Toe nail fungus strikes across class, ethnic, age and hygiene lines. In fact, one study showed that almost 50% of people over the age of 40 have experienced some type of toenail fungus. Fungal infections are incredibly common, but are more prevalent in athletes (due to toenail trauma) and the infirmed (due to a decreased immune response).
The typical athlete’s foot fungus, called a dermatophyte, is the same fungus that infects your toenails. Fungus loves a moist, dark environment like in your shoes, between your toes. The affected toenails can have a whitish superficial infection or a yellow to brown discoloration under the toenails that seems to destroy the nail as it grows. Long standing fungal toenail look like thick, brownish-yellow mountains growing on the end of your toes. The thickness makes them painful and susceptible to a secondary bacterial infection (paronychia). This infection can be quite dangerous and has been linked to gangrene in diabetics.
How is toenail fungus diagnosed? Diagnosis of onychomycosis can only be made by a toenail biopsy. Your podiatrist can take a small piece of the leading nail and send it for a special stain that shows the fungus. A PAS stain is usually faster and more accurate than a fungal culture, because often the fungus does not grow in the laboratory. Do not assume you have onychomycosis. Psoriasis and other skin disorders as well as chronic trauma can look like fungus. Also, a melanoma under the nails can mimic fungus, but can be deadly if there is a delay in diagnosis. If you suspect you have toenail fungus, don’t delay, see your podiatrist today!
How can I prevent toenail fungus?
1. If you get regular pedicures, bring your own instruments or go to a spa that sterilizes their instruments in an autoclave (like our spa, Health Steps).
2. Clean your toenail clippers with alcohol before you use them if you do your own toenails and make sure to replace Emory boards and orange sticks regularly.
3. We also recommend you regularly clean your shoes with either antibacterial spray like Lysol or even better an antibacterial with an antifungal like Mycomist at least once a month and dry them with a hairdryer.
4. Changing socks regularly (even a few times a day if you have sweaty feet) and keeping your feet clean and dry is also helpful.
5. Keep your athletic shoes dry and also change them regularly. If you exercise regularly, buy your athletic shoes a half size larger than your street shoes so you won’t bash your toenails as your feet swell with exercise.
How is toenail fungus treated? There is a lot of misinformation out there about toenail fungus. I have never told my patients to use white iodine, Vic’s Vaporub or organic cornmeal soaks on their toes. There is no evidence that it works.
Topical therapy should have some penetration of the nail plate like Formula 3 (my favorite), organic tetre oil, Nailstat or prescription (now generic Penlac) ciclopirox nail lacquer. This should be coupled with a nail treatment plan from your podiatrist.
If this doesn’t work after several months, oral medication, like terbinafine (generic Lamisil) or itraconazole (generic Sporonox) may be needed, but these have serious side effects.
There is now a new option for treatment that includes a painless laser procedure to kill the fungus in the toenail with usually one treatment! Think about it, one 30 minute treatment by a painless laser and 6 to 9 months later, the toenails have grown out normal! Too bad we can’t figure out how to make them grow faster! The new PinPointe FootLaser has given us a much better treatment option for eradicating toenail fungus. Unfortunately most insurance companies deem it cosmetic so they don’t cover it, but if you think about all the hassles, copays and the risk of side effects; the toenail laser looks like the best option for most patients.
Remember, no matter how you treat fungal toenails, it takes at least 6 to 12 months for the toenails to grow out completely. Relapse is also common, so it’s important to play offense (treat the fungus) and defense (try to prevent the fungus) at the same time.
Toe nail fungus strikes across class, ethnic, age and hygiene lines. In fact, one study showed that almost 50% of people over the age of 40 have experienced some type of toenail fungus. Fungal infections are incredibly common, but are more prevalent in athletes (due to toenail trauma) and the infirmed (due to a decreased immune response).
The typical athlete’s foot fungus, called a dermatophyte, is the same fungus that infects your toenails. Fungus loves a moist, dark environment like in your shoes, between your toes. The affected toenails can have a whitish superficial infection or a yellow to brown discoloration under the toenails that seems to destroy the nail as it grows. Long standing fungal toenail look like thick, brownish-yellow mountains growing on the end of your toes. The thickness makes them painful and susceptible to a secondary bacterial infection (paronychia). This infection can be quite dangerous and has been linked to gangrene in diabetics.
How is toenail fungus diagnosed? Diagnosis of onychomycosis can only be made by a toenail biopsy. Your podiatrist can take a small piece of the leading nail and send it for a special stain that shows the fungus. A PAS stain is usually faster and more accurate than a fungal culture, because often the fungus does not grow in the laboratory. Do not assume you have onychomycosis. Psoriasis and other skin disorders as well as chronic trauma can look like fungus. Also, a melanoma under the nails can mimic fungus, but can be deadly if there is a delay in diagnosis. If you suspect you have toenail fungus, don’t delay, see your podiatrist today!
How can I prevent toenail fungus?
1. If you get regular pedicures, bring your own instruments or go to a spa that sterilizes their instruments in an autoclave (like our spa, Health Steps).
2. Clean your toenail clippers with alcohol before you use them if you do your own toenails and make sure to replace Emory boards and orange sticks regularly.
3. We also recommend you regularly clean your shoes with either antibacterial spray like Lysol or even better an antibacterial with an antifungal like Mycomist at least once a month and dry them with a hairdryer.
4. Changing socks regularly (even a few times a day if you have sweaty feet) and keeping your feet clean and dry is also helpful.
5. Keep your athletic shoes dry and also change them regularly. If you exercise regularly, buy your athletic shoes a half size larger than your street shoes so you won’t bash your toenails as your feet swell with exercise.
How is toenail fungus treated? There is a lot of misinformation out there about toenail fungus. I have never told my patients to use white iodine, Vic’s Vaporub or organic cornmeal soaks on their toes. There is no evidence that it works.
Topical therapy should have some penetration of the nail plate like Formula 3 (my favorite), organic tetre oil, Nailstat or prescription (now generic Penlac) ciclopirox nail lacquer. This should be coupled with a nail treatment plan from your podiatrist.
If this doesn’t work after several months, oral medication, like terbinafine (generic Lamisil) or itraconazole (generic Sporonox) may be needed, but these have serious side effects.
There is now a new option for treatment that includes a painless laser procedure to kill the fungus in the toenail with usually one treatment! Think about it, one 30 minute treatment by a painless laser and 6 to 9 months later, the toenails have grown out normal! Too bad we can’t figure out how to make them grow faster! The new PinPointe FootLaser has given us a much better treatment option for eradicating toenail fungus. Unfortunately most insurance companies deem it cosmetic so they don’t cover it, but if you think about all the hassles, copays and the risk of side effects; the toenail laser looks like the best option for most patients.
Remember, no matter how you treat fungal toenails, it takes at least 6 to 12 months for the toenails to grow out completely. Relapse is also common, so it’s important to play offense (treat the fungus) and defense (try to prevent the fungus) at the same time.
Thursday, February 12, 2009
Casting a Severe Ankle Sprain Yields Better Results!
Alert the Media! A below knee cast was seen to provide better and faster results than a removable walking cast or ace bandage in severe ankle sprains! Duh! You can't take off a cast and it forces you to be compliant. Most of our patients want to be compliant but life gets in the way. Ten days in a cast rapidly improves short term outcomes......what will they report next? That physical therapy imporves long-term outcomes? Who funds these studies? Can I get some of their money to prove common sense? Just kidding......
For complete article: click here
Primary source: The LancetSource reference:Lamb SE, et al "Mechanical supports for acute, severe ankle sprain: A pragmatic, multicentre, randomized controlled trial" Lancet 2009; 373: 575-581. Additional source: The LancetSource reference:Hertel J "Immobilization for acute severe ankle sprain" Lancet 2009; 373: 524-526.
Short version:
Severe ankle sprains healed significantly more quickly with a below-knee cast or air-cell brace compared with a Bledsoe boot or a tubular compression bandage, investigators here reported.
The 10-day below-knee cast and the Aircast resulted in 8% to 9% improvement in the quality of 90-day recovery compared with a tubular compression bandage, Sarah Lamb, D.Phil., of the University of Warwick, and colleagues reported in the Feb. 14 issue of The Lancet.
The degree of improvement with the Bledsoe boot did not differ significantly from that of the tubular compression bandage, which was the least effective device.
The quality of recovery at nine months did not differ among the four devices.
"Contrary to popular clinical opinion, a period of immobilization was the most effective strategy for promoting rapid recovery," the authors said. "This was achieved best by the application of a below-knee cast. The Aircast brace was a suitable alternative to below-knee casts."
"Results for the Bledsoe boot were disappointing, especially in view of the substantial additional cost of this device," they added. "Tubular compression bandage, which is currently the most commonly used of all the supports investigated, was, consistently, the worst treatment."
Severe ankle injuries (grade II-III) can cause significant incapacitation and require three to nine months for recovery in most affected individuals, the authors noted. Systematic reviews have revealed lack of high-quality evidence to aid clinical decision-making related to management of severe ankle injuries.
For more information on the treatment of ankle sprains, click here
For complete article: click here
Primary source: The LancetSource reference:Lamb SE, et al "Mechanical supports for acute, severe ankle sprain: A pragmatic, multicentre, randomized controlled trial" Lancet 2009; 373: 575-581. Additional source: The LancetSource reference:Hertel J "Immobilization for acute severe ankle sprain" Lancet 2009; 373: 524-526.
Short version:
Severe ankle sprains healed significantly more quickly with a below-knee cast or air-cell brace compared with a Bledsoe boot or a tubular compression bandage, investigators here reported.
The 10-day below-knee cast and the Aircast resulted in 8% to 9% improvement in the quality of 90-day recovery compared with a tubular compression bandage, Sarah Lamb, D.Phil., of the University of Warwick, and colleagues reported in the Feb. 14 issue of The Lancet.
The degree of improvement with the Bledsoe boot did not differ significantly from that of the tubular compression bandage, which was the least effective device.
The quality of recovery at nine months did not differ among the four devices.
"Contrary to popular clinical opinion, a period of immobilization was the most effective strategy for promoting rapid recovery," the authors said. "This was achieved best by the application of a below-knee cast. The Aircast brace was a suitable alternative to below-knee casts."
"Results for the Bledsoe boot were disappointing, especially in view of the substantial additional cost of this device," they added. "Tubular compression bandage, which is currently the most commonly used of all the supports investigated, was, consistently, the worst treatment."
Severe ankle injuries (grade II-III) can cause significant incapacitation and require three to nine months for recovery in most affected individuals, the authors noted. Systematic reviews have revealed lack of high-quality evidence to aid clinical decision-making related to management of severe ankle injuries.
For more information on the treatment of ankle sprains, click here
Tuesday, January 6, 2009
Are Crocs Good For Your Feet?
Are Crocs Good For Your Feet?
What's with these Crocs? If you are a shoe watcher like me, you may have noticed an interesting new trend. Crocs! They are a very interesting shoe that comes in almost every color and size. Everyone from toddlers to grandparents is cruising around in this flashy, foamy, footwear. You can even buy decorations for your crocs if getting them in hot pink is not enough. Though these appear very comfy, how do they rate for your feet?
There is actually a special line of Crocs for the medical profession, Crocs Rx. These are made with better material and have more support than the average Croc. They were especially designed for people with common foot ailments. They have a wide toe and firm support! These shoes are a great substitute for your slippers, garden shoes, or even your everyday shoes. They are made with deeper insole that allows for a comfortable fit with your orthotics. Crocs Rx are especially useful for diabetics because they have a wide toe and some have built-in antimicrobial properties. Crocs Rx can actually provide better support than some of your high end athletic shoes. Before you go out and buy your new pair of Crocs, make sure you are buying the Rx line. Crocs are only available through the medical community. You may find them at some pharmacies, and podiatric medical offices.
Always check with your podiatric physician to find out if this footwear is appropriate for your foot type. Like any shoe, it is not good to wear the same shoe every day. A major benefit of these shoes is its ability to fit comfortably with an orthotic insert. This is important because many people have these custom inserts but can not put them in any shoe besides their sneakers. You should be very selective with type of inserts you are putting into your shoes because no foot is created equal.
Your podiatric physician can also assist you in finding the correct orthotic device and can also make you a custom orthotic. These custom inserts are different than the over-the-counter ones. Custom inserts control the way you walk, thus aligning all the joints in the foot as well as the lower extremity. Over-the-counter inserts are just cushions and do not control your feet while you are walking. If all you need is a cushion, then the inserts found in stores might just be good enough for you.
So if you are looking for shoe that is convenient and fun, but do not want to sacrifice comfort, Crocs Rx may the new shoe for you! It's trendy and podiatrist approved!
What's with these Crocs? If you are a shoe watcher like me, you may have noticed an interesting new trend. Crocs! They are a very interesting shoe that comes in almost every color and size. Everyone from toddlers to grandparents is cruising around in this flashy, foamy, footwear. You can even buy decorations for your crocs if getting them in hot pink is not enough. Though these appear very comfy, how do they rate for your feet?
There is actually a special line of Crocs for the medical profession, Crocs Rx. These are made with better material and have more support than the average Croc. They were especially designed for people with common foot ailments. They have a wide toe and firm support! These shoes are a great substitute for your slippers, garden shoes, or even your everyday shoes. They are made with deeper insole that allows for a comfortable fit with your orthotics. Crocs Rx are especially useful for diabetics because they have a wide toe and some have built-in antimicrobial properties. Crocs Rx can actually provide better support than some of your high end athletic shoes. Before you go out and buy your new pair of Crocs, make sure you are buying the Rx line. Crocs are only available through the medical community. You may find them at some pharmacies, and podiatric medical offices.
Always check with your podiatric physician to find out if this footwear is appropriate for your foot type. Like any shoe, it is not good to wear the same shoe every day. A major benefit of these shoes is its ability to fit comfortably with an orthotic insert. This is important because many people have these custom inserts but can not put them in any shoe besides their sneakers. You should be very selective with type of inserts you are putting into your shoes because no foot is created equal.
Your podiatric physician can also assist you in finding the correct orthotic device and can also make you a custom orthotic. These custom inserts are different than the over-the-counter ones. Custom inserts control the way you walk, thus aligning all the joints in the foot as well as the lower extremity. Over-the-counter inserts are just cushions and do not control your feet while you are walking. If all you need is a cushion, then the inserts found in stores might just be good enough for you.
So if you are looking for shoe that is convenient and fun, but do not want to sacrifice comfort, Crocs Rx may the new shoe for you! It's trendy and podiatrist approved!
Got The Ball of Foot Pain Blues?
I’ve got the ball of foot pain blues! I really do! I have had them for over a year now and it is time to come out and share with you all why things like this happen and what keeps me pain- free and happy!
Pain under the ball the foot is known as “Metatarsalgia” in the podiatry world. Where your pain is under the ball the foot makes a big difference on what your problem in particular could be. Mine happens to be underneath where my second toe, next to the big toe, attaches to the ball the foot. This seems to be a pretty common area. The reasons for things hurting in this area are either because you have toes that are bent (hammertoes) which put pressure under the ball the foot (not my problem); you have a lot of flexibility in the front part of the foot (the forefoot) which puts increased pressure under this area (not my problem); you have a bunion which makes your foot unstable, putting pressure under the ball the foot were the second toe attaches (not my problem); you have a whopper callus underneath the ball of the foot (not my problem); you have a fracture from some injury (not my problem) or you've done some pounding, hopping, or other “impact” type exercises for some time (BINGO for me!). But enough about why I got pain in this area and let's move on to why you could have pain in other areas under the ball the foot. Well, it just so happens that pain in any area under the ball of the foot can be caused by any of the above-mentioned reasons! And for the most part, every reason mentioned above, other than the direct impact or other injury, is because of the type of foot you were born with!
The good news is, you can go back to having a pain-free life like I have by seeing a podiatrist (how convenient for me)! My self-treatment was a concoction of a custom-made orthotic with padding in the right places, physical therapy and toning down the impact exercises for while. Oh, and no way on the high heels! Do not wait too long to have your foot checked out or the dreaded cortisone injection or, heaven forbid, surgery may be inevitable! I haven't had to go there in over a year now and I don't expect to anytime soon. In fact, now that I think about it, I haven't been singing the blues for while! Another reason why I love my profession!
Pain under the ball the foot is known as “Metatarsalgia” in the podiatry world. Where your pain is under the ball the foot makes a big difference on what your problem in particular could be. Mine happens to be underneath where my second toe, next to the big toe, attaches to the ball the foot. This seems to be a pretty common area. The reasons for things hurting in this area are either because you have toes that are bent (hammertoes) which put pressure under the ball the foot (not my problem); you have a lot of flexibility in the front part of the foot (the forefoot) which puts increased pressure under this area (not my problem); you have a bunion which makes your foot unstable, putting pressure under the ball the foot were the second toe attaches (not my problem); you have a whopper callus underneath the ball of the foot (not my problem); you have a fracture from some injury (not my problem) or you've done some pounding, hopping, or other “impact” type exercises for some time (BINGO for me!). But enough about why I got pain in this area and let's move on to why you could have pain in other areas under the ball the foot. Well, it just so happens that pain in any area under the ball of the foot can be caused by any of the above-mentioned reasons! And for the most part, every reason mentioned above, other than the direct impact or other injury, is because of the type of foot you were born with!
The good news is, you can go back to having a pain-free life like I have by seeing a podiatrist (how convenient for me)! My self-treatment was a concoction of a custom-made orthotic with padding in the right places, physical therapy and toning down the impact exercises for while. Oh, and no way on the high heels! Do not wait too long to have your foot checked out or the dreaded cortisone injection or, heaven forbid, surgery may be inevitable! I haven't had to go there in over a year now and I don't expect to anytime soon. In fact, now that I think about it, I haven't been singing the blues for while! Another reason why I love my profession!
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