Grapevine TX Podiatrist

Joints Under the Weather??

2011-11-11T08:33:00.000-08:00

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!

2011-11-01T08:19:00.000-07:00

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

2011-10-13T04:10:00.000-07:00

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

2011-10-12T09:39:00.000-07:00

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

2011-10-08T12:09:00.000-07:00

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

2011-10-04T07:30:00.000-07:00

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)

2011-10-03T06:31:00.000-07:00

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

2011-09-27T09:23:00.000-07:00

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

2011-09-22T17:03:00.000-07:00

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

2011-08-16T09:47:00.000-07:00

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!

2011-08-02T12:25:00.000-07:00

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?

2011-07-28T11:10:00.000-07:00

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

2011-07-24T07:37:00.000-07:00

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!

2011-07-19T06:43:00.000-07:00

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!

2011-06-27T18:58:00.000-07:00

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!

2011-05-31T07:42:00.000-07:00

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!

2011-04-17T11:32:00.000-07:00

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?

2011-03-15T07:48:00.000-07:00

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

2011-02-08T07:55:00.000-08:00

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

2011-01-28T08:54:00.001-08:00

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.

How Important are Shoes in Preventing Heel Pain?

2010-11-17T09:31:00.000-08:00

Proper footwear is essential for a patient who is experiencing heel pain. Often the cause of heel pain can start due to improper shoe gear. A proper athletic shoe will help alleviate heel pain if it is the correct type of shoe for the patients foot.

Most people do not realize that there are many models or shoes available and most likely one will fit your specific foot better then others. It is very easy to buy and wear the wrong type of shoe without realizing it. By doing this your feet will continue to hurt, your arches will be tired at the end of the day and your feet will be sore in places that you didn't realize could hurt.

Depending on the specific foot type you have and your bio mechanics (the way you walk and run) can help determine the best shoe for your foot. A person with a high arched foot or a "pes cavus foot type" will be best fit in a cushion of neutral type of shoe. A person with a flatter foot or hypermobile foot or better known as "pes planus foot type" will need a moderate to maximum motion control shoe. A normal foot type is usually best fit in a light stability or mild motion control shoe.

Many times patients will come into our office and will be confused if they are in the correct shoes. When this occurs a shoe exam can be performed checking for heel counter rigidity, midfoot torsion stability, and forefoot flexion of the shoe. Once in the appropriate shoe a gait exam can be performed which includes the patient walking and running in their shoe gear. At that time it can be determined if an orthotic is necessary for your specific type of foot. An orthotic is a custom device that will fit into your shoe and help you function in a more ideal and neutral position.

So if your feet hurt, or you are not sure you are wearing the correct shoes, think about visiting a podiatrist who can help confirm what is the best shoe for your feet.

Laser Treatment for Fungal Toenails: You Have to Treat ALL of the Nails!

2010-11-09T07:09:00.000-08:00

Laser Treatment for Fungus- Calling All Toenails!!!

I have been lasering toenails for quite some time now and only recently have come across more and more people wondering “Why not just laser the affected toenails? It would, after all, come out cheaper that way wouldn’t it?”

The simple answer is “No, not really.” But let me back this up so you can take my word for it.

Fungus is visible when the nail is grossly infected. What many do not realize, is that the process started long before you could see it with the naked eye. This alone is enough reason for the need to laser all ten toenails.

All too often I see patients who tell me that their nail fungus was only on one nail for the longest time. Then, all of a sudden, it has spread to others. Fungus is contagious! It does not just sit in one place. It gets in in your carpet, your bath mats, your shower tile. And worst of all, if you do have fungus, even in just one toenail, that fungus has already grossly contaminated your shoes! For your other nails there is no escape!

Think about how lasering only those affected nails singularly, ignoring all the others which are surely contaminated. How secure do you feel about that? If you had a bad cough and shortness of breath, how secure would you feel about going to a doctor who gave you cough medicine, but didn’t bother to listen to the pneumonia brewing in your lungs? Only treating the “visible” symptom, but not the underlying problem is a problem, whether it is lungs, nails or any other condition. Fungus brews until it has a large enough colony to “visibly” affect other nails or even a previously treated nail! What does that mean to the patient? It means more frequent trips to the podiatrist for yet another “spot” treatment. You will find, is that in the end, you will have coughed up (no pun intended!) what you should have to have all nails treated in the first place! Worse yet, the cycle may continue since only the nails with visible fungus are treated again! Who knows when it might end for you and how much time you will need to devote to these types of visits? Why take that chance?

What I do strongly believe, as do all the physicians at Foot and Ankle Associates of North Texas (FAANT), is that if you are going to spend your valuable time and finances to have this procedure preformed, the least we can do is treat all your toenails at once. This will greatly increase the odds of success! One very effective treatment in one visit!

Another thing to consider is FDA approval. Only one type of fungus-treating laser in the U.S. is FDA approved. Fortunately, we have this laser at FAANT!! This is something that should give you extra piece of mind! You are getting what we know is safe and effective! All ten toenails and FDA approval is money well spent!

2010-11-07T19:20:00.000-08:00

So another athlete down with nothing other than a darn toe injury!!

With Clemson running back Andre Ellington missing the next two games with a toe injury, it is unlikely that the Tigers will become bowl eligible. Sorry Clemson fans!

So what happened? Well, the same thing that happened to San Diego Chargers star running back, LaDainian Tomlinson. Turf toe strikes again! We have written about this before and I will waste no time to link you to our great turf toe article written and available for your perusal. Only wish Andre Ellington knew what he was in for. Being as young as he is, he will most likely heal without incident. Then again, being as young as he is, he may also jump back into what is left of the season a little sooner than recommended. If you are listening Andre, don’t do it! Let this heal and help avoid what could end up being an arthritic toe later on in life that may end your career sooner than intended!

Let this serve as yet another reminder to all of us, athletes or not, that the big toe is just that important! The mere jamming of the toe is enough to jump start an arthritic process. Micro tears in the cartilage cushioning the joint can become deep fissures down to the bone over time. These are allowed to wear down until there is no cartilage to cushion the joint and suddenly there is joint pain when before there was none!

Do not ignore joint pain! It is not normal. Even though it can go away, it will more than likely return more frequently over time and return with a vengeance. As podiatrists, we do not merely treat injuries; we pride ourselves as a profession of prevention! Recurrence prevention is just as important as eliminating the initial pain. Heed our recommendations if we point you to certain shoes or inserts or functional orthotics to better control any foot instability. The cliché is true, prevention is key!

Eleven Tips to Ease Arthritis Pain and Increase Mobility!

2010-10-29T10:36:00.000-07:00

The little things you do can get your arthritis pain under control and increase your mobility. Lots of patient in my Grapevine, TX, office complain of arthritis pain in their feet and ankles as well as their knees, hips and back. The dynamic chain of our lower extremity biomechanics is all connected. Help your back by helping your feet, knees and hips! All the joints benefit!

When you have osteoarthritis, it is very common to cut back on most of your physical activities to minimize your pain. This inactivity often leads to more health problems, so it is important to find ways to keep the pain under control.

Here are my top eleven tips to keep you moving with arthritis:

1. Lose Weight. Every pound matters. Think that if you lose one pound, it takes three pounds of torque off your feet. Every extra pound puts more pressure on all your joints. Find a sound lifestyle changing diet and adjust your eating habits to slowly lose the weight.
2. Give yourself a break. Overuse can increase arthritis symptoms significantly. To ease your pain and the stress on your joints, take frequent breaks. Break large tasks into small ones.
3. Stretch. Athletes always ask, “To stretch or not to stretch, that is the question?” In patients with arthritis, stretching can really ease the pain in your joints, especially you foot and ankle. Learn to stretch properly and make it a daily habit.
4. Exercise. Exercise will help maintain mobility and flexibility as well as strength. Yoga or water workouts are good alternatives for patients with arthritis. If you don’t move it, you will lose it!
5. Heat it up. A hot water bottle, warm compresses or a heating pad can often relieve arthritis pain. Be careful not to make it too hot, especially if you have diabetes and a little neuropathy!
6. Talk to your doctor. There are many new options for pain relief, so don’t think you just have to live with it. Ask your doctors for options.
7. See a podiatrist. A podiatrist can help you with shoe gear, functional foot orthotics and even joint surgery that can relieve your pain. Talk to a podiatrist about options to ease your foot and ankle pain and/or balance the biomechanics of your lower extremity to let your joints function as optimally as they can.
8. See a physical therapist or chiropractor. Many times a little physical therapy or manipulation can help to ease your pain and get you moving in the right direction.
9. Try OTC options. Many people use over-the-counter arthritis pain relievers or topical analgesic creams to help with their pain. My favorite is Biofreeze.
10. Consider supplements. Many patients report relief from glucosamine and chondroitin supplements. Remember that you need to take them for at least a month to see if they help.
11. Start early. Get your arthritis pain under control early. It is much easier to get it under control and focus on a mobility regimen when you are younger. It is easier to lose weight in your 40’s than your 60’s.
Arthritis pain getting you down? Follow these tips to help control your pain and increase your mobility!

Chronic foot and ankle injuries, why not wait?

2010-10-06T06:23:00.000-07:00

I just had a friend tell me this. She has had pain and swelling in her ankle and is ready to have it addressed. Crazy thing is, her injury happened in 1996! Say again?! 1996?! And this prompted me to write about what happens if you wait.

With 26 bones, 33 joints on top of more than 100 tendons, ligaments and muscles, the foot has plenty of places it can injure. All of these parts make a whole in the function of the foot and ankle. And since the foot bone’s connected to the ankle bone and the ankle bone’s connected…well you get my drift. One component stretches, breaks, tears, strains and every other part has to bear the load of that one small part. With as much as we use our feet, one or some components have already given out to some degree.

So now we all have feet that are not in their perfect position to function at their best.
The aches and pains begin. Sure, Tylenol and Motrin are great band-aides. But they mask pain rather than fix what’s wrong. Keep it up and over time, the anti-inflammatories stop working. Not a good sign. The stress from years of small, meaningless injuries start adding up to more stress than your feet and ankles can handle. Now your injury is chronic. What does that mean? It means that you have ignored the small stuff and now your body is ignoring it too and won’t heal it on its own.

Good thing is, most of you are not a professional athlete, like Shaquille O’Neal, whose plantar fasciitis raised havoc on his ability to dunk those hoops! Bad thing is, whether you are Shaq or not, ignoring an injury or chronically re-injuring could have dire consequences.

I found this list off an article about athletic performance by Keith Wassung listing the following athletes using chiropractic care as part of body maintenance:

Joe Montana, Roger Craig, Keith Jackson, Emmit Smith, Chris Carter, Evander Holyfield Sugar Ray Leonard, Roy Jones, Jr., Wade Boggs, Penny Hardaway, Jon Smoltz, Ken Griffey, Jr. Mark McGwire, Ryne Sandberg,, Ricky Bell, Brett Butler, Dominique Wilkins, Michael Jordan, Scottie Pippin, Charles Barkley, John Stockton, Robert Parish, Gerald Wilkins, Lee Haney, Arnold Schwarzenegger, Dr. Frank Columbu, Irving Fryar, Brett Hall, Tiger Woods, Roberto Clemente Michael Carbajol, Bob Hayes, Muhammad Ali, Ed “Too Tall” Jones, Alex Karras, Gary Clark, Mark May, Charles Haley, Bill Fralic, Dan Marino, Warren Moon, Tim Dwight, Jack Dempsey,Fred Funk, Beth Daniel, Mary Lou Retton, Olga Korbut, Wayne Gretzky, Rocky Marciano, Dan O’Brien, Bruce Jenner, Donovan Bailey, Mac Wilkins, Dwight Stones, Mary Decker, Willie Banks, Nancy Ditz, Gregg Blasingame, Billy Jean King. Tracy Austin, John McEnroe, Ivan Lendl, Jim Connors, Jan Stephenson, Shawn Marion, Stephon Marbury, Barry Bonds, Vijay Singh,Steve Nash, LeBron James, Barry Zito, Grant Hill, Shaquille O’Neal

Why not podiatric care to maintain the only set of “tires” you have?!

The simple lesson here is, if you do not want to spend your golden years limping and kicking yourself for not addressing your foot and ankle pain sooner, get in to see your podiatrist when the injury happens! An acute injury is sooooo much easier to treat and your prognosis is soooo much better if you treat EARLY. And remember that with many injuries, though you may have healed, you are also more prone to re-injury. The best thing about early intervention is that you will also be informed of ways to prevent re-injury. Either way, that visit to your podiatrist could take you many more miles and that is golden!

The simple lesson here is, if you do not want to spend your golden years limping and kicking yourself for not addressing your foot and ankle pain sooner, get in to see your podiatrist when the injury happens! An acute injury is sooooo much easier to treat and your prognosis is soooo much better if you treat EARLY. And remember that with many injuries, though you may have healed, you are also more prone to re-injury. The best thing about early intervention is that you will also be informed of ways to prevent re-injury. Either way, that visit to your podiatrist could take you many more miles and that is golden!

Foot and Ankle Injuries in Golfers

2010-09-21T11:17:00.000-07:00

Most of the time, injuries that occur in the foot and ankle during golf activites are either due to overuse type injuries or traumatic injuries. Overuse injuries are more common and are commonly directly related to the mechanics of the golf swing.

The golf swing can be broken down into the following phases:
Set up
Takeaway
Downswing
Impact
Follow-through

At set up: The weight should be evenly distributed on both feet with slightly more weight on the inside of the balls of the feet. During the takeaway or back swing phase, the front foot should pronate, placing more pressure on the inside of the foot while the back foot stays stable as it receives more weight. At times the heel of the front foot will come off the ground to promote a full shoulder turn.

During the downswing: Weight will rapidly shift to the front foot until impact, at that point the weight should be evenly distributed between both feet. A lateral shift of the hips and knees will occur during downswing that continues through the impact of the ball and will continue slightly into the follow-through phase.

During the follow-through phase, the front foot supinates and the back heel comes off the ground with the weight of the back foot being placed on the big toe.

The most common golf injuries that occur in the foot and ankle are heel pain, metatarsalgia, Mortons Neuroma and tendinitis. Most of the time these injuries occur due to an increase of the motion in the feet.

Most common complaint in golfers is an intermetatarsal neuroma. Typically these occur in the third interspace and is almost always in the non-dominant foot. In other words if you swing the foot with the right then the neuroma is more likely to develop in the left foot. The nerve becomes irritated and is more noticeable in longer shots. As the forefoot inverts and the rearfoot supinates the interdigital nerve becomes irritated within the interspace. Symptoms include burning, tingling, numbness and shooting pains into the toes. Treatment begins with NSAIDS, Ice, Injection therapy and custom orthotics. One important treatment option is to adjust the mechanics of the swing to decrease the inversion/supination of the foot. Abduction of the front foot will help decrease the inversion at the end of the swing and decrease the irritation of the nerve.

Extensor Tendinitis: another complaint that we commonly see with golfers. This is due to driving the golf cart. It is often caused after driving a hilly course and using the brake to much. The motion of depressing the brake on a golf cart can cause a strain on the extensor digitorum longus tendons and causes irritation of those tendons. Symptoms include top of the foot pain and sometimes swelling. If this sounds like something you may have developed try alternating feet that use the brake. Using the heel to depress the brake may also help.

Lateral Ankle Pain: Occurs due to excessive motion of the rearfoot during the golf swing follow through. The forces that are applied during the follow through phase cause an abduction of the knee on the non-dominant limb and a supination on the foot on that side with eversion of the rearfoot. Symptoms include lateral ankle pain, lateral midfoot pain and swelling to the foot and ankle. Treatment starts with stabilizing the ankle with a compression brace or ankle brace. Trying to abduct the front foot toward the target and away from the midline of the body in the stance position when the golfer is addressing the ball will help take pressure off the lateral ankle.

Hallux and Subungal Hematomas: this occurs when the golfer applies excessive pressure to the big toe during the golf swing. Typically this occurs at the end of follow through and will only happen on the dominant foot. It occurs due to a jamming of the toe into the top of the shoebox. With repetition the subungal tissue will be injured and blood will form under the nail plate. Symptoms include pain in the hallux, pain with pressure on the hallux and a discolored big toenail. Treatment includes draining of the toenail or removal of the toenail.

We talked at the beginning that most golf injuries are caused by an increase motion of the foot. Studies have found that custom orthotics, which are devices that are made specifically for your feet are able to increase balance and allow golfers to drive the ball farther.

Podiatry Visits Save Diabetic Feet!

2010-06-28T13:41:00.000-07:00

New Study Demonstrates Dramatic Impact of Podiatric Care

Patients with diabetes who receive medical and surgical care provided by a podiatrist are less likely to suffer hospitalization or amputation than patients who do not receive care from a podiatrist, according to a new study from Thomson Reuters. Thomson Reuters is an internationally respected research firm with expertise in the health-care market.

The study examined records for more than 32,000 patients with diabetes under 65 and matched health and risk factors for those who had podiatry visits to those who did not. Care by a podiatric physician, defined as at least one pre-ulcer visit, was associated with lower risk of hospitalization and amputation. The results were presented at the American Diabetes Association Scientific Sessions this weekend in Orlando, Florida.

"The dramatic results of the study demonstrate the important role of today's podiatrist," said APMA President Kathleen Stone, DPM. "As a profession, we make a significant impact on patient outcomes and health-care costs. As more diabetic patients receive high-quality medical care by podiatrists prior to developing ulcers, we will see even greater reductions in cost and improvements in patients' quality of life. The next step is to confirm these findings with prospective pilot programs that identify high-risk patients and provide preventive foot care services by podiatrists."

The importance of regular podiatric care for EVERY diabetic cannot be emphasized enough! If you or a family member suffers from diabetes, go to www.faant.com and request our free book, “Got Diabetes”. It is full of helpful information to keep diabetic feet out of the hospital!

The Oustide of My Foot Really Hurts!

2010-05-20T09:43:00.000-07:00

What is the lateral column of my foot? The lateral column of the foot consists of the calcaneus,the cuboid and 4th and 5th metatarsal bones. Many things can cause you to have lateral column pain including arthritis, biomechanical abnormalities (the way you walk), acute fractures secondary to trauma, or overuse syndrome.

There are certain types of foot structures that make you more likely to develop lateral column foot pain. An adducted foot type can cause an increase in mechanical pressures that can result in lateral column pain. Increased plantar pressures on the lateral column may also be seen in a neutral or supinated foot type. Pronation or flat feet can also lead to lateral column pain.

The most common cause of lateral column pain is known as cuboid syndrome or subluxation of the cuboid bone. This is often difficult to diagnose as the symptoms are not specific. X-rays will be negative because there is not any bone damage with this disease. Often the diagnosis is based on your history and physical and evaluation of your gait cycle. Most often the pain is greater with propulsion and disappears when sitting or pushing on the foot.

Joint stability plays a large role in the development of cuboid syndrome. If your foot is able to pronate during the beginning phase of propulsion it allows certain tendons (peroneus longus) to gain a greater mechanical advantage leading to the subluxation of the cuboid bone. This allows the ligaments and capsule that surround the joints to become irritated and inflamed and cause pain.

How do you treat Lateral Column Pain?

An evaluation of your gait will be one the first treatments. At this time proper shoe gear will be discussed. Accomodative padding,taping, bracing and physical therapy can help with reducing inflammation and pain. Many times the foot needs to be manipulated to allow the bone to sit back into its normal position. Custom orthotics may be necessary to address the biomechanics of your feet.

Meet the Doctors of FAANT

2010-05-18T12:49:00.000-07:00

Check out the new video to introduce the doctors of Foot & Ankle Associates of North Texas. Meet the Doctors of FAANT

Can I Wear Nail Polish with Fungus on my Nails?

2010-05-17T11:46:00.000-07:00

It’s a bum rap! You have fungus on your toe nails and all you want to do is cover it up! Nothing better than nail polish to do that, but you know enough about fungus to know that fungus thrives in moist dark places. Nail polish gives that fungus a wonderful place to grow and thrive! What’s a girl to do??

Well, for starters, it is so very important to look beyond the nail itself and look at your foot surroundings. Where do you walk? What do you wear?

We do not know exactly how you got your fungus, but we want to keep it from happening again. Keeping your surrounding as “fungus-free” as possible will help! Let’s go over the key pointer to keeping fungus at bay.

1. Spray your shoes with an anti-fungal spray. It helps keep the fungus away!
Throw away your old grungy gardening shoes if they are not rubber or those old favorite canvass shoes you’ve had forever.

2. If you have sweaty feet, change your socks once during the day to keep the moisture down. The less moisture you have, the less than ideal environment a fungus has to grow.

3. Use an anti fungal powder on your feet if you tend to sweat a lot.

4. Spray “Scrubbing Bubbles” or “Lysol Tub and Tile” type stuff weekly on your shower tiles.

5. Wash your bath mats weekly. We don’t know what critters are thriving in them.

6. Shampoo your carpet if you haven’t done that in a while. We don’t know what critters are thriving in them either.

7. Give your shoes a breather by not wearing the same pair twice in a row.

8. Get sterile pedicures and stay away from the soaking tubs that have whirlpool effect. They can never get the tubing cleaned properly.

9. Bring your own polish and flip flops to the nail salon.

And yes, we are back full circle to the nail polish thing! It can matter what type of polish you use. Nail polish with Tea tree oil is becoming very popular for a reason. It has been found that tea tree oil is a natural fungal suppressant. What does this mean? It means you can have fungus and wear nail polish too!! Dr. Remedy nail polish with tea tree oil offers just what you have been looking for. I was so impressed with this product and got such good feedback on it, that I recommended them in my article on foot health in the April 2010 issue of Southern Living magazine. Beautiful colors and protection too! Lucky you!

Getting the Most Out of Your Podiatry Visit

2010-05-10T09:54:00.000-07:00

You finally have time to see your podiatrist. You have questions. You need answers. We are really here to help. We understand everyone has different needs and expectations. We do our best to provide that while we visit with you. Predictably those needs and expectations change with every visit.

The best way to help us with your concerns is to analyze the specifics of each concern before your visit with us. Here are some questions we will surely ask you. Answering these will greatly help with your diagnosis.

1. “Where does it hurt?” Yes, though it is true that sometimes pain is everywhere, but pain does tend to originate from a certain area of the foot and spread. Find your most tender spot. Many times we cannot “make it hurt” on exam because your pain is what we call “functional”. This means it only happens when you are “functioning” whether this is walking, running or whatever. If you can’t find it by merely pressing on it, then do what it is that causes it with your shoes off so you can visualize its where-a-bouts.

2. “How long has it been hurting?” We need a ball park figure.

3. “What causes the pain?” We would like to know about what brings your pain on. Is it there with the first step in the morning? After or during activity? Was there a definite traumatic even that started it or maybe a pair of shoes?

4. “What makes it feel better? What have you tried treatment-wise?” Many times I hear that nothing was tried only to discover on further discussion that sticking to a low heel or a different shoe helps. We want to know! Does getting off the affected area do the trick? Icing? Medication? You get the drift!

Just one more thing! Many patients have never seen a podiatrist before and when we see them for the first time they feel the need to address EVERTHING that has ever bothered them. Though they scheduled their appointment to discuss their heel pain, once the doctor enters, they produce a laundry list of other things they also would like us to talk about. If you have many issues you would like to discuss, please remember that although we would like to address everything bothering your feet and ankles, one problem may require more time than others. It makes a world of difference in the quality of care we can provide during your visit, that you let the person scheduling your appointment know the most pressing problems you would like us to address at your appointment so they can give you enough time on the schedule. Understand, not all problems may be addressed that first visit. And do understand that if some problems take precedent over others the day of your appointment and we do not have a chance to devote the proper amount of time to another, we will commit more time to it on your next appointment.

These tips will allow your podiatrist to give your feet the exceptional care they deserve!

Brett Farve Contemplating Ankle Surgery, Are Your Ankle Unstable Too?

2010-05-01T06:36:00.000-07:00

Brett Favre is at it again! He may be the most indecisive man of our era. Every year we sit and wait to see whether or not he will retire. This year, we have even more to look forward to. Is he going to have surgery for his ankle? Brett Favre released a statement that he is considering having a minor surgery to repair his ankle injury. I wonder how long it will take him to make this decision. No statement has been released of the actual diagnosis or the procedure needed but Favre did mention possible removal of bone spurs at the ankle joint.

Bone spurs at the ankle joint are often caused by osteoarthritis or degenerative joint disease. Osteoarthritis of the ankle is common after several ankle sprains or many ankle sprains over many years. Over time, the wear and tear of the joint will lead to damage of the cartilage and bone. As the bone breaks down, new bone is formed. The new bone, or osteophyte, can cause irritation of the surrounding tissues and lead to pain and inflammation.

For Brett Favre, his normal daily activities don’t cause severe ankle pain but complex workouts and games do cause pain and irritation. He has made statements discussing his ankle pain as non-debilitating. I assume that his ankle problems are due to bone spurs and scar tissue that has build up in the ankle joint from repeated ankle sprains or other injuries. This is often referred to as ankle impingement syndrome.

Surgery for this condition is very minor and can be performed with only small incisions. An arthroscope is used to view and inspect the joint. A shaver can then be used with the scope to remove any access tissue and debris in the area of the joint. The bone spurs can also be removed without large skin incisions. These types of procedures are termed minimally invasive and have faster recovery time. If Brett Favre is suffering from impingement syndrome, he can have the procedure done and be back to normal activity within 4-8 weeks.

Considering the surgery is minor and the recovery time is short, it surprises me that there is even a debate on whether or not he will have surgery. If he has surgery, will he be a Viking for one more year? If he does not have the surgery, will he actually retire? I have a feeling we won’t know until the first game of the season. Brett Favre’s career has been full of drama, and we will add this to his epic tale. Football legend debates minor surgery for non-debilitating ankle injury. Neither are career ending but retirement has not been taken off the table!

For more info and a short video by Dr Giacalone on ankle pain click here!

Foot pain ruining your golf swing?

2010-04-28T11:49:00.001-07:00

Golfing in Grapevine, Texas should not be limited by foot pain this spring!

The barrier to a perfect golf swing could lie in your big toe. Or your heel. Or on the ball of your foot. The physicians at Foot and Ankle Associates of North Texas in Grapevine, TX, say these are the three areas of your feet most likely to cause pain that can ruin your golf swing.

Behind these pain-prone spots can lie stiff joints, stretched-out tissues and even nerve damage. But pain relief is possible and frequently does not require surgery.

According to FAANT, the three most common painful foot conditions that can ruin your golf swing are heel pain, arthritis and pinched nerves.

1. Arthritis can cause pain in the joint of your big toe that makes it difficult to follow-through on your golf swing.
2. Heel pain typically results from an inflammation of the band of tissue that extends from your heel to the ball of your foot. People with this condition compare the pain to someone jabbing a knife in their heel. Heel pain can make it uncomfortable for golfers to maintain a solid stance during crucial portions of their golf swing.
3. Neuromas are nerves that become thickened, enlarged and painful because they’ve been compressed or irritated. A neuroma in the ball of your foot can cause significant pain as your body transfers its weight from one foot to the other in a golf swing.

Several other painful conditions can also cause instability during your swing. Some athletes and former athletes develop chronic ankle instability from previous ankle sprains that failed to heal properly. Motion-limiting arthritis and Achilles tendonitis can also affect your balance. Ill-fitting golf shoes may cause corns and calluses that make standing uncomfortable.

For the majority of golfers and other patients the doctors at FAANT recommend simple treatments such as custom orthotic devices (shoe inserts), stretching exercises, changes to your shoes, medications, braces or steroid injections and physical therapy. However, if these conservative measures fail to provide adequate relief, surgery may be required.

“Foot pain is not normal. With the treatment options available to your foot and ankle surgeon, a pain-free golf swing is clearly in view,” says FAANT. “When your feet aren’t in top condition, your golf swing won’t be either.”

For more information on foot and ankle conditions, visit www.faant.com

Barefoot Running Good or Bad for You?

2010-04-13T11:41:00.000-07:00

Barefoot running has become a growing trend. It has gained a lot of popularity due to the publication of the book "Born to Run". This books talks about the story of the Mexico-based Indians who for centuries have been running without shoes at distances sometimes greater than the distance of a marathon.

People are heavily debating the issue of shoes vs barefoot. The book "Born to Run" claims that the Tarahumara Indians are able to run great distances barefoot without being injured. They also claim that there is no proof that expensive running shoes are actually doing there job to prevent injuries. The book suggests that everyone should go back to how our earliest ancestors ran: barefoot.

Barefoot advocates claim that running shoes cause injurues and that it is more natural to run without shoes. Some say that you must be completly barefoot to reap the full benefits while others say it is best to wear a "minimalist shoe" that have thin soles and are lightweight.

So if Barefoot Running is so great how come there have not been more barefoot runners breaking the finishing tape at races. Are these athletes worried that if they trained barefoot they might injure themselves??

If runners ask me how I feel about barefoot running I tell them this:

There are many athletes and runners out there that do run with shoes and are not injured and have never had injuries. I tell my patients that if they want to try running barefoot that it would be safer running in a lightweight racing flat. If you do decide to run barefoot make sure you pick a soft surface. I also make sure to inform all my patients that there is no scientific evidence that barefoot running produces less injuries than running in shoes. Also the book focuses on a group of people that have been raised barefoot in their daily lives. Most of us have been in shoes since we were ambulatory, so due to this our skin toughness, muscles, ligaments, tendons and bones have developed differently.

No matter what you decide shoes or no shoes, be careful and remember if something hurts to seek medical attention.

Pretty Feet for Summer!

2010-04-12T05:26:00.000-07:00

As ecstatic as I am about getting an article into Southern Living magazine, I am even more so about getting the word out nationally on how to get those feet summer-ready!

You will find some surprisingly easy ways to keep the skin on your feet healthy, soft and oh, so smooth! As important as it is to get your feet hydrated, it is just as important to keep your nails safe from those little nasty dermatophytes lurking around (that would be the “fungus among us!”). Keep my pointers in mind next time you hit the nail salon!

And always remember, at Foot and Ankle Associates of North Texas, we are committed to providing you with the exceptional healthcare solutions to keep your feet “summer-ready” the whole year through!

Medial Tibial Stress Syndrome

2010-04-08T12:26:00.000-07:00

One of the most common injuries that occurs among running and jumping athletes...

Medial tibial stress syndrome also been called "shin splints" is the most common injury in the legs of active individuals. Females are more commonly affected, along with 22 percent of all injuries in aerobic dancers. Anyone participating in running or jumping acitvites are likely to develop this stress syndrome.

The pain from MTSS only occurs during the activity (running) with the pain diminshing rapidly within five minutes of activity cessation. If the pain persists during walking activites the suspicion for a stress fracture is high. Most common side effects are diffuse pain and tenderness that occur along the distal aspect of the medial tibial border (inside along the ankle bone)

How is MTSS diagnosed?

Most physicians will start with x-rays but most of the time they will get an MRI which is more specific test and has the abilty to diagnose the injured athlete.

How do I treat MTSS?

After the diagnosis has been made of MTSS, ice should be applied for 20 minutes multiple times a day. Activites should be reduced, patients should focus on exercising on softer surfaces, and wear appropriate shoe gear at all times. Custom foot orthotics are recommended for the vast majority of these patients. Orthotics are able to shift the ground force; as well as reduce subtalar pronation which helps reduce the bending motion of the tibia (which is why we get MTSS in the first place)

Understanding the disease is the key to getting an athlete back to their activites as soon as possible. If you think that your symptoms sound like these make an appointment with your podiatrist.

Fine Tune Your Feet

2010-03-01T10:22:00.000-08:00

On any given day we don’t hesitate to shower to keep ourselves clean, brush our teeth to prevent cavities. We take vitamins and exercise for healthy bodies and a strong heart. We work hard to keep everything in tune to keep ourselves going.

But what do we really do to keep our feet healthy? Aren’t our feet literally what is going to keep us going?? How many of us truly give them the attention they deserve? We only seem to start caring when they start complaining!

Foot fact: By the time we are 50 years old, we will have walked 75,000 miles! A lot of us active types are reaching that milestone much quicker! What happens at that mile mark? Well, we are at a much higher risk for developing arthritis in our feet. This with losing up to 50% of the shock absorbing fat in the balls of our feet can equal a very big OUCH!

Ingrown toe nails, bunions, hammertoes, corns, calluses, foot fungus, painful feet, to name a few, are all signs of foot abuse and neglect.

It is time to fine tune our feet!

When was the last time you really gave your feet a good look-over? That alone can make you aware of a potential problem before it starts to cause pain. Make it a habit to give them a check up every few months.

When was the last time you have your shoe size checked? Our feet spread and grow the more we use them. Next time you go shopping for shoes, take the extra time to have your feet sized. Many of you will be surprised how much they have grown!

Do you like to walk barefoot? I urge you to reconsider. When you rely on your own feet to cushion the blow of your body weight, you can count on wearing down your arch and the fat that cushions the ball and heel of your feet. In your golden years, when you are having a hard enough time keeping your health in check and your body is stiffer, you are going to wish you at least had a good set of feet to carry you through.

Do you really need to cram your foot into those stylish shoes? Yes, I do when I am going to a nice dinner or function. They do make us look great. Unfortunately, your feet can’t talk or they would be screaming for mercy!! Give them a break and alternate with a nice round toe, low or no-heeled, well-padded leather variety and your feet will that you by giving you that extra mileage!

What exercise are you choosing? Daily pounding or non-impact? Makes a big difference! Again, alternate your pounding run or step class with the ellipse, bike, swim, arc trainer or stair master. Wear and tear from a repetitive task can lead to stress fractures, tendonitis, muscle strain. The list goes on and on.

Finally, if you do have foot pain, don't wait and hope it will go away. Pain is not normal. A quick check with a podiatrist means a quicker recovery!

2010-02-17T09:19:00.000-08:00

What is Peripheral Neuropathy and how do I know if I have it??

Peripheral Neuropathy is a medical condition in which the nerves that travel from your brain and spinal cord function improperly. Most people will complain that they are experiencing burning, tingling, numbness, and or shooting pains to their lower extremities. Most of the time the symptoms of neuropathy will begin in the feet. Numbness in the toes or in the ball of the foot seems to be where most people feel these sensations first.

What causes Neuropathy?

There are over 100 causes of peripeheral neuropathy. Some of the more common ones include diabetes, thiamine deficiency, alcoholism, trauma, exposure to toxins, autoimmune diseases, and infections. Sometimes no cause can be determined.

Can you treat Neuropathy?

Yes, a treatment plan can be formed based on the cause of your neuropathy. If you are Thiamine deficient (easily determined with a blood test), you can begin to take supplements of thiamine and the symptoms should eradicate.
Neuremedy is another option for treating neuropathy.

What is Neuremedy?
Neuremedy is a medical supplement that helps treat dysfunctional nerves allowing them to impulse correctly. It contains benofotiamine and has been determined to be safe and successful in treatment of neuropathy. Neuremedy is able to help alleviate the symptoms of neuropathy by delivering a highly bio active form of the micro-nutrient thiamine to the nerve cells.

Is Neuremedy safe?

The active ingredient in Neuremedy is benfotiamine. It has been used since the early 1960's to successfully treat neuropathy. It has been proven to be safe and effective. It does not have any known significant adverse effects and can be safely taken with medicines and supplements.

How Quickly does Neuremedy work?

Most people begin to notice a reduction of symptoms within the first two months of taking the supplement. Unfortunately neuremedy does not work for everyone. Ask your doctor if Neuremedy is right for you.

What Are These Labs For?

2010-01-11T09:47:00.000-08:00

You go into your podiatrist office to have your foot problem evaluated and you walk out with a lab form for some tests. Why do you need them and what do they mean?

Well, laboratory tests are an important tool to help us evaluate your health. Diabetics, people with swollen joints, people with foot pain symptoms that are unusual, people going on a new medication and people with infections are all candidates for blood work. Here are some of the more common labs ordered by your podiatrist, what they are for and what abnormal levels could mean:

Glucose: This tells us how much sugar is in your blood. We usually order this if you are a diabetic and we want to get a measure of your recent sugar levels or if you are not diagnosed diabetic but we suspect you may be. Too high a value is seen in diabetics. You will also see an elevation if you did not fast for this test.

Hemoglobin A1c (HgA1c): If you are a diabetic and we want to know how well you have controlled your blood sugars over the past 3 months, this test will let us know.

Blood Urea Nitrogen (BUN) is a waste product made by the liver. It is excreted by the kidneys. We see high values in people on high protein diets, people who exercise strenuously, and people who have problems with their kidneys. We will order this test if we are placing you on a medication that is processed by the kidney and want to make sure your kidney is functioning properly.

Creatinine is a waste product from muscle breakdown. This is also ordered to evaluate kidney function. A high value here with a high BUN could also mean you have kidneys that are not working well.

Uric Acid is normally excreted in urine. When your body is not excreting this properly, or if your body is producing too much of it, you could end up with gout, a condition that results in joint pain. If you have a swollen joint, we may order this to rule out gout.

If you have a swollen joint or joints and we are trying to further determine a cause, we may also order a Rheumatoid panel. This includes the Rheumatoid Factor (RF) test along with other autoimmune-related tests, such as an ANA (antinuclear antibody)along with other markers of inflammation, such as a CRP (C-reactive protein) ESR (erythrocyte sedimentation rate and along with a CBC (Complete Blood Count) to evaluate the body’s blood cells.

When we decide to put someone on a medication that may affect their liver, or we suspect that they may have liver damage, we may order a panel to check out their liver function. They may include AST, ALT, ALP, SGOT, SGPT, and GGT and Alkaline Phosphatase, Bilirubin, Albumin, total protein.

There are patients who present with weakness of their lower extremity. CPK level is a test we order to help make this determination. If CPK is high in the absence of cardiac history or strenuous exercise (both of which could also cause an elevation), it could indicate skeletal muscle disease.

If we are trying to heal a wound and suspect possible poor healing secondary to nutrition and overall health, we may order Albumin and Globulin levels.Hemoglobin (Hgb) and Hematocrit (Hct) may also be ordered as low levels also contribute to nutritional deficiencies causing anemia

If we suspect an infection, these tests help us evaluate the severity of the infection as well as how well a particular antibiotic is working against it. Usually, the higher the value, the more severe the infection. These labs include: C-Reactive Protein (CRP), White Blood Count (WBC), Sedimentation Rate (SED rate)

It is important to get these requested labs as soon as we order them to help you with your treatment. Doing so will help “get you back on your feet” in no time!!

Five Healthy Feet Tips for a Happy New Year

2009-12-06T18:18:00.000-08:00

As the end of the year winds down (already?!), once again, unless you have foot pain, our tooties are the last things we focus on. Turkey, trips, tantrums and those terrifically terrible relatives are of more importance! So I challenge all of you to take this moment to make those simple changes that will keep our feet happy for a long, long time to come.

A resolution and a fresh foot start for the new year! Let’s get started!

Feet tend to swell more in the afternoon. Shop for shoes in the afternoon so you aren’t stuck with a pair you can’t get off at the end of the day! Be sure they feel good in the store. Shoes are not meant to be “broken in”. And if you are shopping for your children, bring them with you. They may feel something wearing the shoe you couldn’t possibly know without them putting them on!

If you have to wear a heel, stick to one that is no more than 1 ½ inches. Over that, you greatly change the dynamics of foot function putting 75% of your weight on the ball of your foot. Save the stilettos for short distances, not shopping trips if you can’t part with them altogether!

It is a good habit to powder up those feet with a powder that has corn starch before putting your socks on. This will help keep them dry. Moisture causes foot odor and althete’s foot. If you don’t want the powder in a sandal, pick up some Summer Soles at www.summersoles.com. This is a paper thin inlay for sandals and shoes that wick the sweat right off your feet so your feet don’t slosh and slide on it!

Avoid trimming your nails too short. This can cause an ingrown. Keep your nails trimmed so there is still a little “white” showing on the end. Round the corners with a file so they don’t dig in.

Get your pedicures at a place where you see them physically take the nail packets out of an autoclave (the device that sterilizes them). Now is not the time to skimp on nail care. The cheaper the place, the less they want to put into the cost of sterility. And if you don’t know how difficult it is to get rid of a fungus, here’s a pearl: over-the-counter topical nail solutions are only about 12% effective and less! And that is after you use it consistently for a year without painting your nails that entire time!!

Here’s an extra tip because I simply could not stop at 5!! Visit us if you have any type of foot pain that does not go away within a few days of TLC on your part. A chronic foot problem is so much harder to get rid of even with our help!

Remember, feet are our friends until they hurt! Let’s keep them on our good side!

Painful Lump In Your Arch? Could Be Plantar Fibromatosis

2009-11-02T04:00:00.000-08:00

Plantar Fibromatosis. Wow, that's a mouthful! What is it? A lump in your arch that is firm and doesn't move. They usually start out as a very small pea sized nodule that increases in size over time. Most people don't even notice them until they get big enough to be annoying in your shoes or when walking barefoot. They can happen to anyone, but are most commonly seen in middle-aged to older patients and are much more common in men than woman. It is also more common in the Caucasian population than other ethnicities.

Most people come into the office complaining of a painful lump in their arch and are very concerned it is cancer. It is actually just an exuberant growth in the plantar fascia (a.k.a. the ligament that holds up your arch) or extra fibrous tissue. We really don't know why they occur, but it is thought that some kind of trauma plays a role in the formation of the nodules. I often see them in pilots and runners who have constant repetitive trauma to this area. Family history is also a factor. As many as 50% of patient with plantar fibromas also have nodules in the palm of their hands known as Dupuytren's contractures. There has been some correlation with medications like beta-blockers and anti-seizure medications. One study even linked an excessive amount of vitamin C with fibrous disorders. Patients with a history of chronic liver problems, diabetes, seizures and alcohol abuse seem to have a higher rate of plantar fibromas.

Treatments vary, but fall into three categories:
1. Do nothing: the nodules are annoying but usually self-limiting. They do not grow indefinitely, so if you can put them down as life's minor annoyance, most patients choose to just leave them alone.
2. Conservative or Non-invasive: Vigorous stretching, accommodative orthotics, physical therapy, and topical transderamal Verapamil.
3. Surgery: injections with a corticosteroid can be helpful to decrease the inflammation around the nodule, but if they are large and painful; most go on to surgical excision.

What should you do? A personal question, that only you with the help of your doctor can answer. In my opinion, if the nodule is small, leave it alone. If it is increasing in size, then it should be addressed. If the nodule is of moderate size, with no intrasubstance calcifications on x-ray, and is annoying; a three to six month trial of transdermal verapamil coupled with an accommodative orthotic and physical therapy can be helpful. If it meets these criteria and is a little soft, then a steroid injection may also help decrease the size. If the lesion is large, painful, or has intrasubstance calcifications on x-ray; then excision is most likely your best option. Simple excision is not enough with these lesions, removal of not only the lesion, but a large margin is necessary to decrease recurrence rates.

If you have a painful lump in your arch, seek the advice of your podiatrist. Help is only a phone call or mouse-click away!

Here a Cankle, There a Cankle, Everywhere a Cankle Ankle?

2009-10-28T07:36:00.000-07:00

We’ve all heard the term “cankle” but do we really know what it means? Media harps on Hillary Clinton’s cankles and other famous celebrities such as Kelly Clarkson and Katherine Hepburn. Cankle is a non-medical slang word to describe the absence of a defined ankle. The calf seems to extend strait down into the foot. As if the word did not have enough body parts to over criticize, we have not moved on to obsess over the size and appearance of our ankles!

A cankle a fully functional ankle and the so called “deformity” has no medical relevance other than self-esteem issues. The cause of cankles is merely due to a focal increase in adipose tissue or fat. It is thus largely associated with overweight individuals, but it is also widely seen in those who are physically fit. There is always that one part of your body that is really hard slim down. While some focus on the abs, thighs, or arms, some athletic individuals have discovered their cankles to be the problems area when trying to slim down.

Did my mom give me cankles? There does seem to be a family predisposition for the cankle syndrome. Just as some families have big noses or wide ears, some people have the genes for fat ankles. There is no medical proof that supports these claims but ask any cankle syndrome survivor and they can tell you their heart filled story on how cankles has stricken their family to wearing long wide-legged pants.

With the recent cankle phenomenon sweeping the nation, gyms and plastic surgeon have developed workouts and treatments to maximize your ankle appearance. The trick with you working out your cankle is to burn fat and thus a high cardio regimen is essential in the work out plan. In addition, defining your leg muscle will also decrease the appearance of the large ankle. Many people admit that the gym does not bring them close to their wanted appearance and have thus taken the road of liposuction.

Podiatrists, foot and ankle surgeons, do not recognize cankle as a medical term but take an increase of ankle size as a very serious matter. If your ankles seem to increase in size throughout the day or you feel as though your lower leg is swelling, this may be a sign of a more serious condition. Cardiovascular, and lymphatic diseases can cause increase swelling in the ankles. Trauma or injuries to the ligaments of the joint can also cause local changes to the ankle.

The ankle is a very influential joint in ambulation and pain in this area should never be ignored. If you are worried your ankle size is secondary to a more serious issue, seeking medical attention is not unwarranted.

Got cankles? Be reassured that there are millions across the world battling the fatty ankle. Though you may feel like the only girl in the world who is self conscious about her ankle size, you are among many who avoid short skirts, high heels, and skinny jeans. You may want to discuss possible causes of edema in the lower extremities with your doctor if your ankle size has been increasing over time.

What is a "Sausage Toe"?

2009-09-22T12:56:00.000-07:00

A patient came in the other day with a swollen tip of her second toe. She also had a funny looking, thick toenail and really thought that was the cause of her pain and swelling. She related that she had been experiencing throbbing pain, redness and swelling for several months in just the tip of the toe. It had never spread or gotten much worse. She had never experienced drainage or infection symptoms around the toenail. She was unable to wear a closed in shoe and was to the point that she wanted her toe amputated. She had been treated with topical anti-fungals and antibiotics without much result. She was sent to me for another opinion after taking two months of oral anti-fungals and having no change in the nail or toe appearance. What a strange presentation….or is it?

Sausage toe is a whimsical term used to describe a red, hot swollen toe often seen in psoriatic arthritis. It can also be seen in Reiter’s syndrome and other seronegative arthropathies. In English, a non-rheumatoid type arthritis. Sausage toe is inflammation of the distal interphalangeal joints (tip of your toe and adjacent knuckle) that looks like a sausage or lollipop. In psoriatic arthritis, it is often accompanied by nail changes that mimic onychomycosis or a fungus in the nails. The nails can be pitted, yellow, thickened, fragmented, and lifting from the tip of the toe. Psoriatic arthritic can occur without the typical skin changes seen in psoriasis, but most patients have some skin lesions.

Sausage toes should be treated aggressively to decrease the inflammation and joint destruction. Long term inflammation can lead to erosive changes and permanent joint pain and stiffness. Joint ankylosis (complete fusion of the joint) can occur in severe cases. Basic treatment starts with nonsteroidal anti-inflammatory drugs, exercise, physical therapy and education. Patient should be taught the “move it or lose it” principal of arthritis management. Exercise and mobilization of the joints, but not overuse and abuse, should be reinforced. Some patients need more aggressive treatment, and this should be part of a comprehensive treatment plan by a rheumatologist.

Sausage toes should not be ignored. They can be caused by many factors such as trauma, infection, osteomyelitis (infection of the bone), and many different rheumatologic disorders as discussed. If you experience a painful, red, swollen toe that just seems to persist; seek the opinion of your podiatrist. Treated early, sausage toe can just be part of a whimsical story instead of a long term disability.

Why Do Some Younger People Get Arthritis in their Ankles?

2009-09-15T11:04:00.000-07:00

Younger patients can experience arthritis in their ankles. There is no age limit, young or old, for this painful disorder. Some people have arthritis caused by a systemic disorder like juvenile rheumatoid arthritis. Most have a more traumatic type of arthritis caused by an injury.

In the majority of younger patients with ankle arthritis, their arthritis is usually a secondary effect from too many ankle sprains. Most can relate a twisting type of injury which caused a deep cartilage injury that is often called osteochondritis dissicans. This has been seen to occur with no obvious trauma, but most can relate a history of severe sprain. Over time, the injured cartilage starts to deteriorate, then flake and finally many patients have bone on bone contact which is extremely painful.

Osteochondritis often causes significant pain, swelling and stiffness in the ankle. Patients come in several months after experiencing a bad sprain complaining of continued popping, instability, stiffness and pain. Some complain of severe discomfort, but most relate a chronic annoying ache.

Ankle sprains should not be ignored, because many lead to chronic instability and eventual arthritis. A physical examination by your podiatrist is usually followed by x-rays. If plain film x-rays are negative, and you have had pain for more than 2 months from an ankle sprain; an MRI is indicated to rule out a cartilage injury of the talar dome. This MRI can evaluate the cartilage of the talar dome for obvious flaps and for subchondral injury to the underlying bone. A chip fracture can be quite painful and feel like a clicking every time you move your ankle.

Conservative therapy for osteochondritis includes bracing, physical therapy, anti-inflammatories and rest. Many people do well with just conservative therapy and maintain their joints by working on their proprioception and strength.

Unfortunately, surgical intervention of ankle arthriscopy is often needed to remove the cartilage fragments and place tiny drill holes in the deficit to encourage the formation of fibrocartilage or scar tissue. Severe defects may require cartilage grafting.

So, for all you young sports stars out there: Remember that ignoring multiple ankle sprains and ankle instability is usually a prescription for long term arthritis. Osteochondiritis leads to good old fashion osteoarthritis. Arthritis pain can be treated with anti-inflammatories, bracing, and in severe cases; an ankle fusion of joint replacement. In the end, most people wish they had consulted their doctor for their ankle sprains early on and avoided long term arthritic pain.

My Big Toe Joint Hurts! The Arthritis You Never Knew!

2009-09-13T11:37:00.000-07:00

Have you ever suspected you have arthritis in your big toe joint? It is one of those conditions that slowly creeps up on you. You may be going about your business only to notice that your big toe joint hurts! You may end up limping around for an hour or even a few days and then it disappears only to reappear when you least expect it! What’s up with this? Well, it may be plain ol’arthitis!

Arthritis in the big toe (aka: hallux) joint is known as “Hallux Limitus” or Hallux Rigidus” depending on whether it the motion in your toe is limited or not moving at all (rigid). Basically, how much arthritis you have puts you in either one of those categories. So here it how it works. Over the years, all of your joints wear down to some extent. We start to lose the cartilage, (this is the stuff covering the bones at the joint so the joint can glide smoothly). Once we have worn down enough cartilage, the bones at the joint start making bone on bone contact instead of cartilage on cartilage contact, and this causes pain. This bone on bone rubbing is not as smooth either and it limits the amount of movement at the joint. This is arthritis. As the amount of arthritis in the joint increases, the amount of pain in that joint increases as well!

How does it all start? I tell my patient that simply stubbing your toe, which most of us have done at some point or other, can accelerate the wearing down process. Many times, arthritis in the big toe joint shows up in people with other foot conditions, such as bunions, or flat feet or high arched feet simply because of how our bones line up in the feet. If they are not perfectly aligned, that joint will wear down quicker because it was not meant to work in that position.

What can be done about the pain? Once you have been diagnosed, your podiatrist will be able to tell you just how severe the arthritis in your big toe joint is and treatment will be based on that. Treatment could include anti-inflammatories, custom inserts, physical therapy, shoe alterations, padding, cortisone injections, and in the worst of cases, surgery. That being said, the sooner you see us about your big toe pain, the quicker we can slow down the damage being done to that joint and keep you moving!

2009-09-08T08:12:00.000-07:00

My toes are starting to curl!!

I first noticed it when I wore a pair of heels the other night(that were maybe a little to pointy). I figured that the 2-3 hours that I wore them wouldn't kill me, but my goodness... By the end of night I had severe pain in my feet, right on the top of my toes.

Today I was looking at my toes and I noticed a small area of redness on the top of my toe right where it is starting to curl. It is sort of hard and painful to the touch, and truthfully a little ugly.. I think it is a corn.

If you are suffering from anything similar to this you may have hammertoes. Hammertoes are a contracture of a joint in the toes, that usually start off flexible and may progress to a more rigid deformity. The more rigid they become the more they will interfere with your ambulation and may lead to corns, or even worse an open sore.

What causes Hammertoes? Hammertoes are a mechanical imbalance of the tendons in the toes. The tendons on top of the foot gain control over other tendons and start to contract and curl your toes. Why does it happen?

1.Can be caused by biomechanics (your foot structure and the way you walk)
2.The wrong shoes (high heels, pointy shoes)
3.Neuromuscular condition
4.Broken toe or trauma to the toe (jamming)

Treatments for Hammertoes:

Treatments usually include accomodative padding, different shoe gear, trimming of corns, anti-inflammatories, injection therapy and surgery. Orthotic devices may also help control abnormal biomechanics.

If you are suffering from any of these symptoms talk to your podiatrist. There are many advances in the treatment of these silly toes!

2009-09-02T10:57:00.000-07:00

Toenail Disorders Due to Chemotherapy:

I am training to walk the Susan G Komen Breast Cancer Walk Dallas of 2009. During my training I have met a lot of great women. Some are walking as survivors, and others are walking because someone close to them is suffering from the disease, or have lost someone they love.

As you can probably imagine there is a lot of talking during these long training walks. I happen to be a podiatrist, so I commonly have people asking me questions about their feet, proper shoe gear, how to prevent injuries, and most commonly their toenails! Most will say they have either lost toenails or they have turned colors due to the chemotherapy.

Alot of the survivors agree that when undergoing chemo, most of the time they are not warned on what to expect their toenails to begin to look like. No one tells them that their toenails will most likely fall off, turn colors, get thick, have skin attached to them and possibly smell.

When undergoing Chemotherapy the drugs that are commonly used; (Adriamycin, Taxol, 5-Fluorouracil) cause damage and attack the tissue that keeps the toenail in place. This is called onycholysis. It is common for the nail to loose its attachment to the entire nail bed or sometimes only half of the nail bed. Either way when a nail looses its attachment it allows dermatophytes( the bugs that cause fungus) to get under the toenail, also known as onychomycosis.

Tips to Keeping your Toenails Looking There Very Best:

1. Clip toenails straight across and keep them short, this prevents splitting and breakage of the toenail.

2. Keep toenails clean and moisturized. If getting a pedicure make sure all instruments have been sterilized.

3.Cut away any loose cuticles, do not pick or pull at them. This can cause bleeding which can easily lead to an infection.

4. Try to avoid injuries to your toes and toenails, they will bruise easily. Wear wider shoes that have plenty of room in the toe box. Wider shoes will also allow for more circulation to the toes and toenails.

If your nails become infected, inflamed or painful you may need to see a doctor. There are some over the counter treatments that may be fine for your type of infection or you may need a doctor to prescribe a medication to help combat the problem. There are some very advanced treatments that are now available including topical treatments, oral pills and laser treatments.

“Mom, My Heels Hurt!”

2009-09-01T09:51:00.001-07:00

It is that time of year again. Returning to school and those extra curricular activities. Kids are excited about sports and band practice, but this sudden increase in activity can cause them to have heel pain. Pediatric heel pain is nothing to ignore. It is not your typical adult heel pain caused by plantar fasciitis and will not go away with advil alone. It can be excruciating for some children to the point they cannot walk. So what is it really and why does it happen?

Calcaneal apophysitis is the medical term for inflammation of the growth plate in the heel caused by the pull of the plantar fascia below it and the Achilles tendon above it. As we grow, the bones in the legs get longer, but the muscles and tendons have to stretch to grow with them. If these structures are tight and have not reached the same length as the bones, then they pull much harder on the growth plates. This causes significant pain that usually occurs after activity and improves with rest. Other symptoms including swelling of the heels, pain with pressure and increased warmth.

Treating pediatric heel pain early is important. In our office, youf child will be fully evaluated including xrays to make sure that the growth plate is normal and the pain is not caused from other reasons like a stress fracture. Rest, ice and stretching are key factors in treating heel pain in children. Appropriate shoe gear, orthotics and physical therapy will also improve their pain and reduce recurrence. In severe cases, complete immobilization may be necessary.

If your child is complaining of heel pain, don’t ignore it. This pain can prevent them from participating in the activities they enjoy. At Foot and Ankle Associates of North Texas, we are here to get your children back in the game.

Why are my feet hurting now?

2009-08-03T12:01:00.000-07:00

“I have never had a problem with my feet before. Why are they hurting now?” I have heard on so many occasions patients ask this question. I must admit, this is really a very good question! Why do your feet hurt now?

The easiest way I can get across to explain this phenomenon is that, unlike our teeth, which we make sure to brush several times a day, we completely and utterly seem to abuse our feet taking them completely for granted! We expect them to go on and on like the Energizer Bunny and never give out. Sure, we may moisturize them and pedicure them and soak them thinking this is how we are to care for them (and some of us do not even do that!). This does make them look on the outside and to a certain extent feel good. We also spend our years walking on them barefoot, without as much as a slipper for cushioning. We women strap strappy sandals and heels that force our feet to walk in no way God intended. Even if you don’t wear heels or strappy sandals, we too often put them into shoes with confined spaces and so very much UNlike the actual shape of our feet. This brand of torture does a whole lot of damage to the insides of our feet and ankles.

Now think about this. In our life time, we have walked around the earth several times!! That is a lot of mileage! Add the above mentioned abuse to our feet and Voila! Foot pain! I tell people we do more to take care of the tires on our cars than our own “tires”! No wonder at some point in our lives, we will all experience some form of foot pain! And when we do, oh, we will long for the days when we were able to walk without limping!

A reminder to all: Do not take your feet (or your podiatrist) for granted!! We will do all we can to get you dancing again. We only ask that you take our advice to help you take better care of those feet! You have so many more miles to go!!

Am I Ready for Surgery Yet?

2009-08-03T10:26:00.000-07:00

Am I ready for surgery yet? Seems like such an easy question to answer huh? Actually, unless it is something obvious like getting your foot stuck in a lawn mower or shattering your ankle putting up Christmas lights, this question is a little more challenging.

Some important questions to ask yourself:
Do I have pain nearly on a daily basis? Having pain more often than not is a red flag. If your answer is yes, that doesn’t necessarily mean you need surgery, but it does mean you may have let your condition drag out longer in hopes that it would get better on its own.
Is it difficult to find shoes that are comfortable? This is a “biggie” if the only shoes you can wear is a sandal and fall is quickly approaching!
Am I unable to perform my day to day activities because of the pain? A good example of this, and one I hear often, is not being able to exercise because of the pain. The lack of exercising causes weight gain and your foot or ankle pain gets worse because of it!
Have you ever seen anyone about your pain? It is surprising to me how many people I see on their first visit wondering when they can be scheduled for surgery without their ever having seen a podiatrist! Have you seen a podiatrist yet to even be evaluated? If you think you are ready, that is a most important step (no pun intended!). There are a number of conditions that we can treat conservatively. We will be able to tell you how serious your condition is and whether or not you can hold off from doing anything as drastic as surgery.
Is my pain severe enough that I am willing to risk the potential post-operative complications to have a chance of relief? This may be the hardest question to answer. There is no guarantee when it comes to surgery. You have to be willing to accept the risks involved. After you have run the gamut of conservative treatment options with your podiatrist and understand not only what your surgery would entail, but also what complications could occur post operatively, hopefully, this question will be easier to answer.

Unfortunately, we abuse our feet to no end. When they start to hurt, we should not ignore them hoping it will all go away. That is like hoping that cavity in your tooth will magically heal itself! The real message here is getting to your podiatrist before things get this bad.

Be assured that if surgery becomes our only answer, our goals for surgery are the same. We want to eliminate pain. We want to restore function. Simply stated, we want to make your feet happy again!

When is a Bunion Not a Bunion?

2009-06-26T04:18:00.000-07:00

It happened again today in my office. A woman came in asking for bunion surgery. She had put up with the pain in her big toe for years and finally had had enough. Many years ago her family physician told her to wait until she couldn’t stand the pain in her foot before discussing surgery with a podiatrist. Like many physicians, she assumed any pain in the great toe accompanied by a bump was a “bunion” or Hallux Abducto Valgus. Unfortunately in this case, she was wrong. The patient actually has Hallux Limitis also known as osteoarthritis of the great toe joint. If she had sought treatment many years ago, her joint may have been salvaged. Now her joint was so destroyed that she needed a joint replacement or fusion. Not what she wanted to hear! In her mind, she came in the office asking for a simple bunionectomy and left needing a joint replacement. She regretted not seeking the advice of a podiatrist earlier.

So what’s the difference between Hallux valgus and Hallux limitis?

Hallux valgus is a crooked big toe joint. Over a period of years, the great toe becomes much friendlier with the second toe and drifts toward and eventually under or over the second toe. At the same time, the first metatarsal (long bone connected to the great toe) drifts towards the center of your body making the distinctive bump. This starts out as a minor annoyance, but then quickly becomes a shoe problem with rubbing on the bump. Most people seek the attention of a podiatrist when the bump is rubbing in their shoe and becomes painful. If the deformity is allowed to progress, the great toe joint can actually start to dislocate and you will start to experience joint pain and degeneration.

Hallux limitis is wear and tear arthritis or osteoarthritis of the great toe joint. Many people are predisposed to have this problem by the underlying biomechanical function of their joint. It becomes much worse after an injury or repetitive trauma from things like high heeled shoes, ballet or some sports. The symptoms are different than Hallux valgus. Hallux limitis usually starts with a feeling of stiffness of the joint. It can be accompanied by swelling and redness. This usually progresses to a decrease in range of motion, a distinctive crunching feeling when moving the joint and then a bump that forms usually more toward the top of the joint, not the side like Hallux valgus.

Hallux valgus and Hallux limitis can occur together in a more complex foot deformity. Usually the bunion deformity has progressed and then is injured by repetitive trauma or a distinctive injury. This starts the progression of the arthritis change. Bottom line: don’t ignore pain in your great toe joint. Treatment of Hallux limitis early can save you from needed a fusion or joint replacement!

Why is treatment of Hallux limitis so important in the early stages?
Once you have destroyed the cartilage in your joint, there is nothing a physician or surgeon can do to make more cartilage. Research is underway trying to replace or regrow cartilage, but we are many years from a solution. Hallux limitis in the early stages can be controlled with a functional shoe orthotic to control the biomechanics. A clean up procedure known as a cheilectomy can help remove all the debris from the joint and get rid of much of the crunching. This will slow down the progression. Some patients can really benefit from a surgical procedure to realign and shorten the metatarsal to give the joint better biomechanics and more joint space. Unaddressed Hallux limitis leads to complete joint destruction and the need for a fusion or joint replacement.

The flip side to this story is that patients with Hallux valgus or your tradition bunion can often delay treatment until they start to have pain. Bunions in the early stages are a cosmetic concern, but the joint is usually not damaged until the later stages. It is important to address Hallux valgus when it starts to hurt so the joint is not permanently injured, but a bump, in the absence, of pain can wait.

The take home message is to have your great toe pain examined by a podiatrist. A full examination including functional biomechanics and x-rays can determine whether your pain is from Hallux valgus, Hallux limitis or a combination. Only then can you make an informed decision on treatments for your foot deformity and pain. Waiting until you can’t stand it anymore is a recipe for unhappy outcomes! If you have great toe pain with or without a bump, don’t delay. See your podiatrist today!

Albert Pujols Twists His Ankle

2009-06-02T07:45:00.000-07:00

“Ouch!” Did you see the replay of Albert Pujols twisting his ankle sliding into base? It actually looked much worse than it was in the instant replay. Looked terrible, but he toughed it out and stayed in the game. Boy, did it look like he was going to be in pain this morning! Over and over they played the tape on Sports Center!

What should you do if this happens to you or your child athlete? The trainer from the Cardinals was immediately evaluating Pujols, but most of us don’t have a trainer on standby!

If you have an ankle sprain, you should be evaluated by a sports medicine podiatric foot and ankle surgeon if you have localized pain, swelling and bruising, as well as inability to walk more than 5-7 steps comfortably. Many a foot fracture has been missed in the emergency room when x-rays were taken only of the ankle and not the foot. The fifth metatarsal is often broken with the same mechanism of injury of an ankle sprain, so the foot should be evaluated as well. If severe ligament injury is suspected, an MRI can evaluate the grade of injury. This is really what decides whether surgery is needed for full recovery.

Treatment for ankle sprains really depends on the degree of severity, which can only be determined by your doctor. Initial treatment always includes “R-I-C-E” therapy – Rest, Ice, Compression, and Elevation. Pain and edema is usually controlled with NSAID’s (non-steroidal anti-inflammatories) like ibuprofen. Bracing or casting coupled with non-weightbearing on crutches may be needed in more severe injuries to rest and stabilize the ankle while it heals. Return to pain-free ROM(What is ROM?) and stability is the goal. Surgery is only recommended in Grade 3 severe injuries in athletes or in those patients who have had multiple ankle sprains and suffer from chronic ankle instability. Long-term ankle instability can often be avoided with an aggressive physical therapy program. Bracing should only be used in the short-term during rehabilitation because long-term bracing actually causes atrophy and decreased ROM.

Physical therapy is needed for all ankle sprains. The goals of physical therapy should be to regain full ROM, strength and proprioception (where your brain thinks your ankle is in space). Regaining strength in the peroneal tendons as well as overall balance training are the keys to successful rehabilitation of an ankle sprain. A maintenance program of ankle strengthening, stretching, and proprioception exercises helps to decrease the risk of future ankle sprains, particularly in individuals with a history of multiple ankle sprains or of chronic instability.

Bottom line: if you happen to fall down and go “Boom”, have your ankle sprain evaluated by a podiatric foot and ankle surgeon. Delaying treatment and rehabilitation can lead to life-long instability.

For more information on ankle sprains and chronic instability, click here.

Could it be Ringworm?

2009-06-01T08:11:00.000-07:00

Rest easy, Ringworm is an infection of the skin caused by Fungus, not by actual worms. The types of fungi that cause ringworm are found on the superficial (top) layers of the skin. They grow best in warm, moist areas, such as locker rooms, swimming pools and in skin folds.

Ringworm is contagious, and spreads easily through skin to skin contact. It can also spread when you share towels, clothing, or sports equipment.

How do I know if it is Ringworm?

Symptoms of Ringworm usually include a very red itchy rash, it often makes the patttern of a ring. Your skin may be dry, scaly, and thickened in the areas of the rash. Ringworm of the feet may present between the toes and at the soles of the feet.

How is Ringworm treated?
Most times ringworm can be treated with a topical medicine (anti-fungal cream) that you can buy over the counter without a perscription. Make sure you use the cream till the rash is completly gone or you risk the rash coming back. It will take up to 2 weeks for the rash to clear up. If you do not treat the ringworm your skin could blister, have open sores and become infected with bacteria. If this happens you will need antibiotics.

Prevention of Ringworm:
Avoid walking barefoot in locker rooms and near swimming pools
Wash your hands often
Dont share pool towels with your friends
Wash clothes in hot water with fungicidal soap if suspected exposure occurs

If for some reason your rash does not go away with the use of the cream, medical attention is necessary.

Dr. Giacalone Ponders Summer Shoes

2009-05-18T15:09:00.000-07:00

Well, even your podiatrist isn’t immune to wanting and wearing those adorable, not-so-good-for-you shoes! This weekend I purchased a very comfortable pair of Fit Flops and of course, true to my style, covered with sequence. But I realized during my searching for summer shoes that I have an unfair advantage over the average shopper. I know what is good for my feet, what is not and what I can get away with.

So which shoes are good for you? All shoes with a thick supportive sole, full top and back or large strap over the arch will keep you from toe gripping while you walk. This reduces foot fatigue and will keep things like heel pain and ball of foot pain from occurring. If you are flat footed, you’ll want something with good arch support and a stiffer sole. If you have a high arch, think arch support, but a little softer. You need the shock absorption. For summer shoes, the best option is a sandal that has a strap over the arch and behind the heel. And don’t forget tennis shoes for activities requiring a lot of walking.

So what should you avoid? Obviously the new 7 inch heels are out! And the ballet slippers need to be passed by as well. Any heel height over 2 inches causes increased pressure to the ball of the foot leading to things like metatarsalgia and neuromas. They also shorten the Achilles tendon which can result in Achilles tendonitis. The ballet slippers are glorified socks. And when was the last time you went shopping in your socks alone?

So what about flip flops? Well, these fall into the “what can I get away with” category. Most of the time, you will hear us say, “don’t wear them”. But we know you are going to and here’s the reason we don’t like them. The only way you can keep a flip flop on your foot is to grip your big toe and second toe together. This is not natural and causes the smaller muscles in your foot to work harder leading to foot fatigue, arch strain and overall foot pain. For those with flat feet, they also cause the large tendon on the inside of your ankle to work harder as well, leading to posterior tibial tendonitis and ankle pain. If you have bunions, wearing flip flops on a regular basis only emphasizes the forces that can make the deformity worse. The thing about flip flops and any other shoe that may not be good for you is to think minimalist. Wear them only once a week or special occasions. And if the shoe hurts as soon as you put it on, don’t try to break it in. It should be comfortable from the very beginning.

If you are not sure what foot type you have or what shoes are good for you, our Certified Pedorthist, Janet Dixon is available to help you. She is located at Healthy Steps DFW and is available for one on one assistance with appointment or walk in. But if you are having any foot pain, our physicians would be happy to evaluate your condition and help get you back to summer fun.

Is Yoga Bad For My Feet?

2009-05-05T07:06:00.000-07:00

I have always been curious about yoga. I have tried every possible form of exercise in my quest to find the perfect one for me (alas, I am still searching; aren’t we all?). The one form that I avoided was yoga. My mother was the one who finally convinced me to give it a try. She swore it to be the perfect form of exercise and swore it was relaxing at the same time! An oxymoron, I know!!

I avoided yoga because yoga is performed barefoot and the poses, I imagined, could put a great deal of stress on them. I could only imagine! The curse of being a podiatrist!! Seriously though, my curiosity was such that I had to see for myself just how much twisting and torque was involved.

On my first class, I used the thick mats provided by my gym. It had to be better than the flimsy mats some of the other people were coming in with right? Needless to say, I need to work on my core because I was working really hard to keep my balance and could not concentrate to keep the stretch! And I can tell you for a fact that the thicker the mat, the harder the tendons and ligaments in your feet are working along with your balance to keep you in check. It is very easy to develop a tendonitis or a muscle strain doing the required poses on a thick mat. So yes, the flimsy thin mats are better! Invest in the yoga mat if you have had a tendon or ligament injury or are prone to getting one. People with “extreme” foot types, the flatter foot type or the super high arch type are more prone to these potential yoga-induced tendon/ligament injuries.

The next week I bought this yoga mat. It is “stickier” so your feet do not have to grip as much and much thinner so you have better control of your movements. Over all, much less strain and stress. This is a trade off. If you have joint problems, the thinner mat could aggravate your pain just by the fact that there is less to cushion an aching joint. On the flip side, it can also aggravate tendon and ligament injuries for the same reason.

Beyond the mat are the poses. There are some pretty severe hyper extensions and pressure points going on here! Those “downward dogs” and “half-moons” and don’t get me started on some of the other ones I am no where near perfecting! Not for the light-footed! I can see how easy it is to cause some serious over-use injuries.

The conclusion to my curiosity is that you do not enter a yoga class thinking it will be easy because it doesn’t involve rapid movements. It needs to be approached as one would any exercise. Build your way into it slowly if you do not have foot problems to see if your feet can tolerate what is required of them. Modify the position of your feet if what the teacher is doing to her feet just doesn’t feel right to yours. I do not recommend the “standing” or “inversion” yoga poses to those of you who are trying to recover from a foot injury even though it is “non-impact” simply because of the lack of support it places. That being said, as resistant as I was to try it, I must say that, though it is not my “nirvana” form of exercise, it is now not one I will easily give up either! I have found harmony with yoga and my feet after all!

2009-04-22T09:39:00.000-07:00

Be Careful of Those Spiders, They Are Not as Innocent as They Look.

Spring is here, the weather is warming up and we are finally able to wear those cute open toe sandals. With that being said, there are some new concerns to be aware of. All of the creepy crawlers that have been sleeping the winter months away are coming out of their favorite hiding places and we are all at risk for bug bites.

Brown Reculse Spiders are one of the more common spiders in the South part of Texas. They are yellowish-tan to dark brown in color, about the size of a half dollar. They measure around a half-inch in length.

The most common times for these spiders to bite are in the Summer Months. Spiders prefer dark, dry, undisturbed locations to live. Think garages, basements, under rocks, in piles of wood, and the attic.

How do I know if I was Bitten by a Spider? Or maybe it was just a Mosquito...

One of the first ways to tell if it was an actual spider bite:

1)It will be very painful, and the pain will not go away.

2)A central Blister may form around the bite site. The skin will often blanch(turn white in color) around the blister and the skin around that will become very red and irritated.

3)The redness will not be symmetric. We call this the "RED, WHITE, BLUE" sign. It is an excellent way of identifying a recluse spider bite.

What should I do if I think I was Bitten by a Spider?

1)Avoid exercise and avoid heat. Heat will spread the venom faster.
2)Elevation of the extremity.
3)Cold Compress
4)Cleansing of the wound
5)Topical and Oral antibiotics
6)Simple analgesics (tylenol for the pain)
7)Steroids

Typically these spider bites will heal in 1-3 weeks and the pain will usually reside in one week but, it is important to have the bite looked at by a professional. There have been studies that have shown these spider bites can cause necrosis of the skin, fever, nausea, and even renal failure. The best treatment is to avoid getting bitten at all. Learn to recognize the spider, patient awareness is the primary factor in making the correct diagnosis and forming an appropriate treatment plan.

Are Your Kid's Shoes Making Their Feet Deformed?

2009-03-25T11:00:00.000-07:00

Children's Shoes Are Too Small and Causing Deformities, a New Study Finds

A new study of 250 children in Switzerland presented by the American Academy of Orthopaedic Surgeons (AAOS) found that a vast majority of young children are wearing shoes that are too small, increasing the risk of foot deformities. "The most striking finding was that more than 90 percent of children's shoes were too small," says Norman Espinosa, MD an orthopaedic surgeon at the University of Zurich. Overly-tight shoes are the leading cause of Hallux Valgus, a condition that occurs when the big toe begins to angle sideways in the direction of the second toe, causing a bump or bunion on the side of the foot.

For more information on juvenile Hallux valgus click here.

I Have a Neuroma.. Do I Need Surgery?

2009-03-24T06:58:00.000-07:00

Neuromas can be very Irritating and Painful. A neuroma can prevent you from wanting to walk around and be active, and with summer around the corner who wants that?

Most of the time a neuroma will cause you to feel like you are walking on a pebble. It may cause shooting pain and tingling to the ball of your foot as well as to your toes, you may even experience numbness in your toes. Others might complain that it feels like they are walking on a rolled up sock in their shoes. All of these symptoms can be signs that you are suffering from a neuroma....
So what can we do to get rid of a neuroma??

There are many treatment options for neuromas.

1) Because neuromas are an inflammation and irritation of a nerve commonly from the bones in your feet, an injection into the area of the nerve can be helpful. It will calm down the inflammation and allow the nerve to become less irritated = less pain.

2) Accomodative Padding is another great option, by taking the pressure off the bones that are causing the nerve to become irritated, the nerve is able to relax and heal.

3) Custom Orthotics are another great treatment option. Nobody has a perfect foot and most people really will beefit from a custom device. An orthotic made specifically for your foot will allow a doctor to offload any areas in your foot that may be taking to much pressure.

4) Surgery is always an option once all conservative measures have been exhausted. Most of the time we are able to give patients a lot of relief from the other options listed above.

To learn more about neuromas click here.

Obesity Linked to Earlier Death!

2009-03-18T04:14:00.000-07:00

Obesity has been show to shorten your life! New study shows similar effect as smoking on longevity

Obesity causes kidney disease, liver disease and several types of cancer, but the most common way it kills is by causing stroke and, most importantly, heart disease. Obesity causes heart disease by elevating blood pressure, by interfering with blood cholesterol levels, and by bringing on diabetes.

BMI is a calculation that expresses a relationship between height and weight. People are considered underweight if their BMI is less than 18.5, normal weight when the BMI is between 18.5 and 24.9, overweight when BMI is between 25 and 29.9, and obese when BMI is 30 or more, according to the U.S. National Heart, Lung, and Blood Institute.

People who are moderately obese with a BMI (body mass index) in the 30 to 35 range reduced their life span by two and four years. For those who are severely obese with BMIs between 40 and 45, their life span was reduced by eight to 10 years. That's very similar to the effects of smoking.

Of course, I would think that this a is a no-brainer! The fatter you are, the more likely you will die from chronic disease. This is common sense, but for all those peolpe in complete denial in the drive through at McDonalds, here is your wake up call!

Complete article is a must read!

Encourage your friends and family to start exercising and decrease their BMI! Add a few years to their life!

State-of-the-Art Treatments For Foot Pain

2009-03-11T12:45:00.000-07:00

Let me start with the fact that foot pain is NEVER normal. If your feet or ankles hurt, there is usually a reason. Some common reasons may include poor shoes, infections, injuries or strained or torn tendons or ligaments. Understanding and fixing the cause of the pain, or making adjustments to alleviate the pain over time is often possible. What I want to discuss is a new treatment that allows correction of pain that is not alleviated through standard treatments.

Topaz Radiocoblation/Microdebridement treatment is a minimally invasive surgical procedure utilized to treat chronic foot pain from tendon or ligament abnormalities. For years, chronic pain to tendons or ligaments that didn't resolve with conservative treatments including rest, stretching, bracing, oral or topical medicine or injections often lead to aggressive surgical procedures with long periods of recovery.

Topaz Radiocoblation now provides a minimally invasive procedure that won't compromise the mechanical structures of the foot caused by traditional surgical techniques. Recovery is also quick and easy without the need for splints, casts, walking boots or physical therapy. In fact, a patient will usually return to shoes within 4-5 days, often with significant improvement of pain.

Topaz Radiocoblation is performed either through small incisions or through small "pin holes" (percutaneous) and often allows rapid return to regular shoegear and activities. This procedure utilizes a small wand that produces radiofrequency waves within the tendon or ligament to stimulate new blood vessel formation (neoangiogenesis), migration of growth factors, decreased inflammation, decreased pain and ligamentous or tendinous repair. This procedure is commonly performed on plantar fasciitis, peroneal tendonitis or Achilles tendonitis, and has been shown to be 80-90% effective at resolving pain from these entities.

The effectiveness of this procedure can also be improved through the addition of platelet-rich plasma injected locally. During the procedure, a small amount of blood can be drawn from the patient and concentrated to allow a large combination of proteins, growth factors, platelets and healing cells to be directly injected in treated tendons or ligaments to further speed the recovery process.

Platelet-rich plasma or PRP has been utilized for years to treat wounds and stimulate healing in areas that were previously difficult to heal. By adding this treatment to the already effective Topaz procedure, the probability of healing increases to 90% or above.

Theses results were not possible with previous treatment modalities.Although these treatments are state-of-the-art when it comes to foot pain treatment, they have been used for years by orthopedic surgeons in treating tendons elsewhere. They likewise found good success with these treatments.

So remember, your pain is not normal. You don't have to continue to suffer with foot pain, even when previous conservative treatments have failed. You now have a new technique to alleviate your pain and return you more quickly back to regular activities. You deserve to walk without pain. You deserve the opportunity to continue to enjoy life.

How Long till I Heal Doc?

2009-02-24T07:01:00.000-08:00

This is the age old question isn’t it? “Doc, so how long will it take for this thing to heal?”
Where to begin on this seemingly so easy a question? There are sooooo many factors to take into consideration. This explains why you will hear doctors say “on average…” or “typically…”. We know from experience, and what we’ve read in the mountains of medical literature, when things are suppose to heal. This is the easy part. Here is a very short list of when certain body parts heal:

Bone: 6-8 weeks
Tendons: 3-4 weeks
Ligaments: 3-4 weeks
Stitches: top of foot or leg: 2 weeks, bottom of the foot: 3 weeks

Simple huh! Now for the fun part; we add the human factor to the equation and suddenly, all this simplicity flies out the window! What most patients don’t understand is why they may not fall into these criteria! There is a LAUNDRY list of the reasons why things don’t heal when they should and the number ONE reason things don’t heal when they should is that many patients (yes, I could be talking to you!) say they are listening but they are not doing what they are told to do to get them better! They cheat! Not a lot (though there is that distinguished class of patients who do!), but just a little bit! Yes, that little bit over the weeks it could take sets you back even more weeks! I have heard every excuse in the book as to why people couldn’t follow through with what I asked from them and believe me sometimes there is good reason. But all too often the reason is not all that worthy. A sampling of my favorites so far: “I walked around school in a regular shoe because the boot is ugly, but I was really good at wearing it around the house!” or “I know you told me not to, but I walked on it because I just wanted to see if it was getting better and now it hurts worse!”

Let’s keep it real. There is no guarantee that anything will heal at all much less in the intended time frame. But by not following instructions, you are just plain sabotaging your healing. We are a very small part of the healing equation. YOU MUST DO YOUR PART! Regardless of the reasons why you think you can’t, if you don’t, it will take you longer to get back to doing what you want to do in the first place! Do your part and at least give your body the chance it needs to work the miracle of healing. It really is trying and us “Docs” are really trying too!

Got Toenail Fungus? Laser Can Help!

2009-02-15T14:59:00.000-08:00

My nails are thick, yellow and seem to have something growing underneath them. I’m not a dirty person, how did this happen?

Toe nail fungus strikes across class, ethnic, age and hygiene lines. In fact, one study showed that almost 50% of people over the age of 40 have experienced some type of toenail fungus. Fungal infections are incredibly common, but are more prevalent in athletes (due to toenail trauma) and the infirmed (due to a decreased immune response).

The typical athlete’s foot fungus, called a dermatophyte, is the same fungus that infects your toenails. Fungus loves a moist, dark environment like in your shoes, between your toes. The affected toenails can have a whitish superficial infection or a yellow to brown discoloration under the toenails that seems to destroy the nail as it grows. Long standing fungal toenail look like thick, brownish-yellow mountains growing on the end of your toes. The thickness makes them painful and susceptible to a secondary bacterial infection (paronychia). This infection can be quite dangerous and has been linked to gangrene in diabetics.

How is toenail fungus diagnosed? Diagnosis of onychomycosis can only be made by a toenail biopsy. Your podiatrist can take a small piece of the leading nail and send it for a special stain that shows the fungus. A PAS stain is usually faster and more accurate than a fungal culture, because often the fungus does not grow in the laboratory. Do not assume you have onychomycosis. Psoriasis and other skin disorders as well as chronic trauma can look like fungus. Also, a melanoma under the nails can mimic fungus, but can be deadly if there is a delay in diagnosis. If you suspect you have toenail fungus, don’t delay, see your podiatrist today!

How can I prevent toenail fungus?
1. If you get regular pedicures, bring your own instruments or go to a spa that sterilizes their instruments in an autoclave (like our spa, Health Steps).
2. Clean your toenail clippers with alcohol before you use them if you do your own toenails and make sure to replace Emory boards and orange sticks regularly.
3. We also recommend you regularly clean your shoes with either antibacterial spray like Lysol or even better an antibacterial with an antifungal like Mycomist at least once a month and dry them with a hairdryer.
4. Changing socks regularly (even a few times a day if you have sweaty feet) and keeping your feet clean and dry is also helpful.
5. Keep your athletic shoes dry and also change them regularly. If you exercise regularly, buy your athletic shoes a half size larger than your street shoes so you won’t bash your toenails as your feet swell with exercise.

How is toenail fungus treated? There is a lot of misinformation out there about toenail fungus. I have never told my patients to use white iodine, Vic’s Vaporub or organic cornmeal soaks on their toes. There is no evidence that it works.

Topical therapy should have some penetration of the nail plate like Formula 3 (my favorite), organic tetre oil, Nailstat or prescription (now generic Penlac) ciclopirox nail lacquer. This should be coupled with a nail treatment plan from your podiatrist.

If this doesn’t work after several months, oral medication, like terbinafine (generic Lamisil) or itraconazole (generic Sporonox) may be needed, but these have serious side effects.

There is now a new option for treatment that includes a painless laser procedure to kill the fungus in the toenail with usually one treatment! Think about it, one 30 minute treatment by a painless laser and 6 to 9 months later, the toenails have grown out normal! Too bad we can’t figure out how to make them grow faster! The new PinPointe FootLaser has given us a much better treatment option for eradicating toenail fungus. Unfortunately most insurance companies deem it cosmetic so they don’t cover it, but if you think about all the hassles, copays and the risk of side effects; the toenail laser looks like the best option for most patients.

Remember, no matter how you treat fungal toenails, it takes at least 6 to 12 months for the toenails to grow out completely. Relapse is also common, so it’s important to play offense (treat the fungus) and defense (try to prevent the fungus) at the same time.

Casting a Severe Ankle Sprain Yields Better Results!

2009-02-12T16:25:00.000-08:00

Alert the Media! A below knee cast was seen to provide better and faster results than a removable walking cast or ace bandage in severe ankle sprains! Duh! You can't take off a cast and it forces you to be compliant. Most of our patients want to be compliant but life gets in the way. Ten days in a cast rapidly improves short term outcomes......what will they report next? That physical therapy imporves long-term outcomes? Who funds these studies? Can I get some of their money to prove common sense? Just kidding......

For complete article: click here
Primary source: The LancetSource reference:Lamb SE, et al "Mechanical supports for acute, severe ankle sprain: A pragmatic, multicentre, randomized controlled trial" Lancet 2009; 373: 575-581. Additional source: The LancetSource reference:Hertel J "Immobilization for acute severe ankle sprain" Lancet 2009; 373: 524-526.

Short version:

Severe ankle sprains healed significantly more quickly with a below-knee cast or air-cell brace compared with a Bledsoe boot or a tubular compression bandage, investigators here reported.

The 10-day below-knee cast and the Aircast resulted in 8% to 9% improvement in the quality of 90-day recovery compared with a tubular compression bandage, Sarah Lamb, D.Phil., of the University of Warwick, and colleagues reported in the Feb. 14 issue of The Lancet.

The degree of improvement with the Bledsoe boot did not differ significantly from that of the tubular compression bandage, which was the least effective device.

The quality of recovery at nine months did not differ among the four devices.

"Contrary to popular clinical opinion, a period of immobilization was the most effective strategy for promoting rapid recovery," the authors said. "This was achieved best by the application of a below-knee cast. The Aircast brace was a suitable alternative to below-knee casts."

"Results for the Bledsoe boot were disappointing, especially in view of the substantial additional cost of this device," they added. "Tubular compression bandage, which is currently the most commonly used of all the supports investigated, was, consistently, the worst treatment."

Severe ankle injuries (grade II-III) can cause significant incapacitation and require three to nine months for recovery in most affected individuals, the authors noted. Systematic reviews have revealed lack of high-quality evidence to aid clinical decision-making related to management of severe ankle injuries.

For more information on the treatment of ankle sprains, click here

Are Crocs Good For Your Feet?

2009-01-06T14:34:00.000-08:00

Are Crocs Good For Your Feet?

What's with these Crocs? If you are a shoe watcher like me, you may have noticed an interesting new trend. Crocs! They are a very interesting shoe that comes in almost every color and size. Everyone from toddlers to grandparents is cruising around in this flashy, foamy, footwear. You can even buy decorations for your crocs if getting them in hot pink is not enough. Though these appear very comfy, how do they rate for your feet?

There is actually a special line of Crocs for the medical profession, Crocs Rx. These are made with better material and have more support than the average Croc. They were especially designed for people with common foot ailments. They have a wide toe and firm support! These shoes are a great substitute for your slippers, garden shoes, or even your everyday shoes. They are made with deeper insole that allows for a comfortable fit with your orthotics. Crocs Rx are especially useful for diabetics because they have a wide toe and some have built-in antimicrobial properties. Crocs Rx can actually provide better support than some of your high end athletic shoes. Before you go out and buy your new pair of Crocs, make sure you are buying the Rx line. Crocs are only available through the medical community. You may find them at some pharmacies, and podiatric medical offices.

Always check with your podiatric physician to find out if this footwear is appropriate for your foot type. Like any shoe, it is not good to wear the same shoe every day. A major benefit of these shoes is its ability to fit comfortably with an orthotic insert. This is important because many people have these custom inserts but can not put them in any shoe besides their sneakers. You should be very selective with type of inserts you are putting into your shoes because no foot is created equal.

Your podiatric physician can also assist you in finding the correct orthotic device and can also make you a custom orthotic. These custom inserts are different than the over-the-counter ones. Custom inserts control the way you walk, thus aligning all the joints in the foot as well as the lower extremity. Over-the-counter inserts are just cushions and do not control your feet while you are walking. If all you need is a cushion, then the inserts found in stores might just be good enough for you.

So if you are looking for shoe that is convenient and fun, but do not want to sacrifice comfort, Crocs Rx may the new shoe for you! It's trendy and podiatrist approved!

Got The Ball of Foot Pain Blues?

2009-01-06T07:03:00.000-08:00

I’ve got the ball of foot pain blues! I really do! I have had them for over a year now and it is time to come out and share with you all why things like this happen and what keeps me pain- free and happy!

Pain under the ball the foot is known as “Metatarsalgia” in the podiatry world. Where your pain is under the ball the foot makes a big difference on what your problem in particular could be. Mine happens to be underneath where my second toe, next to the big toe, attaches to the ball the foot. This seems to be a pretty common area. The reasons for things hurting in this area are either because you have toes that are bent (hammertoes) which put pressure under the ball the foot (not my problem); you have a lot of flexibility in the front part of the foot (the forefoot) which puts increased pressure under this area (not my problem); you have a bunion which makes your foot unstable, putting pressure under the ball the foot were the second toe attaches (not my problem); you have a whopper callus underneath the ball of the foot (not my problem); you have a fracture from some injury (not my problem) or you've done some pounding, hopping, or other “impact” type exercises for some time (BINGO for me!). But enough about why I got pain in this area and let's move on to why you could have pain in other areas under the ball the foot. Well, it just so happens that pain in any area under the ball of the foot can be caused by any of the above-mentioned reasons! And for the most part, every reason mentioned above, other than the direct impact or other injury, is because of the type of foot you were born with!

The good news is, you can go back to having a pain-free life like I have by seeing a podiatrist (how convenient for me)! My self-treatment was a concoction of a custom-made orthotic with padding in the right places, physical therapy and toning down the impact exercises for while. Oh, and no way on the high heels! Do not wait too long to have your foot checked out or the dreaded cortisone injection or, heaven forbid, surgery may be inevitable! I haven't had to go there in over a year now and I don't expect to anytime soon. In fact, now that I think about it, I haven't been singing the blues for while! Another reason why I love my profession!

Safe Pedicures A Must!!

2008-12-28T08:38:00.000-08:00

Turns out that Healthy Steps is not unique any more. A podiatrist in Virginia is offering his patients spa services as well!! I love it...maybe we'll save a few lives and lots of pretty toes :) To read the entire article about "The Foot and Hand Spa" or to make an appointment with Healthy Steps click here! If you need more convincing, read Dr Crane's article on Safe Pedicures!!

Cowboy's Marion Barber Out From a Pinky Toe Injury!

2008-12-07T06:26:00.000-08:00

Marion Barber dislocated his right little toe in the first half against Seattle on Nov. 27 and did not practice all week. He did not join the team for the trip to Pittsburgh on Saturday, so he is out for the game. All from a toe???? What's with the Cowboys? First Tony Romo is out with a pinky finger then Barber with a pinky toe!! Are they wimps?? What happened to being a tough football player?

In all seriousness, a pinky toe injury can really hamper the running style of a running back. And, if you have ever broken your pinky toe; you know that it is almost impossible to wear a shoe comfortably. Toe dislocation with or without an accompanying fracture can take 4 to 8 weeks to heal. The treatment is to strap the toe to the next one and immobilize the foot. Very rarely do these need surgery and the worst case scenario is a painful corn developing from the enlarged toe. Life goes on.

So, if my patients can survive broken and dislocated toe, why can't Marion Barber play? It's cold in Pittsburgh and his toe would be numb anyway!!

Preventing Foot and Ankle Pain From Winter Court Sports

2008-11-29T09:14:00.000-08:00

No wonder our feet and ankles hurt! With the pounding and movements that feet, ankles and the Achilles and other tendons around the ankle endure, court sports such as basketball, racquetball and tennis present unique problems for athletes, whether they’re professionals or weekend warriors. But preparation and common sense go a long way toward prevention.

Hard surfaces and sports calling for fast, lateral movements are two characteristics of indoor sports that can contribute to injuries. One of the most frequently encountered court injuries is the common ankle sprain, due to the lateral aspect of those sports and, especially in basketball, the potential for stepping on a competitor’s foot.

Other court injuries are more shock-related or due to overuse, such as stress fractures in the foot or tibia. Stress fractures can be hard to detect and many times people with stress fractures will continue to play and delay the correct diagnosis.

If the stress fracture is in the metatarsal bone, the most frequent site for stress fractures, there can be swelling in the forefoot. But stress fractures can occur in any of the 26 bones of the foot without many symptoms. Some are more common than others, but all of them can happen in court sports. In the stronger, more dense area of the mid-foot, stress fractures can take a long time to diagnose, and if not properly diagnosed, can lead to devastating consequences. Whether competing in court sports on an organized level or in everyday use, the foot should not hurt. If pain persists, consult a foot and ankle surgeon.

Another common injury site is the heel. Heel pain can indicate a plantar fascia injury or bone spur. The plantar fascia is a thin, very strong tissue band that supports the arch of the foot, stretching from the heel to the ball of the foot. As the arch falls, the band of tissue is under increasing tension and the weakest link is where the tissue attaches to the bottom of the heel. Over time and with repeated shocks, micro-events can occur and cause the fascia to tear from the heel, resulting in bone spurs.

Ninety-nine percent of the time, conservative care is effective in relieving painful heels. For the few who don’t respond, surgery may be considered.

Foot and ankle surgeons frequently see injuries to the Achilles tendon and other tendons about the ankle that often could be prevented. Appropriate stretching for Achilles and calf muscles go a long way toward prevention. A ruptured Achilles tendon requires surgery and is very common in older athletes who aren’t flexible and don’t warm-up.

For a gentle stretching of the lower extremities and the Achilles tendon, lean against a table or wall, placing one foot behind the other. Point the toes slightly inward and roll the ankle toward the outside. Gently lean forward and feel the stretch high up into the calf muscle. Always roll the weight to the outside border of the foot and never stretch to the point of producing pain.

Additional tips include:
· Buy new, quality athletic shoes and replace them frequently (at least every 6 months).
· Have the proper footgear for the sport; running shoes are not proper for sports such as basketball due to their lack of lateral support.
· Seek appropriate support for arches; flat and high arches often call for custom-made orthotics in shoes.
· In children, be aware of the potential for injuries of the growth plate in the heel. Persistent heel pain is more than simple overuse; kids should stop participation immediately and a diagnosis should be sought. Boys and girls often go from soccer season right into basketball and the collective shock from running and the pull of the Achilles can cause growth plate damage.

Start your winter sports season off on the right foot! Follow these tips and try to avoid the common pitfalls associated with indoor sports.