Do Orthotics Work?

I am officially convinced after over 15 years in practice that there is no “perfect” foot. My wonderful occupation allows me to help people get back on their feet! I can do that with all kinds of conservative treatment and with surgery some times. Over the years, I have found that the most effective way of relieving pain and preventing recurrences for certain conditions is through something called a “functional orthotic”. Recently, I had a patient that made me need to clarify the question: Do functional orthotics work for everyone?? Let me first explain how these things work and how they are different from an over-the counter insert (aka arch support). In the simplest of terms, an arch support comes out of a box and is based on the size of your foot. They may call themselves “orthotics” (and most insert manufacturers will call their over-the-counter support an “orthotic”). It supports the arch fine if you happen to have the similar arch type of foot the insert was modeled after. For people wanting a little more support than what they get in a regular shoe, these are fine. An arch support can give some relief to some foot problems some of the time. I use them routinely to get feet on the right track to better foot health. They act as a good starting point. I see new patients who have been battling foot pain for months who tell me they finally made an appointment with me because “My arch supports helped some for a little while, but then it stopped working.” This happens because an arch support is made out of cheaper materials. For this reason that it will quickly flatten and lose its integrity (which is what made it work to begin with) and may flatten before you get the long term relief you are seeking. Yes, it is true an orthotic is more expensive out of pocket than an arch support insert, but this is because they are custom crafted to your foot type for your condition. What a functional orthotic can do that an arch support cannot do, is control the function of your foot. Let’s look into this a little more. The foot and ankle work best when the bones and tendons and ligaments and muscles work together to place the foot and ankle in the best position to walk. This is known as the foot’s “neutral” position. To some degree, all feet are out of alignment. There is no perfect foot. And when bones, tendons, ligaments and muscles struggle enough to where they can no longer effectively control the foot and ankle, you end up with foot and/or ankle pain. Functional orthotics work by supporting and balancing the entire foot, to neutralize the abnormal pressures, thereby relieving pain. It can actually correct your abnormal foot function for the time you wear them. An orthotic is customized to your foot like eye glasses are customized to your eyes. No one else can use them because they are made for your particular problem. They last longer because they are made of a material sturdy enough to bear your weight while you walk. Can I guarantee that they will work for your foot problem? Much to my chagrin, I can’t! I can assure you however, it is worth it every penny to take a chance on them!! It really is the best chance you may have to relieve pain, prevent recurrences and even help to avoid potential surgery! Think of the lifetime of unsupportive shoes your feet have had to put up with. Isn’t it time you give them the best of what there is to offer?

I've Got a Tumor...I Just Know It!

Several times a day I will see patients that are convinced they have some sort of soft tissue mass or tumor on the bottom of their foot.  Usually their pain is under their 2nd or 3rd toe and it feels like they are walking on a mass or as I call it a "wad".  Complaints range from stabbing, sharp pain to numbness in the toes to an overall ache across the ball of the foot.  Often this is followed by pain across the top of the arch or outside of foot.  So is this a tumor?  Rarely.

Pain and swelling under the 2nd and 3rd toes is often what is called capsulitis.  This is the swelling of the capsule or balloon that surroundings your joints.  All of our joints have a capsule who's job is to keep joint fluid in place so that the joint moves smoothly.  But when this capsule takes too much pressure, it swells causing pain and the feeling of a mass or tumor on the bottom of the foot.

So how does this happen?  Here's the most common set up:
You have a bunion.  This causes a shift of the weight when you push off from your big toe to your 2nd toe because the 1st MPJ isn't working correctly.  You wear flip flops all summer and force your 1st and 2nd toes to squeeze like crazy to keep the shoe on and now you are really pushing off your 2nd toe joint.  Now the swelling begins and all shoes hurt, so does walking barefoot.  You look at the bottom of your foot and holy smokes....there is a localized pocket of swelling under your toes!  Now it hurts to even bend your toe.  Sound familiar?

Other things that can cause this to happen:
* 2nd or 3rd metatarsals that are much longer than normal
* 2nd toe that curls up and almost (or does) cross over the big toe
* plantar plate injuries that allow the 2nd toe to dislocate
* severe arthritis in the big toe joint
* actual tumors

So what is the best way to get rid of this pain?  First, ice. This will reduce some of the swelling and improve discomfort.  Stiffer soled shoes that do not allow the toe area to bend very much, this allows rest.  Actual rest is a good too.

But the best option is to have your foot evaluated by a member of the FAANT team to explain exactly why you get this pain and how to prevent it from coming back.

This Little Piggie Wants to Go to the Market! (but can't because of chronic pain!)

I know, I know! We wish all our “piggies” (or our feet for that matter!) were always in good enough shape to go to the market! So why are you not better already? Have your feet been hurting you for a while? Did you think you could just shake it off or work through the pain? Maybe in the past that was the case. Why would it be any different now?

The difference is that if you have had pain for months, you are most likely suffering from a chronic injury. A chronic injury is an injury that will not get better because the body is essentially ignoring it!

When you are experiencing a “foot first hurt”, when you first notice pain in your foot, the body has recruited and shipped down its repair “squad” of cells (known as “inflammatory”cells) that work actively to try and make it better. If the foot is properly treated off the bat, more likely than not, the squad will get it healed. Realistically, unless you are a podiatrist, most of us may not fully understand the nature of what is causing the hurt. The result is that we may not fully give our foot the exact attention it needs and, unfortunately, sometimes these healing cells need outside help!

The moral of this story is basically, if you think you are doing what your foot needs to get better and two weeks later it is still not better, don’t wait the month before you see a podiatrist! Getting feet better (and ankles too!) is what we do and we are GOOD at it! Let us help find out what for sure is causing your pain! Believe it or not, sometimes just plain old wear and tear can actually cause a hairline fracture in your foot even though you may not have done anything excessive to cause it!! We can get to the bottom of what is going on. We want to get you, and most importantly, KEEP you on the right track, so your body can do what you want it to do best: keep you up and running again!

What Does an Achilles Tendon Tear Look Like?

You have probably read several articles and heard on the news multiple times about someone famous tearing their Achilles tendon.  This is no simple fete.  The Achilles tendon is the largest tendon in the leg and the force it takes to tear it has to be significant.  Often it is a force that causes the foot to come up towards the leg sharply, causing tremendous stretch of the tendon.  When this occurs, you feel a pop in the back of your leg and often describe it as being hit by a baseball bat or getting shot with a gun.

I have many curious patients who have these types of injuries and they always want to know what it looks like.  So in a recent surgery to fix this rupture, I took a couple of pictures.

In this picture, the stringy thing in the center of the incision is the ruptured Achilles tendon. You can see how large the tendon actually is and there is an obvious tear straight across the tendon.  Also note that there are multiple tears running longitudinally along the length of the tendon.  This gives it the "horse tail" appearance that we often use to describe the tendon after rupture.  

This picture shows how traumatic a rupture can be with significant bleeding and trauma to the tissues.  In this particular case there was also a large bone spur present prior to the injury which caused the tendon to be thicker than normal.  For this patient, the majority of his tendon was degenerative and there was minimal healthy tendon available for use.  So in this case, the tendon was replaced with a graft.  But in cases with healthier tendon, often repair can be done by just sewing the two ends back together if it is repaired quickly.

Recovery for this traumatic event is lengthy, but once healed this patient will return to digging holes, climbing trees, running or anything else they feel comfortable doing.

Chemotherapy Effects on the Feet

Cancer is a difficult thing to deal with.  Once you are diagnosed, there are so many decisions to make regarding your treatment options.  And if chemotherapy is in your treatment plan, your oncologist will describe the side effects and complications as well as the benefits.  But so often, you don't hear about what happens to the feet and legs from chemotherapy treatments.  What you will read below does not affect everyone undergoing chemo, but will help you understand what's happening if it does.

1.  Tinea pedis or athlete's foot
A couple of my patients have described this as "wicked athlete's foot".  It often presents as multiple small red blisters that can be filled with a clear fluid and itches like mad.  As your immune system is lowered by the therapy, your ability to fight off fungal infections is reduced. This type of blistering athlete's foot can also be very painful.  And the open areas can become infected. The best option is to use an antifungal gel instead of cream to dry the areas and kill the fungus.  We will attempt topical therapy unless the infection is so bad that pills are necessary.  Often a short course of oral antifungals is all it takes, usually less than 2 weeks.

2.  Paronychia or infection around the toenails
The skin around our toenails is full of bacteria which naturally occur on the skin.  In a patient with a lowered immune system, this bacteria can overgrow and cause redness and swelling around the nail borders and cuticle area.  The more swollen the skin gets the more likely an ingrown nail can occur.  Wash your feet and toes daily with soap and water and don't forget to get between your toes.  If you are noticing redness around the nails, topical and oral antibiotics are your best option preventing serious infections.

3.  Nail discoloration and loss
Increased stress on the body can often be seen on our toenails, just like the rings on a tree.  After significant events like major surgery and chemotherapy, the nails can become brittle, yellow, crumbly and actually just fall off.  Sometimes the color of the nails can be quite intense like blue or purple or red.  Don't worry to much if your nails change or fall off.  Often within 1-2 years after you have finished your treatments, the nails regrow.  But beware, they may look a little funny.

4. Edema
Excess swelling of the legs (and arms) can occur with cancer treatments and should be addressed by your oncologist as soon as it is discovered.The more swelling you have the more painful your extremity can be, thus making you feel worse than you already do. Oral medications can help with the swelling as well as compression garments.   It is very important to bring this swelling to your doctors attention as it could be caused from a DVT, deep vein thrombosis, or clot in your leg.  These can be serious and need immediate attention.

5.  Ulcers
Increased pressure to the heels from sitting or laying in one position too long can cause a sore or ulcer. Certain cancer treatments like radiation can also cause sores. And if you are diabetic or have neuropathy or poor circulation, you are at high risk of ulceration. While undergoing any type of treatment for cancer, if you develop a sore on your skin, it needs to be addressed right away.  This can become infected quickly and just putting neosporin or vaseline on it isn't going to help. Wound care from a wound care specialist is your best option at preventing severe infections and complications.  The team at FAANT are experts in lower extremity wound care.

If you are reading this and you or a loved one have cancer, we wish you a speedy recovery.  And we are here for all your foot and ankle needs to help you through this process.

The Foot Bone's Connected to the Back Bone (and Hip and Knee...)!

I heard THE BEST saying from one of our FAANT “team” members today. She said “It’s amazing that something that far down can affect something that far up!!” No truer words have been spoken when it comes to feet and what I call “podiatry philosophy”!


I saw a patient recently who was wondering why his orthopedic spine specialist sent him to see me when they had been discussing surgical intervention for his back! This is not an uncommon occurrence for a podiatrist. In fact, I see patients who have back, knee and hip pain, at the request of their orthopedic specialist, while having NO pain in their feet!

Why is this??

Rather than get into the complicated world of biomechanics, I am going to use an analogy that I like to use quite often. Visualize if you will… Your body is your house and your feet are like the foundation of your house. Stay with me! When you build a house, you want to build it on the most stable foundation, right?! You would never build on sand or on mud. You would most likely build on a solid foundation. Your house will last longer that way. No sags, no cracks in the walls, floors or ceiling, no doors that won’t shut! The same is true for your body! When your feet are unstable, even though they may not hurt, the rest of your body has to compensate for the instability. Add those cute, but mega unstable shoes and sandals, and yikes, we start to break down! Over time, unstable feet and/or unstable shoes for umpteen years can strain and injure the “house”! A proper biomechanical exam can uncover misalignment. The good news is that, sometimes, by getting control of the instability of the foot, with proper shoes and functional orthotics, the pain “above” may be much less, if not gone!
Heed your specialist’s advice! The body works a one whole unit! Don’t let your feet become the limiting factor in your recovery!

Flip Floppin' Away to Flip Flop Injuries

Trust me! I can absolutely relate to the thoughts of so many who have waited an entire winter, (which thank goodness is not a long one in Texas!), to finally let their feet “breathe”! And what better way to do this than in a flip flop?? Even the bottom of the foot gets some air as the flip flop flips up!

As you may have already suspected, podiatrists do not love the flip flop. And as much as you may love them, deep down you know they are anything but stable, and not the best contraption to protect your feet. I wanted to give you a "leg up" on the flip flop injuries we see on an almost daily basis in case you were considering spending your days of summer in them!

You may be surprised how many injuries are as a result of the flip flop. The most common injuries to look out for are turf toe/bruising, nail injury, tendonitis from prolonged wear, heel pain, arch pain, ankle pain/sprains, and fractured toes!

Now, believe it or not, and I know it sounds inconceivable that a podiatrist could actually recommend wearing them, but I actually do recommend using a flip flop around pools and locker rooms, where athlete's foot and warts thrive! In fact, I feel strongly that in these circumstances, you should wear these (or a water shoe) for a barrier of protection! I also like the idea of wearing a flip flop at home to avoid walking around barefoot! Look for flip flops with little to no wedge in these areas and one with an arch. Now, flip flops at Disney World or sight seeing in Europe or on a long day of shopping?  Think again!

Could we possibly keep you out of a flip flop? For the die-hards, it is unlikely that we can keep you out of them!!

Ahhh, but we have just the thing for you, around the corner here at Healthy Steps! Step through our lobby door and you will find Healthy Steps carries the cutest, most stylish flip flops with, yes indeed, WITH an arch that really can provide some support!

Maybe while you are there you will also notice the arch sandals with straps around the ankles that are just as stylish and a lot more supportive! Happy Shopping!

Beach Etiquette for Feet

As many of my patients know, I love to travel.  And beautiful beaches are my favorite.  During a recent trip to Grand Cayman I watched some appalling things happen to feet.  So I thought I would share my top tips for your feet at the beach.

1.  Shoes are a good thing and for numerous reasons.  But there is no need to wear cross trainers and socks all the time.  Flip flops or sandals are the way to go.  But leave the "fancy" flops for dinner out.

2.  Planning on running on the beach?  Don't do it barefoot unless you are used to running barefoot.  The sand is much softer than your treadmill and will cause things like achilles tendonitis and posterior tibial tendonitis to occur and quite possibly ruin your trip activities.  Take your running shoes for this one.

3.  Heading out in the water and not sure what type of shoreline you are dealing with?  Water shoes are great.  I've been to several beaches that looked like there was a soft sandy entrance, only to find out that  it was a rocky, spiny ledge in disguise.  But if it is soft like baby powder...let those toes free!

4.  I try to get in at least one spa day while on vacation and there is always a question of spa etiquette in different countries.  But the one thing that is never a question...wear the provided slippers everywhere!  It may be the top spa in the world but that doesn't mean the spa goers have the healthiest habits.

5.  Don't forget your feet when applying sunscreen.  One of the worst burns I ever got was on the tops of my feet.  I could wear shoes for 4 days!  Melanoma on the feet is rare, but can be the most deadly when it occurs.  And don't think that beach time is the only time your feet are getting sun.  Those walks out shopping with flips or sandals on allow plenty of sun time for those tootsies.

6.  Feel a sting or a burn while walking?  You may have stepped on glass hidden by the sand or a broken seashell.  You can also step on broken coral at the waters edge that can really hurt.  Best thing to do is immediately wash your foot with soap and water and check for anything that may be stuck in your foot.  If necessary, seek medial attention.

7.  If you are diabetic or have any problems with your sensation or circulation, always think "protect my feet"!  Check the bottom of your feet often for cuts, scrapes or burns you didn't know you had.  Again, seek medical treatment if you see any cut or burn on your feet.  The organisms that grow in the ocean can cause serious infections very quickly.

Not sure what shoes are right for your beach vacation?  Visit our certified pedorthist at Healthy Steps.

I love the beach and the water.  And I am often barefoot on the beach when I can be, I'm just careful.  But I must touch on one other topic.  If you are snorkeling and come across a beautiful coral reef, please don't touch it or stand on it.  This is not a resting area for humans.  It is a home to millions of living organisms and fish and it is our job to protect them!

Kobe Bryant is Out for the Rest of the Season After Suffering a Torn Achilles Tendon

The Laker fans are crying this morning after their star, Kobe Bryant, suffers a torn Achilles tendon last night. Kobe felt a "pop" and stated he thought someone kicked him during a routine cut to the basket last night. He took a time out, then returned to make his free throws on one foot. He watched the rest of the game from the locker room. He is having an MRI this morning to plan for surgical repair of his torn tendon.

Several times in the last few weeks, it has been discussed whether or not this was the last season for the 35-year-old Laker. The Lakers are holding onto the last playoff spot by the tips of their fingers and it seemed like Bryant was playing them into the playoff with sheer will and determination. What will happen to the Lakers now? They are one game up on the Jazz for the last playoff spot with two games to go.

Will Kobe come back next season? Good question. He has the will and determination, but this is a devastating injury that often takes up to a year to recover from. That would put him out most of the next season as well. At 35, this could be the end. This is the same injury that ended Dan Marino's career to name just one of many stars who's bodies betrayed them before their mind had given up the game.

For more on Achilles injuries, Achilles tendon surgery. If you have chronic Achilles pain or suffer an injury like Kobe, contact us for help! The doctors at Foot and Ankle Associates of north Texas in Grapevine and Keller, Texas are here to help!

Foot and Leg Cramps Driving You Crazy?

Foot and leg cramps can be caused by all sorts of things. Nighttime cramps are usually a sudden spasm, or tightening, of the muscles in the calf, arch and toes. They often occur just as you are relaxing and falling asleep or when waking up. The cause can be mysterious in many cases.

Muscle cramps can be caused by many condition and activities. Here are 10 of the most common:

1.       Exercising, injury or overuse of muscles

2.       Standing on hard surfaces or sitting in an awkward position for a long time.

3.       Peripheral arterial disease (PVD)

4.       Abnormal foot biomechanics like flat feet or really high arches

5.       Kidney or thyroid  disease

6.       Multiple sclerosis

7.       Peripheral neuropathy

8.       Lack of potassium, calcium, magnesium and other mineral in your blood

9.       Dehydration

10.   Many medications including diuretics, birth control pills, statin, steroids and antipsychotics

How can you eliminate the cramping?

1.       Massage and stretch the muscles involved

2.       Soak your feet in warm water or take a warm bath

3.       Stretch the areas

4.       Take a walk

5.       Over-the-counter anti-inflammatories like Advil or Aleve

6.       Drink plenty of fluids, especially an electrolyte solution like Gatorade can be helpful

7.       Wear supportive shoe gear and talk to your doctor about arch supports or custom orthotics if you feel it is foot fatigue related

How can you prevent muscle cramps?

1.       Drink plenty of water and other fluids

2.       Limit alcohol and caffeine, especially on hot days

3.       Eat healthy foods rich in calcium, potassium and magnesium

4.       Take a multivitamin every day

5.       Exercise every day, especially walking, running or riding a bike to move your muscles

6.       Stretch on a regular basis, as well as before and after exercise

7.       Don’t suddenly increase your exercise regimen. Don’t increase by more than 10% each week.

8.       Tal k to your doctor about any new medications that you are taking that may be causing the cramping.

If the cramping keeps occurring even though you are doing all of these things, a thorough exam is needed to assess for peripheral arterial disease, peripheral neuropathy, thyroid and liver disease as well as any underlying biomechanical problems that may be causing cramping. Foot and leg cramps are never normal, so don’t ignore them!

For more info contactus@faant.com or click here

Why Am I Still Swelling?

We hear this question after almost every post op patient or any patient who has had a moderate to severe injury.  And as I tell my patients preop, expect swelling.  And I’m really not kidding when I say it will take 6-8 months or more to stop swelling after bunion surgery; at least a year for any major reconstructive surgery.  But the question remains, why does the foot swell?

During surgery the soft tissues (and bone depending on the type of surgery) are injured in a controlled manor.  We cannot due surgery without cutting your skin and the soft tissues directly under it.  We also have to move tendons, vessels and nerves out of the way to get to what we are working on.  This involves holding these tissues to each side of the incision with instruments.  All of this is done very carefully, but it is still an injury.  The body has to heal this injury and brings in certain cells to the area to make this happen. This healing process makes you swell.

We repair incisions in layers from deepest to most superficial (skin).  This is done purposefully to help improve incision healing and reduce swelling. The sutures or stitches we put in the deep layers are absorbable.  Your body slowly breaks them down into water and CO2.  This process makes you swell.

Remember that your foot is the body part closest to the ground and gravity.  And it is the only part of your body that you walk on, thus applying at minimum your entire body weight with each step.  Gravity pulls fluid downward causing increased swelling and walking increases pressure thus increasing swelling.

Do you have spider veins or varicose veins?  These occur from your leg veins’ inability to pump blood efficiently back up the leg which forces more blood into your vessels.  This causes fluid retention in the legs, thus causing swelling even without surgery.  So add a controlled injury and guess what....LOTS of swelling.

There must be a healing time.  How long that healing time is is very individual.  If you follow your post op instructions of keep the foot elevated and iced as much as possible, this reduces your swelling.  Staying off the foot as much as possible helps as well.  Compression is great at controlling swelling.  That is why you will have a compressive dressing on your foot or ankle and be placed in some type of shoe, boot, cast or splint.  All of these devices help control your swelling.

The hard part is estimating how long the swelling will be there.  We can give you averages, but everyone is different.  If you are noncompliant with your post op care, it is very hard to control swelling once it gets started.  If you have varicose or spider veins, expect your swelling to be present 3-5x longer than normal depending on the surgery you are having.  If you have varicose veins with swelling to start off with, you may develop severe swelling requiring chronic therapy to control the swelling.  This could take a good year to improve.

Swelling is totally normal in all surgeries.  And no matter how quickly you recovered from surgeries or injury to other body parts, the foot and ankle is totally different.  You can’t just “push through” the swelling and expect it to go away when you decide you want it gone.  Will you still be swollen at 3 weeks post op bunion surgery...you betcha!  How about 3 months?  Yep.  But each week you should notice improvements in swelling until one day you realize that it disappeared without you evening knowing it.

Shoe Gear After Bunion Surgery

You have gotten your bunions surgically corrected and have grand expectations of wearing any shoe you want, when you want, for as long as you want.  Sound familiar?  Let’s talk about realistic expectations after you have bunion surgery.

First, your shoe selection immediately after bunion surgery will be dictated by the amount of swelling you have.  When you are allowed to transition to regular shoe gear from your post op shoe or boot, we always suggest a thick soled athletic shoe.  Often a mess style is better than a full leather upper.  This allows you to continue to control your swelling, but is the most accommodating type shoe.  You want one with great support as you will have considerable arch strain if attempting to wear shoes without arch support.  In the beginning, you may not be able to wear an insert inside your athletic shoe, mainly due to swelling.  But as this subsides, put your custom orthotic or Healthy Steps insert in your shoes to improve your recovery process.

Once you are allowed to wear different types of shoe, please don’t expect to return immediately into your 4 inch heels or ballet flats or Cole Hahn loafers.  Your foot is going to retaliate and give you a lot of unwanted pain.  So be patient.  Want to wear a dress shoe or sandals?  That’s ok, but think supportive, thicker soled shoe, not thin, flat and flexible.  The stiffer the sole of the shoe, the more comfortable it will be.

What about flip flops?  You can wear them only if you want to go through the surgery process all over again!  No joke, not kidding.  The only way you keep a flip flop on is to grip the small strap between your toes with your first 2 toes.  This causes your big toe to move outward or lateral.  This is the same direction it was going before surgery and causing increased pressure on the metatarsal head inward or medial.  If worn immediately after surgery, you risk the chance of causing an immediate recurrence of your deformity.  Sooooo not worth it!  Now in many cases, I will often let my patients wear flip flops occassionally after the first year.  But there are some cases when they are just not ever an option.  But same holds true for the type of flip flops you wear.  Think thicker soled and not Old Navy throw backs!

Ok, what about those heels? If you are a lover of high heels, they will feel comfortable in 6-8 months after surgery.  But don’t expect to be able to wear them all day long in the beginning.  Again, be patient.  When in heels, you walk directly on the area where surgery was performed, so that bone has to be ready for the increased pressure.  Otherwise, you’ll have pain.  And as always, we love for you to keep heels to a minimum.  But for some, they are a dress code requirement.  In this case, think wider heel, not narrow and thicker support under the ball of the foot.  34 Minutes shoes are a great example of supportive heels that maintain great style.

Now for you gentlemen, the options are a little easier.  You will still start with your athletic shoes, but your next step if you are needing dress shoes is a lace up or full upper shoe.  Avoid loafers or slip on style shoes where the tongue of the shoe stops just passed your toes.  When wearing these shoes, there is a forced toe gripping effect that must happen to keep your shoes on, which in turn causes pain.  Make sure your shoe fully covers the top of your foot.  And you are no different than the women when it comes to the sole of the shoe...think thick and rigid.

Everyone is different in their healing process and we help you through shoe transitions based on what we see during your recovery.  Just be patient with your foot and don’t force it into a shoe that it’s not ready to be in.  

Acute Vs. Chronic Heel Pain: New Treatments Available

Dr Marybeth Crane discusses acute versus chronic heel pain in this informative video. It is important to understand the difference between acute plantar fasciitis and chronic plantar fascists and their treatments.

Foot Check-Up- What Am I Looking For?

Last night I checked my feet. I don’t know why. They do not hurt. But I gave them a good look over on the bottoms, tops, heels, in between my toes. A foot check-up!  It has been a while since I’ve done that! I see and help so many feet during the day in my occupation, and I am very good about wearing good shoes, but checking my feel regularly? Admittedly, I have not! We are all guilty of ignoring our feet unless they make us pay attention to them!

As I was looking, I realized many of you out there reading this may now be thinking about doing so yourselves, but have no clue what you are looking for. And if you found something, would it be something you would need me to look at? I thought I might share with you a list of things you may want to see your podiatrist for!

 Looking at those feet, notice the nails. Are they yellowish or opaque? Are they brittle? You may have a nail fungus. A fungus that has taken root in your nail is very rarely rid of with over the counter topical product (and that is assuming you are willing to use that product consistently for at least 8 months!)

 Do you have a dark stripe or splotch under the nail that has not grown out with the growth of the nail? Do you have a mole that has grown, darkened or become irregular? Or maybe a mole has developed that was not there before? Or maybe there is just a strange looking discoloration you did not have before. Believe it or not, skin cancer can happen on the foot or under the nail! If there is any question, have it checked out!

 Look in between the toes. Is it scaly? Is it red? You may have athletes foot (a form of fungus!) or worse, a bacterial infection! Fungus like to start here where it is especially dark and moist between the toes before spreading the sides or bottom of the feet! What is the quality of the skin on the sides and bottom? When fungus gets a hold, feet or nails, it is tough to shake off quickly. Scratching can introduce bacteria into those areas and no fungal cream out there will make bacteria go away! Get to it before it starts letting you know it’s around!

 Look for areas of the skin that look thicker. Is it a pin point callus, a broad callus or is it a wart? Or could you have possibly stepped on something? Sometimes it is hard to tell. They are all treated differently, but one thing is common for all. They all do worse in the long run if they are picked at with whatever contraption you may have gotten a hold of in the bathroom!

 Do you have what looks like a mini grand canyon invading your heels? We call these “fissures”. This condition is hereditary and does not go away with simple lotions. Worse, the deeper the canyons get, the greater the chance of you developing a bacterial infection in the deepest grooves. Treatment is advised for fissures before they become painful.

 Feel the bottoms of your feet with the pressure of a massage. (Not a bad idea in either case!) Do you feel any deep lumps? You should not have any. If you do, let us take a look and feel. It is good to get what we call a “baseline” or early measurement. Getting a look and feel and measuring these lumps will give us the best information on whether this lump something that needs to come out or whether it just needs to be monitored.

Are you checking yet? If you can’t see the bottoms, use a mirror or have someone else take a look! Don’t have either option? We won’t retire for a while! Come out for visit!

Is Bunion Surgery Worth It?

Is Bunion Surgery Worth It?

Interesting question that can be answered yes and no.

Yes, if you have pain every day in your foot around the bunion and it is keeping you from doing the things you want to do.

No, if you just think the bunion is ugly and it is keeping you from wearing cute shoes.

In general, surgery for bunions is only recommended when pain from the bunion prevents a patient from wearing normal shoes and performing their normal daily activities. If your bunions only hurt when you are wearing pointy toed, high heeled shoes; surgery is not your best option. You should try padding, wider shoes, orthotics and injections; as well as much more sensible wider toe box, lower heeled shoes.

There is a common misconception that surgical treatments for a bunion are better and quicker than non-surgical treatments. Unfortunately, patients who rush into surgery may have unrealistic expectations, and may be unsatisfied with surgery.

Patients considering bunion surgery should understand the following about surgical treatments of bunions and also dispel some common misperceptions or myths about bunion surgery:

Myth #1: It is a common myth that bunion surgery is often unsuccessful or “botched”. This is simply not true. Almost 95% of patient surveyed 6 months after bunion surgery would not only do it again, but would recommend it to their friends and family. That’s a pretty good success rate. Patients must have realistic expectations. Bunion surgery can be helpful at relieving pain, but patients should not expect to have "perfectly normal" feet after surgery. And surgery cannot make your foot fit into a 4 inch heeled shoe comfortably.

Myth #2: Bunion surgery is extremely painful. Again, simply not true. Bunion surgery is not particularly "more" painful than other surgeries.  There is pain after surgery, but most patients only require narcotic pain medication for a few days after surgery then use anti-inflammatories to control their discomfort and swelling. Foot surgery, in general, can lend itself to increased pain post-operatively because the foot is below the level of the heart and blood can rush to the area, causing a throbbing feeling. This can be well controlled with a post-operative pain management program.

Myth #3: Bunions come back even after surgery. Again, not true. A majority of patients are satisfied with their outcome after bunion surgery. Recurrence is possible, but not particularly likely. And, return of a bunion is not necessarily a complication, but something that can happen over time. Some patients have excessive motion in the foot that may predispose them to recurrence. This is why functional foot orthotics are needed in many patients post0operatively to control foot function. Another possible reason for recurrence occurs when a procedure that was performed did not best suit the severity of the particular bunion -- so it's important to have the surgery tailored for your particular bunion. Discuss this with your surgeon or get another opinion prior to surgery.

Myth #4: Bunion Surgery = cast and crutches for months. While this was true years ago, more modern techniques have allowed surgeons to mobilize patients quicker. Mild bunions typically involve walking in short walking boot cast for one month, then a sneaker for another month. Surgeons consider casting with crutches with larger bunions because setting the bones is more complex. Some surgeons have moved away from bone cuts and instead perform a fusion procedure that allows for realignment of the entire deviated bone. This fusion procedure is called the Lapidus Bunionectomy, and contemporary approaches allow for early protected walking at four to six weeks postoperatively. Recent technological advances in medical implant devices have also helped surgeons modify their techniques to get patients moving quicker.

Myth #5: You have to be off work. This, again, is simply not true, and a function of the demands of your workplace. A patient can return to a sedentary desk job within a week of the surgery, and varies based on surgeon protocol and type of bunion surgery performed. Jobs that require excessive walking, standing and physical activity may require a medical leave of absence -- which can be up to two to three months depending on healing and job requirements. Getting around can be difficult and driving may be off limits if you have your right foot operated on and/or drive a manual. Job demands of a pilot certainly differ than those of a secretary.

Myth #6: Don't fix a bunion unless extremely painful. The concern with surgically correcting a non-painful bunion is that the surgery can result in longstanding post-operative pain that may not have been there prior. The old rule-of-thumb, if it ain’t broke, don’t fix it. However, people do have surgery for non-painful bunions if the bunion interferes with activity, continues to become larger, or if they have difficulty wearing certain shoes. Surgeons strongly prefer that patients have a painful bunion before they consider surgery. Fortunately, pain is the most common reason people seek treatment.

Myth #7: Bunion surgery results in ugly scars: Surgical healing is part of the process with any surgery, and bunion surgery is no different. Incisions can be minimized, or alternate surgical approaches may be used to hide surgical scars. Bunion incisions are usually located on the top of the foot and technique varies based on surgeon. A surgeon may perform a plastic surgery-type closure to keep scaring minimum. Decreasing swelling, avoiding infection in the postoperative period, and scar cream can also minimize scars.

Bunion surgery, just like any surgery, has its share of myths. Basically, because not all bunions are treated the same, information that may apply to someone with a large bunion may not apply to someone with a small bunion. Take the time to discuss your reservations and alternatives with your surgeon. Often you will find that myths like the 7 discussed are just simply not true. 

The majority of patients, having bunion surgery for the right reasons, end up with a good to excellent outcome and would tell you that bunion surgery is definitely worth it!