Joints Under the Weather??

Ahhhh. The leaves are turning, the gym junkies are getting back outdoors to exercise and the weather is, well, unpredictable! And so are the joints!! This is the time of year where your foot and ankle specialists here at FAANT are seeing an jump in the number of patients who cannot keep their joints from aching! Good and bad days are here again!

So is it true that weather affects the joints? Surprisingly, there is not a lot of research on this subject. We have to look back at a study performed in 1961 by arthritis specialist Dr. J Hollander. He tested 12 patients in a climate chamber he built and discovered that low barometric pressure and high humidity caused an increase in pain and stiffness in joints. Each weather change individually, however, did not. This study had a very small number of patients, but it is true that there seems to be a certain number of people with arthritis whose symptoms are influenced by these climate changes. Is one of them you? How can we help?

While it is easy to tell you to control your symptoms with anti-inflammatories and rest, little is said about controlling your environment!

We can treat weather in the same way we treat environmental allergies. Many people stay indoors whenever there is a high count to whatever they are allergic to.
The same can be helpful when your weather trigger is present. Remember, individual environmental changes are not have as much infulence as the combination of the weather changes (ie: pressure and temperature). If you can identify what combo affect you, you will know when to limit outdoor time in these environments. I have many patients purchase a temperature gauge that also shows pressure and humidity to help find what their trigger is. Just as many of them have changed the humidity and temperature in their homes during certain times of the year when they consistently show flare ups. It does make a difference!

For others, it is more of a muscle cramp or spasm that worsens an arthritic joint. If you fall into this group, know that when the temperature drops, you need to properly warm up your muscles with stretches and slowly progress into the exercise. In other words, if you like to jog, start off with a brisk walk before you start jogging.

Weather also plays a role in joint pain with systemic conditions such as Raynaud’s phenomenon and Lupus.

Raynaud’s phenomenon in particular can be seen in a number of arthritic conditions such as polymyositis, scleroderma, systemic lupus erythematosus, rheumatoid arthritis and mixed connective tissue disease. When the weather turns cold, the small blood vessels in the extremities constrict, causing not only the digits to temporarily lose some circulation, but can in turn cause the joints to become stiff and painful as a result! Avoiding drastic changes in climate can make a big difference in this group of people. Though it cannot be said for all arthritic patients, if you have this condition, and it is severe, you may actually benefit by moving to a warmer climate.

Systemic Lupus Erythematosus without Raynauds could benefit from cooler climates. These patients are very sensitive to sun exposure. Exposure to ultraviolet light can trigger inflammation to internal organs, including the joints. If you fall into this group, limit sun exposure and protect with sunscreen and clothing.

If your feet or ankles are feeling “under the weather”, visit with your podiatrist and let them evaluate you! You may just end up discussing the weather!!

Snap, Crackle, Pop....My Ankle Hurts!

Snap, Crackle, Pop. Ankles are not supposed to make that noise.

It softball season and you just attempted to slide into second base and you managed to twist your ankle. You have done this before but this time it was followed by an audible snap you have not heard before. Oh yeah, and don’t mention that strange lump at the ankle you did not have this morning. You treat it like you have treated your previous ankle sprains, icing, elevation and trying to walk a little more gingerly, but it has not gotten better after several days, and any pressure to your foot is excruciating and unstable.

You may have an ankle fracture. Ankle fractures can typically occur during a violent injury like a car accident, fall from a height, or twisting motion of the ankle. The ankle consists of three bones that are bound to each other tightly by ligaments and allow motion of the foot up and down to allow for normal running in walking. When a fracture occurs the normal alignment of the bones of the ankle is lost as well as ligament integrity and instability, and pain ensues.

Ankle fractures need to be diagnosed and treated as soon as possible in order to provide the most appropriate treatment. Minor fractures can sometimes be treated with a period of immobilization while more major unstable fractures require surgery. If an ankle fracture is left untreated it can lead to chronic instability of the foot and ankle as well as chronic pain from arthritis.

Typical recovery from fracture to a normal shoe is around three months, so if you don’t want to miss next year’s softball season or possibly every softball season in the future, see a podiatrist immediately after any ankle injury.

FAANT Popularity Contest

Dr Crane and Dr Giacalone had a bet going on in the office on who has more patients that love them! They challenged their Facebook friends to rate them on Google Places and Yelp! They tied after the first round (figures), and the other docs wanted to get in on the friendly wager (winning doctor gets dinner at the Silver Fox), so this is your opportunity to help your favorite FAANT doc (and win a free pair of running shoes or comfort sandals or slippers from Healthy Steps)! Contest ends November 1st at 7am! Here is how it works: Help your favorite FAANT doctor win by posting a review to Google Places formerly known as Google Local. If you post a review of the practice and/or review just the doctor (click on their name) Crane, Giacalone, Karpati, McCreary, Steinke and email the contest administrator a copy, they will enter you in a drawing for a free pair of Brooks running shoes or a pair of orthopedic sandals or comfy slippers from Healthy Steps Shoe Store. You can get two entries if you do both the practice and a doctor individually. We will even throw in a third entry if you review the practice on Yelp! Contest starts right now and ends on Novemeber 15th at 7am! We will keep all of you updated on how the contest is going so please help your favorite doctor win!!

Knowing When to Say Uncle When Treating Fire Ant Bites

Almost every fire ant attack story begins with, “I was minding my own business” and usually ends with “I never thought such a little bug could cause so much pain,” or some variation of the above. Fire ants are unfortunately something you have to learn to live with, and avoid, if you live in the Southern United States. Avoiding them can be easier said than done because they usually attack without any harassment.

When fire ants attack they inject a venom into the skin using their stinger, as if biting us wasn’t enough of a warning to stay away. This venom is theorized to induce more ants to bite so the most important thing you can do is to move to a safe area, quickly. You’ll need to brush the ants off because once they latch on they don’t usually let go easily.

The venom increases the pain of the bite making it feel like your foot or leg is on fire, hence the name fire ants. Bites usually form small red bumps, but can form small pustules that can become infected.


What to do if you are bitten/stung

• This usually goes without saying, but step off of the ant hill and move to a safe place.
• Cleanse the bite area with soapy water for several minutes and then pat dry.
• Apply antiseptic to area like hydrogen peroxide or betadine(iodine) solution.
• Apply icepack to reduce pain and inflammation.
• To reduce itching apply hydrocortisone or another over the counter steroid cream to areas of bites. Calamine lotion can be used as well, or baking soda mixed 3:1 with water. Apply twice daily.
• DO NOT POP PUSTULES!!! Popping pustules can force fluid into deeper tissues inducing infection.
• If pustules form you can apply antibiotic ointment like Neosporin to lesions.
• If redness spreads or pustules become very large, SEE A DOCTOR IMMEDIATELY!!!
o Infection has probably set in and antibiotics or stronger topical medications may be required.

Allergic Reactions

o Mild reaction - If you experience swelling and redness to site this may indicate an allergic reaction to bites, and over the counter Benadryl can help to reduce this reaction

o Severe Reaction – This is a medical emergency. You should call 911 or go immediately to the Emergency Room. Symptoms include:
 Difficulty Breathing
 Swelling of lips, throat or tongue
 Dizziness
 Faintness
 Confusion
 Rapid Heart rate
 Hives all over body
 Nausea, Vomiting and Cramping

Most cases of fire ant bites resolve on their own with time, usually after a few weeks spots are gone. Diabetics should see a doctor ASAP to help prevent infection if bitten. Recognize your limitations, and if conservative therapy is not working contact us for an appointment.

Ryan Howard Has Torn His Achilles Tendon

If it isn't hard enough to take a loss that exits your team from the MLB postseason, first baseman Ryan Howard of the Philadelphia Phillies ruptured his Achilles tendon. With two outs, Ryan hit a ground ball to second base resulting in an easy play at first sending the Cardinals to the NLDS. What was out of view of the play was the injury that occurred to Ryan as he tried to advance to first base. As he planted his foot to advance he crumbled to the ground. Several attempts were made to get back up and run but he was just unable to push off of his left foot. He described his injury as follows.

"I was trying to run, and I just felt this pop," said Howard. "The whole thing just went numb, like it was on fire. Just tried to keep going, and went down. It literally felt like I was on a flat tire. I tried to get up. Couldn't go." He also said, "[I] didn't have any pain. I think it was flexed trying to come out of the box. It felt like the bat hit it."

Ryan had been suffering from Bursitis near his Achilles tendon and had been given a cortisone (steroid) injection in the area to reduce inflammation and pain prior to the playoffs.

It was almost like Ryan Howard had read the textbook on Achilles tendon injuries by the way he described his injury. Ironically many people who injure this tendon describe the injury like being hit with a baseball bat, then loose the ability to flex at the ankle and can have a burning sensation. An MRI has confirmed the diagnosis of rupture.

Achilles tendon ruptures occur when one plantarflexes the foot rapidly, which is a downward force at the ankle, or when a rapid force is applied to the foot forcing it upwards while flexing the calf muscle simultaneously.

The motion alone usually does not cause the injury, but usually involves one of the following problems

1) Overuse of a diseased tendon, or overuse in people with a weak calf muscle. Your typical Weekend Warrior.

2) Use of a group of antibiotics called fluoroquinolones. Usually just taking the medication is not enough, a rapid ankle movement is needed as well.

3) Finally, the use of cortisone(steroids) near any tendon can result in rupture. Cortisone temporarily inhibits the normal healing process of the tendon.

In Howard's case, his injury is probably a combination of a diseased tendon and injection of cortisone in close proximity to tendon.

Howard is in for a long recovery. In a complete rupture of the tendon, surgery is required to repair the tendon and recovery will likely take 6 or more months.

Unfortunately for Ryan and the Phillies organization, don't expect to see Howard rounding the bases at the start of the next MLB season.

1 in 5 Women in Grapevine Will Suffer From a Fracture

Everyone hears their grandparents, parents or someone they know talk about having osteoporosis.  But what is it?  Osteoporosis is a loss of bone density causing a thinning of the bone.  Density of bone is what we call the structure of bone making it strong.  The less dense the bone, the weaker it gets.

This only happens in those 85 or older, right? 

This is not a disease of the very elder population only.  It mostly effects women over the age of 50.  Last time I checked, 50 does not count as elderly!  It is estimated that HALF of women over the age of 50 will have a hip, wrist or spine fracture in their lifetime.  Researchers estimate that 1 in 5 American women over the age of 50 have osteoporosis.  Men can also have osteoporosis, but this usually occurs after 70.

What causes osteoporosis?

There are 2 minerals that are necessary for bone strength, calcium and phosphate.  The imbalance between these two can cause a loss of bone density.

• if your body doesn’t absorb enough calcium from your diet
• if your body actually pulls calcium and phosphate out of your bone for other purposes (yes, it can do that!)
• reduced estrogen in women after menopause
• a drop in testosterone in men
• sedentary lifestyle or bed confinement
• chronic disease like Diabetes, Rheumatoid Arthritis, eating disorders
• chronic steroid use
• vitamin D deficiency

There are some at greater risk than others.  Those who have a family history of osteoporosis, a low body weight, smoking history or excessive alcohol intake can all increase the risk of osteoporosis.

Ok, so what? What’s the big deal about osteoporosis?

Because of the lack of structure to the bones, they become weak which can lead to fractures.  In the advanced stages, fractures can happen from a simple thing like getting out of bed in the morning.  It often does not take a lot of trauma, if any.  These fractures can occur anywhere, but most commonly occur in the neck, low back, hip, wrists and feet.  The bones are often painful and fractures of the spine cause stooping and dysfigurement.

How do you know if you have osteoporosis?

The easiest way to find out is a bone mineral density test or DEXA scan.  In some instances a regular xray can detect some changes in bone, but a DEXA scan is the gold standard.

So what do I do now?

If you have any of these risk factors, then talk to your doctor about a bone density test.  Increase the calcium in your diet, but you must combine it with vitamin D which helps your body absorb calcium.  Exercise is a great way to reduce fractures.  Walking, dancing, weights, yoga, biking...all great forms of exercise that help maintain bone strength.

If you are concerned about pain in your foot and think it may be related to your osteoporosis, visit us now for more information.

Knee Pain Go Away. Patellofemoral Pain Syndrome (PFPS)

Stop trying to convince yourself knee pain is a normal part of running. That aching pain just means I am working hard, right? Everyone’s knees hurt after sitting for long periods of time, I think? Knee pain when running hills or squatting is normal?

That deep ache you feel deep inside of your knee could be caused by a condition called patellofemoral pain syndrome (PFPS). Pain is caused by abnormal tracking of the kneecap (patella) in the front of the knee leading to abnormal friction between the kneecap and the thigh bone (femur). While there is some argument among doctors and researchers on what leads to the abnormal tracking, the friction between these bones in PFPS is most frequently attributed to the following three problems.

Knock knees (genu valgum)

For those of us who have knees that point slightly inward, this allows the quadriceps muscle to pull the patella laterally leading to rubbing in the joint.

Flat feet (adult acquired flatfoot)

When people have flat feet this leads to rotation of the leg bone (tibia) below the thigh bone (femur). This results in abnormal tracking of the kneecap.

Weakness of quadriceps muscle

The quadriceps is composed of 4 muscles. Weakness of one or more of these muscles can lead to poor tracking of patella.

What do you do if you think you have this problem?

First of all, take it easy. Pain is not a normal part of any training program. Relative rest is important. Pain is usually pretty predictable with this condition the pain usually begins after overuse, so rest before it becomes painful.

Try another form of cardio like swimming, biking or the elliptical.

Run on soft more forgiving surfaces like a rubber track.

Keep your affected knee(s) extended when at rest. Knee flexion can illicit pain when at rest. Get up and walk around every once and a while.

See a professional. Some knee pain can be caused by more serious conditions within the knee that can be diagnosed by a physician.

Icing knee for 20 minutes after exercise and taking anti-inflammatories can reduce swelling and pain but does not treat cause of condition.

Orthotics. Orthotics can be helpful to help support those with fallen arches when placed in appropriate running shoes.

For those with week quadriceps muscles or knock knees, strengthening of muscles can often help reduce rubbing in knee and improve tracking.

Strengthening and stretching. General quadriceps strengthening can be performed by extending the knee and holding muscle contraction for 10-20 seconds and repeat 10 times each leg. It is very difficult to isolate one muscle of the quadriceps.

Hamstring stretches can also be helpful for those with tight hamstrings which can lead to abnormal pressure to the patella during exercise.

Weightlifting can be helpful if it isolates the quadriceps muscle. Avoid exercises like squats which can aggravate condition.

Support. Knee supports designed to alter abnormal patellar movement are available, however, their effectiveness is controversial. Physical therapists and trainers can also tape the knee to reduce friction.


If you are suffering knee pain don’t wait until it is too late to see a professional. Untreated PFPS can lead to more serious condition that lead to permanent cartilage damage.

Elliptical Woes

You’ve Got That Tingling Feeling....

The elliptical has become an extremely popular piece of exercise equipment today. I mean there aren’t very many cardio machines that allow us to read a book or catch up on the latest episode of Survivor. The elliptical is a great low impact exercise for those of us with chronic back, hip, knee and ankle problems.

While the elliptical is a great way to get our cardio in, it can lead to discomfort for some users. Many people report feelings of burning, numbness or their feet falling asleep with prolonged use. This is due to the constant position on the balls of the feet throughout the exercise. This constant pressure on the nerves with no relief can cause that “strange” feeling. In addition the constant pressure can reduce the blood flow to the pads of our feet and exacerbate the condition. If you continue use of the elliptical in the presence of pain, inflammation of nerve can occur called a Morton's neuroma and pain can persist even after exercise is completed.

In order to prevent this from happening try to apply more body weight on your heels, and even mix up your workout by reversing the motion of your legs like you are back pedaling. This will place more pressure on your heels and should reduce symptoms. Adding a metatarsal pad to your shoe can reduce pressure and reduce or eliminate symptoms.

If problems persist try another form of low impact exercise like swimming or biking. If pain continues even with a change your regimen or continues after your exercise is complete, you may have a more serious condition like Morton's Neuroma that requires treatment.

Contact us and come see us at FAANT so we can get you on the road to recovery.

Halle Berry injures her foot by just being Halle Berry

It was reported that Halle Berry broke her foot today while walking down the streets of Mallorca, Spain.  She is there shooting a new movie that I am sure we won't want to miss, but her foot injury is now going to make her miss several weeks of filming.  She was taken to the hospital in Spain where she was placed in a cast.  Other details are unknown at this time.

So how can a person break their foot just by walking down the street.  Well, given the streets in Mallorca are cobblestone, she likely twisted her foot on the uneven surface.  A quick twist or turn of the foot when a person is walking is all that is needed to put enough force on any foot bone to make it break.  But other factors can help. Those with diabetes, rheumatoid arthritis, and osteoporosis are at greater risk due to poor bone density which is the "hardness" of the bone.

If a foot fracture ( or break, same thing) occurs, best thing to do is get off the foot immediately and see help right away.  Ice and an ace wrap will help with swelling initially.  Xrays will confirm your fracture.  If the break in your bone is stable meaning it is not way out of place, then a cast or boot is all you need for 4-6 weeks.  If the break is much worse, surgery may be necessary.

Want to know more about feet?  Visit us at FAANT.

Ankle Sprains Improve with Swelling Control

Ankle pain is no fun especially on a great summer vacation. And it never fails, that you sprain your ankle getting off the plane just as you start your vacation. So what's the best thing you can do? Follow the RICE principle...Rest, Ice, Compress, Elevate.

After an injury, the first thing you will notice is swelling and pain. Rest will reduce the amount of swelling you have, thus improving your pain. If you are on a relaxing vacation, this should not be a problem. But otherwise, do your best to find a way to get off your foot.

Ice reduces the amount of bloodflow to the injured area which in turn reduces the amount of swelling. This ultimately improves your pain. Remember to never apply ice directly to your skin. Always protect your skin with a towel or sock to prevent frost bite.

Compression helps splint the injured ankle and control swelling. The more motion the ankle has immediately after injury the more painful it can be so applying an ACE bandage or some type of splint will improve pain, but also improve your long term recovery. Again, if you control swelling you improve your pain.

Elevation simply means getting your foot off the floor. Hip level or higher is ideal. Gravity can significantly worsen your pain from the simple fact that it makes swelling worse. Getting your foot off the floor lessens the pull of gravity on your injured ankle, thus (and you have to know what's coming by now) reduces swelling which reduces your pain.

Do I sound like a broken record? It's pretty simple. Injuries cause swelling, swelling causes pain. Control swelling, improve pain!

For more information on ankle sprains and all things foot and ankle related, visit our website at www.faant.com.

Got Sweaty Feet? We Have Solutions!

Wet, sloshy and sweaty feet that slide around in your sandals. That can’t feel good. Why don’t they stop sweating?

You’re not alone!

Hyperhidrosis, or excessive sweating, can be embarrassing and cause emotional stress. This disorder predominantly affects the palms, soles and under arms.

Hyperhidrosis may actually be a symptom of other medical conditions, medications, or over-activity of certain nerves that control the sweat glands.

We know what all this sweating does to your feet. Patients have an increased incidence of irritation, blistering, skin infections, foot odor, and can impact your personal and social life.

Treatments options include:
1. Foot powders
2. Anti-perspirants
3. Prescriptive medications
4. Herbal remedies
5. Acupuncture
6. Botox injections
7. Iontopheresis (Electrical stimulation to your feet while in the water)
8. Surgical sympathetomy (Destroying the nerves that are responsible for this sweating. Yikes!)

Here are some easy things you can start doing now:
1. Alter your diet and avoid hot, spicy food! If it makes your head sweat, guess what?
2. Chose natural materials such as leather for your dress shoes which allow your feet to breathe. Pleather is OUT!
3. When you are sitting on the couch, let those feet air out!
4. Wear the newer athletic synthetic socks that absorb sweat and change them often. Nylon hose or socks are the absolute worst!
5. Need to wear the nylon for your dress shoes and what about sandals?
Do we have the product for you!

If you do nothing else, pick up a few pairs of Summer Soles inlays for all your shoes and sandals. Check them out at www.summersoles.com Gets rid of wrinkles and makes your feet stop sweating?! What a bargain!

Alex Trebek Tore Achilles Tendon...What Next?

It has just been released that Alex Trebek tore his Achilles tendon while fighting off a burglar in his hotel. Wow! So now what? Alex should be expecting surgery to fix that torn Achilles tendon and a year long recovery.

In trauma situations, the Achilles tendon can be injured by sudden forceful movements of the foot against the leg. Or blunt trauma to the tendon area can cause the tendon to tear or rupture. When this occurs, the person often feels a sharp pop or pull on the back of the calf and often describes a feeling of being shot in the leg. Instant swelling and bruising occurs with an inability to really use that foot. Without the Achilles tendon the foot has a tendinacy to "flop" on the leg.

On exam, the back of the leg will be swollen and bruised. Pain is usually not as bad as you would expect, but is still present. And there will be a gap along the leg just above the heel where the tendon is torn. In the office we do a simple calf squeeze test to check the tendon integrity. If you squeeze the calf and the foot fully points, all is good, no full tendon tear (normally). But if you squeeze and the foot just stays the same...not so good, the tendon is no longer attached.

Now we need to fix it because leaving it torn will cause drop foot and the need for long term bracing to walk. Fixing the tendon requires surgery where the 2 ends of the tendon are sutured back together. A fiberglass cast is applied to protect the tendon and there is no walking on that foot for 4-6 weeks.

Long term, physical therapy is necessary to regain strength of the calf muscle and improve confidence in using that foot and leg. This process can take about a year before the patient returns to full unlimited activity.

Job well done, Alex, on fighting off the bad guys. We wish you a speedy recovery!

A Cut on the Foot Leads to Hospital Stay

Summertime is great in Texas. We have clear skies, very hot weather and plenty of lakes to cool off in. So you would think that a fun day on the lake with your friends should leave you with some funny stories to tell your children when they are old enough. But for one patient this weekend, it landed her in the hospital with urgent surgery and IV antibiotics...and did I mention pain...lots!

All you lake and river rats, take notes. This very pleasant young patient was enjoying a day on the lake when she cut her foot on broken glass on a sandy beach just at waters edge. She knew it was not just a small nick in the skin and immediately went to the local ER. She was treated and sent home with antibiotics and told to follow up with her physician to remove her stitches in a week. Within 3 days her foot become so red, swollen and painful that she took herself to another ER where she was admitted with a severe foot infection.

So what happened? She did all the right things. Unfortunately, she needed more aggressive antibiotics. What she had is called a laceration which is a traumatic cut in the skin. It it normally deeper than skin and often requires stitches to close the injury. Appropriate care of any laceration includes a deep cleansing to remove dirt and debris and any foreign objects that might be sitting in the wound. Sometimes this can be done in the ER, but there are times that cuts may need to be taken to the operating room for more aggressive "washing" or what we call incision and drainage. Once the wound is clean and sutures or stitches are used to close the skin, then healing occurs within 10-14 days.

So what happened here? The lake is what happened! Lakes, rivers, oceans and stock tanks are full of water borne bacteria and with our 100+ degree weather certain bacteria are thriving. These bacteria are very aggressive, not killed with basic antibiotics and cause severe infection. They can lead to tissue loss or even limb loss in unhealthy patients.

If you do happen to cut your skin while enjoying water activities, don't ignore it. Seek treatment right away and make sure you get antibiotics and a tetanus shot to prevent a possible surgery in the future!

Ingrown Toe Nail Hell!

There is no question about it. You have dug on that ingrown toenail one too many times and it has just about had it! It is swollen and red and painful and you just can’t get it out this time. Where do you go from here? Well, to your podiatrist by golly!

An ingrown toenail is a toenail that simply looks like it is digging into the skin surrounding the nail (aka, into the “nail fold”). Ironically, you can have a nail that looks ingrown but is not painful. That is perfectly ok! It is the nail that decides to step it up a notch and cause irritation to the nail fold that becomes a problem! Squeezing your toes into the stilettos seen at the royal wedding may just provide all the irritation it needs to get the ball rolling!

If you have ever had an irritated ingrown nail, you know what I am talking about. It feels like absolute self-induced torture trying to dig those out with your handy-dandy nail clipper. If the clipper or the toe is not clean enough, you can end up inviting all the nasty critters for a visit and end up with a nastier infection.

Trust me on this one. If you have had to dig out an ingrown nail several times a year, it will not go away the longer you fuss with it. It is riskier to keep fussing with it than getting over to your podiatrist office to have it taken care of. What does that mean? Well, for one, it means cleaner and more precise instruments, expertise and resolution to the problem. That means you likely won’t get it back for the rest of your life with one visit!!

A podiatrist can perform what is known as a “matrixectomy”. The “-ectomy” part of that term means “removing” and the “matrix” part of the word means the nail root in question. We, in essence, remove the portion of the nail root that is growing the portion of nail getting ingrown. It is very precise; removing only what is needed to keep the nail from getting ingrown and leaves the remaining nail intact. For the most part, once it is healed with a little TLC on your part, it never looks like anything was ever done! Only a very small percentage of nails try to grown back in the section removed. Overall, a very, very successful permanent result to your chronic problem!

Leaving an ingrown nail to get infected is leaving it too long! An antibiotic will only work to temporarily relieve the symptoms. As long as the nail is growing into the skin, you will continue to have the problem. Don’t wait to get in to see your podiatrist at the first signs of discomfort. I have seen too many 60-year-old patients saying they wish they would have done this 20 years ago. Don’t let this be you!

The Hikers Guide to Hiking Boots!

I had a great trip to the Grand Canyon and Sedona this past month and I will tell you why. I had the BEST hiking boots and shoes! So many of us enjoy roughing it outdoors and those trips can be less than peachy if your dogs are barking!

It can be so tempting to go shopping on-line for shoes. I know I have. There are on-line stores offering free returns and with such limited time in the day to shop, this method is very enticing! If you have some time before your trip, say at least 4-6 months to experiment, then have at it! If any of us that have any even remotely nearby access to a sporting goods store, I recommend going this route. Chances are you will not find the perfect hikers with the first pair you try on or the first store you hit for that matter.

When you do go shopping, take these pointers with you…

Go shopping towards the end of the day. Your feet swell more in the afternoon. No doubt your feet will be swelling even more than that during your trip!

Count on getting a pair of hikers at least one half to sometimes a whole size different than what you measure. There are several reasons for this:
1. What goes up, must come down. When you hike down, you will get a lot more in the way of the toes jamming repeatedly towards the end of the shoe. No exercise we do can mimic this. Some of the top sporting good stores, like REI, have a fake boulder in there shoe department. The rule of thumb is being able to “make your way down the boulder” without the tip of your big toe touching the end of the boot. If it does, try one half size larger.
2. I always recommend wearing hiking socks when you know you’ll be doing a lot of hiking. Even though they are bulkier, the wool or synthetic sweat wicking blends do a much better job at keeping your feet dry than cotton. I tried socking liners this trip underneath the socks and wow, what an improvement over a sock alone! A sock liner will help prevent blisters. More of a bonus is that you can get away with washing the liners, which dry in a snap, and wear the same pair of socks for a few days without them getting too grungy!

If the boot does not feel good off the bat, try on a different style. It is worth paying the extra if what you like is not on sale. You will have these boots for years to come! If it is not a matter of comfort, but one of heel slippage, most of the better sporting stores have sales persons who know how to adjust the lacing to control slippage.

Consider the terrain you plan on encountering. Assuming you do not have any major ankle problems or weakness, consider trying on a pair of hiking shoes, rather than boots, or a shorter boot rather than one that goes up past the ankles. Hiking shoes or shorter boots are lighter and may suit you more. This really is a matter of comfort. For anyone with ankle weakness, stick to a higher boot. You won’t risk a sprain at the start of the trip!

Consider what others say about the shoe or boot you are eyeing. There are several sites to look up your brand and style for comparison. Sites such as consumersearch.com for instance, will give you reviews from various other sites and magazines.

Last but not least, make sure what you buy is water proof or very resistant. Read the labels well. If they are not and you really like them, add the water repellant spray to your shopping cart and avoid bringing home athletes’ foot as a souvenir!!

Happy trails to you!!

Pregnancy Foot Woes!

It helps to come from a place of experience, and having had three children, I can definitely relate to the whole "pregnancy foot woes" thing and it isn’t fun.

When we think about it, feet don’t rank very high on the list of important things to think about when we are pregnant. Fitness however, ranks way up there! Go figure, when your feet hurt, you are not too motivated to get moving. The extra pounds can really pile up (My weakness was SAMS-size Cheetoes!). The more pounds, the more foot pain, the more foot pain… well, you get my drift!

Feet need to rank higher on our list of things to think about! I’ll make it easy by doing the thinking for you!!

Tip #1: Don’t walk around barefoot
“Barefoot and pregnant” is a nice cliché, but is not a good idea for so many women suffering with foot pain. The additional weight can sometimes be too much for some feet to handle. Wearing a slipper with an arch support is a great idea! Remember the ligaments loosen everywhere with pregnancy (not just at the hips!) and this can cause increased flattening of the arch. That is why many of us go up in shoe size and never go back down even long after a pregnancy.

Tip #2: Buy new shoes!
Yes, yet another good reason to go shoe shopping! We cannot expect our feet to remain the same size during or after pregnancy. It is a great idea to get your feet re-sized about 4-5 months into your pregnancy

Tip #3 Take a load off!
Swelling during pregnancy is very common. We hold on to more fluid when we are pregnant. You can end up with achy extremities and those nasty spider and varicose veins. It is important to elevate your feet to the level of the heart for a good 15-20 minutes (those your legs will take what you can give them!) several times a day. If you can’t get off of them completely, then at least sit with your feet propped up and don’t cross your legs. Avoid anything binding at the knees or ankles. Stay cool since heat can aggravate swelling! And please don’t forget to control salt intake! More sodium equals more swelling!

Tip #4 Wear supportive shoes when out and about
When you’re feeling marvelously pregnant and you want to style it up, your best bet is a nice supportive shoe. If you insist on a heel, choose a wedge of no more than 1.5 inches. Any more than that puts 75% of your ever increasing body weight on those poor feet. That can cause serious compression of the fat pad in the balls of our feet and we can’t get that or add that fat pad back. Yes, there is fat we want to keep! You may not feel the effect immediately, but with the wearing down of the fat pad, you may end up feeling like you are “walking on bones” with chronic pain to the balls of the feet as your post-pregnanacy years wear on.

Elderly Skin Care. Why We Should Care!

Let's be honest with ourselves. There comes a time when you realize that you just cannot get down to reach places you previously could. It may be because you have gained weight with age, or developed arthritis, or lost flexibility, or lost vision. In whichever case, you get out of that bath or shower and know that your body is not as clean as you were 10 years ago. You may not care, but as a good and caring podiatrist, I need to respectfully tell you that you need to care! There are so many foot conditions that can be prevented just by taking the steps to make sure you tend to your feet like you do your other more accessible areas.

I see alot of athlete's foot in the elderly. As nice sounding as they made the condition sound, this is a fungal INFECTION! It should not be ignored. Fungal infections can spread to the nails and if it starts on the nails, it can spread to the feet!

Dry skin is also very common in the elderly. What's the big deal about dry skin? Well, dry skin is caused by a decrease in collagen production and cell turnover. This basically means you hold on to the unhealthy skin cells which cannot hold onto moisture. You also loose the flexibilty in the skin provided by collagen. This unfortunate combination makes you prone to cracks in that dry, inflexible skin. Cracks allow bacteria to work their way into these crevices. This can easily turn into cellulitis, a skin infection sometimes requiring admission to a hospital for IV antibiotics! Scary huh!

Another condition I commonly see is a skin reaction called "dermatitis" from irritation to the skin. It can itch, and itching can introduce bactertia into the skin. This can look alot like athlete's foot or dry skin, but the treatment for it is very different. And if not properly treated, it can become chronic and much more difficult to treat.

If you have what you think may have any of these condidtions, it is imperative to be evaluated by your podiatrist to discuss options for treatment. Don't have one? That why we are here! Let us help! If you cannot get to us right away and are now convinced that you no longer want to ignore your feet, here are some things you can do to get your skin in better condition.

You may not be able to see the bottoms of your feet, but you sure can have someone else look at them every once in a while. If you can reach, you can feel them.

Fungal infections in the elderly commonly start in between the toes. You may not know what the term "toe cheese" is. It is the nasty, smelly stuff that comes out from between the toes that are not properly cleansed. It is as bad as it sounds! This term will instantaneously produce an unsightly grimace on the face of the most poised of podiatrist(me included!). And any podiatrist will tell you it is up there with the worst smells on earth! Even though the patient may come to our office for some other foot condition, out of comprehensive care, we clean that stuff out! The patient has no idea how bad it is because they don't see or smell it, but it can wreak havoc on you skin. This stuff is chock full of athletes foot causing fungus and even bacteria! If you suspect this condition, apply a thin coat of anti-fungal cream to your feet after drying them well. Be very sparing about applying the cream between the toes. Make an appointment as soon as you can with your podiatrist!

If you do not have a shower seat, it is a most worth while investment. Have a seat and simply run the edge of a wet soapy wash cloth between you toes during bathing. Then wash the bottoms of your feet. There are many contraptions I have seen in major stores and pharmacies to clean your feet without bending over or trying to bend your feet up to get them clean. They look like soft bristles lying face up from the shower floor. This way you can just rub your feet against them. Either method will keep your feet cleaner than they are now and help keep fungus away.

It is important to get a cream moisturizer on those dry feet (and body) the minute you dry off. Reason for the urgency is that skin can only hold on to moisture for about 3 minutes. It is that moisture you are trying to "trap" into the skin before it has a chance to escape. This will help to help keep skin supple. Ointments such as shea butter and lanolin do an even better job at stopping evaporation of water from the skin. Remember bathing does not dry out your skin. Dryness comes from the neglect of not moisturizing after you bathe. Just take care not to moisturize between your toes. Those area tend to stay too moist. Dry those areas between your toes well.

Help to avoid dematitis irritation by avoiding strong perfumed creams and soaps. Avoid chaffing socks. Stay away from nylons. They should not have been invented! They make your feet sweat and form that irritation and odor causing bacteria! Control sweaty feet! Stay away from shoes made from synthetic man made materials. They are a big culprit to dermatitis.

No more excuses! It really is all about maintanence and prevention from head to toe! It just may save you from another doctor's appointment you need to keep!

Got Painful Ingrown Toenails?

Ingrown Toenails

Perhaps not the most glamorous injury, but ingrown toenails are easily one of the more common and painful foot problems seen in our Grapevine, Texas office. In fact, in a recent survey by the American Podiatric Medical Association, they were listed in the top three with heel pain and blisters as the other most common complaints.

Also known as Onychocryptosis, there are a variety of ways an athlete could suffer from the problem. Excessive pressure on the outside of the great toe, stubbing or having a toe stepped on, tight socks and shoes, even improper trimming of your nails can cause ingrown toenails. Don’t forget the dreaded toenail fungus (Onychomycosis) which can cause an abnormally shaped nail that tends to get ingrown.

The pain isn't easy to deal with, as most athletes are usually always on their feet! With running and most other sports being a dynamic in nature, training and racing with an ingrown toenail can be incredibly painful. Soreness and sensitivity along the margins of the toenails may lead to infection (watery discharge, blood, pus). If infected, immediately visit a podiatrist.

If uninfected, treat the feet by soaking them in either salt or warm soapy water. Drying them thoroughly, applying a mild antiseptic solution, and bandaging the toe will make a difference.
However, if the athlete takes proper care of their feet, ingrown toenails can be certainly prevented. Make sure your shoes are long and wide enough. Don’t forget that socks come in sizes as well. Cut your nails straight across. Keep your toenail clipper clean. Don’t pick at them or try to perform bathroom surgery! And treat fungus as soon as it shows it’s ugly head!

For more info on infrown toenails, click here!

http://www.faant.com/library/avoid-bathroom-surgery-on-ingrown-toenails.cfm

15 Harmful Things You're Doing To Your Feet

When it comes to your health, you're hopefully already committed to eating right, getting regular check-ups, and exercising. But staying healthy means paying attention to all parts of your body, inside and outside. Taking care of your feet, for instance, can prevent all sorts of problems and conditions which could land you in the hospital. Back pain, circulation problems, infections and other injuries are common side effects from poor foot health. To prevent such issues, take a look at this list of 15 harmful things you might be doing to your poor, tired, old feet.

Wearing shoes: Certain shoes are worse than others — you'll find that out as you keep reading this list — but all shoes hurt our feet. A study conducted by the University of the Witwatersrand in South Africa found that societies who didn't wear shoes had the healthiest feet, making them believe that humans had better feet before they began wearing shoes. Why? Shoes alter our natural walking pattern and inhibit our natural gait, a system that took 4 million years to perfect. We don’t advocate that you don’t wear shoes at all unless you grew up in one of these societies, but choose your shoes carefully. Look for good construction and sturdy soles.

Careless pedicures: Many women enjoy decades of weekly pedicures without consequence, but there's still a risk for infections. Going to get a pedicure on the same day you shaved your legs or if you have cuts or wounds on your feet or toes raises the risk of infection. Poorly or unsterilized instruments are also a threat, and make sure your technician doesn't trim your toenails too short or push back your cuticles, your toenails' natural protector.

Flip-Flops: Once just a beach or pool-side "shoe," this form of footwear is an American staple, symbolizing our casual attitude or chronic laziness and disrespect for basic manners, depending on your viewpoint. But besides the gauche-ness of flip-flops, there's a health issue at hand, too. Flip-flops offer no arch support, which causes feet to roll inward and develop pain over time. Other problems include overworked muscles and tendons, calluses, heel fissures, lower back pain, and leaving your feet vulnerable to sharp pebbles, glass and other debris.

Walking barefoot in public areas: It's sounds disgusting, but it happens more often than you'd think. Walking barefoot in locker rooms, and even in seemingly clean and posh spas or saunas puts you at very high risk for Athlete's foot, a fungal infection that causes uncomfortable itching and burning, as well as plantar warts, which can become very painful.

Cramped shoes: Wearing shoes that are too tight in the toe area don't let your toes stretch out, leading to hammer toe over time. You can perform various toe exercises to stretch them out.

Narrow-toed high-heels: Cramped shoes lead to hammer toe, but narrow-toed high-heels can cause you to develop painful and/or unsightly bunions, which cause the big toe to point outward because of an enlarged joint or even extra bone formation. Swelling, redness and discomfort accompany bunions, which can be treated by wearing more comfortable shoes, applying cold packs, taking anti-inflammatory medication, or simply resting the foot.

Wearing shoes that make your feet sweat: Wearing shoes too long or wearing shoes that don't breathe don't just make your feet stinky. You end up breeding bacteria and fungi in your socks and shoes, and also allow blisters to develop with all of that chafing and slipping going on against your poor heels or toes.

Forgetting sunscreen: We usually remember to slather the sunscreen on our shoulders, backs and even faces, but our feet are often forgotten. And when you're suntanning for hours at the beach, your poor feet — which aren't used to being exposed to the sun in such an extreme way — can get toasted very easily.

Forgetting the socks: When you wear shoes without socks — especially tennis shoes, boots or other tie-up shoes, you increase your chances for developing calluses and corns. Wear thick enough socks to avoid the slipping and friction that causes these painful, ugly developments.

Not taking extra care of your feet if you have diabetes: Diabetics need to take extra care of their feet to avoid injury and other problems as they lose feeling and circulation in the area. Washing feet in warm water daily, moisturizing, cutting toenails, wearing socks and correctly fitting shoes, and examining your feet for cuts, sores or calluses is recommended.

Not protecting your feet against the elements: If you're hiking, skiing or just walking in extremely cold conditions, you've got to take care of your body, especially your feet. Frostbite occurs after cells begin to die when they're exposed to frigid temperatures, and continue to die after they've been denied oxygen. Wear thick socks and shoes designed for such temperatures, and never expose your skin directly to the air or snow.

UGGs: Like flip-flops, the hefty sheepskin boots — and all their knock-offs — are either loved or hated. Fans of UGGs praise their comfort and warmth, but a Philadelphia podiatrist found that the boots lack any kind of arch support, and many women complain of tired feet if they wear their UGGs too long. Knock-off UGGs have result in the highest risk for discomfort and bad arch support.

Not getting enough -iums in your diet: Calcium, magnesium and potassium are integral for good muscle health, and painful charley horses can attack when you're not getting enough of these nutrients in your diet. They can also point to dehydration and can cause soreness that lasts for days, so take supplements or modify your eating habits accordingly.

Not cutting your toenails correctly: Avoiding ingrown toenails or nails that are cut too short (and lead to painful infections or sores later) involves more than cutting straight across. Cut nails when they're dry, filing instead of cutting, and leaving the cuticles are recommended techniques.

Wearing old shoes: Shoes that have more than 350-500 miles logged aren't giving you the arch support you need. They may also be worn on the insides, which allows for more slipping, chafing and friction, causing blisters, corns and calluses.

Content adapted from http://www.nursingschools.net/blog/2011/02/15-harmful-things-youre-doing-to-your-feet Thanks!

Risk of Developing Fungal Toenails with Diabetes

Compared to the general public, people with diabetes mellitus are predisposed and more likely to develop fungal infections in both their skin and nails. Once they have an infection, it is also harder for the body to fight the infection.

Research shows that one of the most common complications of having diabetes is developing a diabetic foot ulcer. An estimate of 15% of people with diabetes will develop a foot ulcer during the course of their disease. In particular diabetic patients who suffer from neuropathy and compromised circulation in the lower extremities are at an increased risk for foot ulcers. Once you develop an ulcer it can be difficult to heal the ulcer and many times will lead to an amputation of the foot or area on the foot.

Onychomycosis or a fungal infection of the toenail, is a serious factor for diabetic patients. You may think it is only your toenails...BUT... The toenails become long, thickened, painful and distorted in how they grow. They also change in color and can become loose and not attached to the nail bed.


Complications of Onychomycois in toenails:

Nails can become loose and detach from the nail bed. Nails can result in injury to the surrounding skin and due to the extra pressure can cause erosion of the nail bed. Many times a nail will dig into an area on the skin, a diabetic patient may not feel the pain from the nail and an ulcer will develop. Most times it takes the area that is compromised to become very symptomatic including redness, swelling and possibly drainage to get the attention of the patient. Often times an active infection has already begun.

This is why it is very important for our diabetic patient to pay attention to their feet. Exam them daily and remember if you see something that does not look normal make an appointment to have it looked at.