Friday, August 28, 2015

When Your Feet Still Hurt AFTER You Take Your Heels Hurt!

High Heels - some people love them, some people leave them.  Most women are like myself, wear them on occasions.  Granted, most women will admit that their feet hurt while they are wearing their heels, but what does it mean if your feet hurt after you take them off?

Pain at the ball of the foot, most commonly felt while wearing high heels, can be more of a problem then direct pressure from shoes.  Wearing heels, even occasionally, can cause tearing in one or more of the ligaments that are on the bottom of the joints located at the ball of the foot.  Pain at the ball of the foot is usually due to inflammation, scar tissue or a partial tear of this ligament.  The pain remains even when wearing flat shoes or without shoes because damage has occurred.

This ligament, known as the plantar plate, is responsible for keeping the toes straight.  When torn even partially, the ligament causes the toe to rotate or displace over time with or without pain.  Even without pain, there are can be swelling on the top of the foot in that region.   But its not just pain, swelling and damage to the ligament that you need to worry about.  It is not uncommon to develop hammertoes because of a disruption of this ligament. 

Treatment for this problem is dependent on when you seek treatment and how much damage there is to the tissue.  Sometimes extended physical therapy and taking the pressure off the ligament can allow the tissue to heal.  Often, using some of the newer forms of regenerative medicine can result in a quicker resolution.  Finally, surgery may be necessary as a last resort.

One thing to caution you on pain in this area.  NEVER have a cortisone injection unless you have ruled out damage to this ligament.  Cortisone, often used for inflammation in the area and/or neuromas in the area can weaken the ligament and cause further damage.

Wednesday, April 29, 2015

Great - Now I Have Blisters BETWEEN My Toes!!

I read an advice column this past weekend suggesting to wear "toe socks" as a way to avoid blisters between the toes on a woman who recently started a walking program and I take issue with that advice! 

Blisters are a sign of irritation and blisters between the toes would indicate irritation of one toe against the adjacent toe.  Usually, there are bone protrusions on the adjacent toes that cause pressure from one toe to the next piggy.  Hammertoes commonly cause a thickness of the toe joints which can be an  irritant by themselves or with bone spurs on the toe bones.  These bony prominences, when pressed together in tight shoes, cause the body to try to protect itself by creating fluid under the skin.  That fluid turns into a blister and can become quite painful on its own due to inflammation. 
 
Wearing toe socks may seem to give cushioning there is already a blister present but tend to take up even more room in an already crowded space and wearers would find continued walking quite uncomfortable!  Small blisters usually resolve on their own although they may cause a callus over the area.  Blisters that are painful, whether between the toes or elsewhere, need to be relieved of the fluid.  Using a sterile needle to incise the blister on its most dependent location will work, but if any blood is in the blister or any fluid that is not clear comes out, it is time to see your podiatrist.  If any signs of infection are present (swelling, drainage, redness), a trip to the podiatrist is also very important.
 
The best way to avoid blisters is to make sure you are wearing shoes that are wide enough to comfortable fit all five toes!  I often advise my walkers to use running shoes.
 
Removing the bone spurs or correcting any hammertoes that may be present will usually solve the problem once and for all!

Tuesday, February 24, 2015

BEST Treatments for Toenail Fungus would NOT Include Cornmeal Mush!!

I was shocked recently to read in the Chicago Tribune that "Cornmeal Mush" may help "cure" toenail fungus!  This article suggests soaking your cornmeal for an hour then soaking your feet for an hour.  While I have heard MANY home remedies, this is the first I have heard that cornmeal has antifungal properties!
Fungus residing in the toenails is very difficult to "cure" because there are so many factors that contribute to its existence and infection - its not so easy to just say the infection developed because of a pedicure.  While pedicures can, and often do, directly cause fungus to be seated within a toenail, there are many other factors that make treating fungus challenging. 

It is important to treat toenail fungus, known as onychomycosis, because it can spread to other nails, worsen in an isolated nail, cause deformity of the affected nails and cause a fungal infection in the skin.  Once you have decided to treat the nail, you need to be committed as persistence is very important.  Despite what the pharmaceuticals would have you believe, there is no "magic pill" that rids you of fungus permanently. The best defense we have now is a combination of treatments which includes laser treatments, topical treatments, treatments and possibly including short term oral antifungal treatments. 

Not everyone is ready to treat their fungal nails and while I am a podiatric physician I am also a woman who understands that decision!  There are certain times when a pedicure is a must!  Many podiatrists now offer a cosmetic temporary solution that will allow you to show off your pedicure without worry that your toes will be a source of embarrassment.   I have recently began using KeryFlex which will transform your ugly nails (whether there is fungus in them or not) to a normal looking nail that will last for weeks.  KeryFlex will also help stop the spread of the disease as it creates a seal over the fungal nail.

Deciding when and how to treat your onychomycosis is a decision you should make with your podiatrist.  While home remedies may show improvement in some individuals, the most effective and direct treatments should have research behind them and clinical results.  I think most podiatrists would agree - leave the cornmeal at the breakfast table and bring your feet to us!

Monday, July 14, 2014

I LOVE Kitten Heels

As a woman, a female podiatrist and the American Podiatric Medical Association's expert on shoes, especially women's shoes - I must say that I do NOT agree with the statements made  here in Yahoo this morning about Kitten Heels!  I think they are the perfect alternative to heels for women who want or need to feel dressed up.  The height is perfect and the usually skinny heel is not an issue with sidewalk cracks!  All women know what to avoid walking over when wearing skinny heals - especially in the city where there are all kinds of grate coverings.  I also do not agree that shoes cause bunions, even shoes that pitch the foot forward as stated in this article.  They can aggravate bunions, but its foot type that generally causes bunions.  I encourage patients to wear Kitten Heels every day in my practice due to their modest heel height!

Thursday, February 27, 2014

Emergency Padding!!

So...........

A few months ago I was interviewed for an article on emergency padding for blisters.  At the time, I spoke of coban which is a self adhesive bandage that works great on toes and controls friction to stops irritation.  Of course, it was pointed out that most  people don't carry around a small section of coban (I do) and I spoke of how you can modify a Band-Aid to protect a blister without adding too much bulk to the blister itself.

Well............

I was in a similar situation this past weekend
when the boots that were so comfortable on my last trip ended up being NOT so comfortable on this past trip!  I felt as if I was developing blisters at both my heels and the balls of my feet.  Cobain would not work in this situation!

So I tried to figure out what to do for the following day and then I remembered that I had panty shields with me!
It was perfect.

They provided the perfect amount of friction control and didn't add too much bulk in my shoes.  The adhesive was strong enough that they stayed in place and it was quite a successful!  I was totally comfortable all day long. 

Tuesday, February 4, 2014

SNOW!! More Dangerous than Ice!

Most people  think of ice when they think of the dangers of winter.  While our office receives emergency calls due to slips and falls from the ice all winter long,  we see even more foot problems that become symptomatic from walking on snow!
 
While walking the uneven surface of snow laden sidewalks, drives and alleys, many existing problems worsen.  Many people feel that they are more protected wearing snow boots but in reality snow boots give a false sense of security because most snow boots don't provide any ankle stability.  And the continued fashion of Uggs and similar boots cause people with all foot types to have problems in the winter!
 
 If you find yourself feeling unstable while walking on the uneven snowy surfaces or have pain on the outside of the foot just below the ankle bone, you may be experiencing an inflammatory problem called Sinus Tarsi Syndrome (STS).  STS is very common in people with more flexible feet and is often misdiagnosed as an ankle sprain.  If you have fallen or sprained an ankle and the emergency room treatment or that provided by your primary doctor doesn't seem to help, it is very possible you have STS.  STS can be caused by an injury but just as frequently can be caused by a foot that has excessive motion.  Flexible flat feet are feet that lose their arch height when you bear weigh.  STS is probably one of the most common misdiagnosed causes of pain to the foot or ankle because the joint involved, the sinus tarsi, is very close to the ankle and it is often confused by a doctor who does not specialize in the foot and ankle.
 
To diagnose STS, the joint is isolated and injected with local anesthesia to confirm that at the pain is coming fro that joint.  Since treatment for STS consists of injections of cortisone into the sinus tarsi, it is added to the initial diagnostic injection.   STS, in its early form, is an inflammatory problem and responds quite well to one or a few of cortisone shots.  Treatment also consists of controlling the flexible foot type and the excess motion by using custom orthotics or the placement of a stent within the sinus tarsi to block the excessive motion.
 
However, as time goes on and the problem is ignored, the tissue within the joint becomes thickened and almost like scar tissue and may not respond as well to the injections. If the injections fail to help, we will often order an MRI to confirm the diagnosis and to evaluate the tissue within the joint.  Surgery, either arthroscopic cleaning of the joint or opening the joint to clean out the thickened tissue.  The surgery is not very invasive and allows return to work and activities quickly.
 
Like many foot problems, the key is to treating the problem early before the problem becomes chronic.  Remember - foot pain is never normal!!
 

Tuesday, September 17, 2013

Timberland Boots - Are They Really Making a Comeback??

I just read an article about Timberland Boots from the 90's making a comeback!   The fashion site listed them as fall's must-have footwear.  Yah!!   I think we all still have them in our closets, waiting for that hiking trip that never happened.

So are they really a fashion statement?  Are they that different from my daughter's vintage Doc Martens?  Or her current Doc Martens? 

I may not be the person to answer those questions, but I am the person to answer the questions about their function and support and how they are for the feet!

Most bulky boots, like Timberlands, have an intrinsic arch support within them.  Many of them are removable so that you can put your custom orthotics in them to be able to benefit from them on a daily basis.  The boots have a supportive heel so they are great for those with plantar fasciitis or heel spurs.  The forefoot of the rugged style boots is boxy in shape so they are great for people who have bunions.  The heel height of Timberlands is usually less than an inch and a half, so they are great for all of us to ensure stability when we walk.

Unless of course, people start to consider alternatives.....



 All in all, I couldn't be happier from a professional point of view. 

From a fashion point of view, however...................