Fallen Arches

I just answered a question on another blog about "fallen arches" are decided this was a topic that needs to be addressed - even if I have done that before!

Fallen arches are not normal. Usually it happens when the tendon that holds and supports the arch (the posterior tibial tendon) weakens or tears. This tendon can weaken with age, weight gain or flat feet. The problem is very subtle at first and may just present itself as subtle aching of the inside ankle and/or arch.

If diagnosed early on, simply supporting the tendon and the arch with custom orthotics is usually all that is needed; but if the tendon continues to be stressed without support it can tear or even rupture.

I currently have a patient who's tendon partially tore during her second pregnancy and she had been suffering for year until it finally ruptured.

Sometimes physical therapy is helpful, but if the tendon has tears and scar tissue, surgery is generally needed. The good news is that people do GREAT after repair of the tendon. Actually, that is the case with any tendon. If there is prolonged pain, there is always pathology. Once surgery addresses the pathology (tears or scar tissue) the person does great.

The only other consideration is what to do to stop the stress on the tendon after it is healed. Custom orthotics are used but it is also possible to have a stent inserted into the joint that supports the arch for a more permanent type of support. This surgery is a simple procedure that should be considered with this problem.

Why Some Shoes No Longer Fit

I was getting ready for an upcoming trip and all set to pack my red/black/white floral skirt and my really cute red peep toe pumps that I haven't worn in awhile and slipped them on to make sure they still looked cute. But I got a surprise - they were no longer comfortable!

The fit of a shoe may change for a number of reasons. First of all, anyone with deformities such as bunions or hammertoes may find that shoes are suddenly causing more pressure and tightness around those deformities. This is usually a sign that those deformities are advancing, even if there is no pain associated with them. Custom orthotics made by a podiatrist can help reduce the progression of bunions and deformities.

Swelling of the feet often occurs in the summer months due to the heat. Swelling can tightness in shoes that were once comfortable. Swelling can also be due to a tendon problem or injury and should be evaluated by a podiatrist if persistent. Lower leg swelling that is continuous can be due to systemic problems, vein problems or even kidney or heart problems and should be evaluated by your primary care physician.

And finally, foot size can change as we get older. Pregnancy can cause the ligaments and tendons of the foot to stretch which may make the foot longer. The tendon that holds the arch commonly becomes stretched, torn or injured in people that have a flexible flat foot or are overweight. It is very important to see a podiatric physician if you develop pain in the arch with or without swelling!

So, I went shopping to set to find comfortable black sandals that I could wear with multiple outfits and I ended up finding really cute red sandals. Happy Day - red shoes make me happy!! It quickly became a really happy day when I saw the price of those red shoes!!

Try this link for the Video on Flip Flops

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Summer Shoes - Flip Flops are NOT the Answer!!

With the weather improving, more and more people are participating in their favorite outdoor activities and for many people, the flip flop is the first shoe they reach for. Easy to put on, airy and light weight– flip flops seem like the perfect summer shoe!

But, all flip flops are NOT always the best choice for your feet

Sometimes, it IS appropriate and safe to wear flip flops. For example – its fine to wear them to the beach and the pool, relaxing outside in your own back yard, or at a party where you won’t be walking too much.

But most flip flops are not appropriate for walking, biking, doing lawn work or for other athletic activities. Flip flops should not be your go to shoes in the summer!

For those who might over use these flimsy non-supportive shoes, you risk

• Tendonitis
• Heel pain
• Stubbing or jamming toe
• Ankle injuries
• Foot lacerations

Not all flip flops are bad, but most are.

Those that can easily be bended in half from toe to heel and twisted as well will not provide adequate support for normal daily activities.
If the “toe thong” is made inexpensively, either by design or material, you can also experience blistering in between the toe area because. This is a very common problem with flip flops. You want to make sure there are no seams that would cause irritation and its best when the material is soft. Blistering can also occur with constant slippage of an ill fitting flip flop.

Not all flip flops are bad however. Some flip flops have a more structured, solid arch support and make with a more sturdy material. Look for ones that bend at the ball of the foot and do not twist easily. Thicker soles and padding can be found in some flip flops. Look for those that have somewhat of an arch, a deeper heel cup and a soft and natural toe thong.

Go to http://abclocal.go.com/wls/story?section=resources/lifestyle_community&id=8173033 to see my discussion of better flip flops with Linda Yu and Sylvia Perez on a recent ABC Chicago News story.

Any sandal or flip flop that forces you to scrunch your toes or use your tendons abnormally is not a shoe you should be wearing.

Any shoe related problems should not be ignored. The bottom line is that no matter what shoe you wear, if you have foot pain, see a podiatric physician- foot pain is never normal!

Resolution#11: Don’t believe rumors and don’t be afraid of the unknown

If foot surgery is recommended to you, there is no reason to panic. Foot surgery is designed to not only treat existing conditions, but to prevent further ones as well. Foot surgery rarely requires you to be off your feet for more than a few days, although some surgeries may require you to either have a cast or use crutches for up to several weeks. Our patients find that pain is usually mild after foot surgery, if at all. Our surgeons have the education, training and experience you want in a physician! When performed by either Dr. Marlene Reid or Dr. Lawrence Kosova, your feet and ankles will be in good hands!

Resolution #10: Don’t let flatfeet slow you down!

When kids complain about their legs feeling tired, it’s often because of flat feet; flexible flat feet to be exact. While it may look like they have arches, flexible flat feet lose their arch when they bear weight during walking. The muscles have to work harder than normal and tired feet and legs are a common complaint. Adults suffer from problems from flat feet as well. Bunions, hammertoes, arthritis and heel pain develop over time due to the instability of flexible flat feet. Tendons in the arch are commonly affected in adults with flat feet. Many women over the age of forty have this problem but men can develop it as well. The tendons can become inflamed, tear, develop scar tissue and even rupture all because of the lack of support. There are so many ways to treat the symptoms of flat feet now – ways that do not involve the extensive reconstructive surgery that was once the norm. Dr. Reid and Dr. Kosova have had special training in a simple procedure that uses a stent to keep the arch from collapsing that many of our patients are benefiting from.

Resolution #9: Clear out that fungal infection once and for all!

2011 brings much good news for fungal nails! New laser treatments are now being used to attack the fungus within and beneath the nails and are showing great success and Family Podiatry Center is the first (and one of the only) offices to offer it in the western suburbs! It’s no longer necessary to decide if the anti-fungal pills are worth the risk – laser treatments for fungal nails will change the way we look at our toe nails!

The laser we are using is a dual wave length laser that acts by destroying the fungal cells within the nail and the skin beneath the nail. The results we have been seeing are dramatic. The advantage for this laser is that you only have to treat the nails that have the fungus so it is more economical than outer options.

Resolution #8: Walk for fitness but make sure you have the right gear

Walking is the easiest fitness program you can create but you need the right gear! A good pair of walking or running shoes that compliments your foot type is essential. Many people also benefit from custom orthotics that are like eye glasses for your feet. Custom Orthotics made by a podiatrist are prescribed based on your foot type, problems you are having and the amount of control you may require to keep your feet working their best. At Family Podiatry Center, orthotics are used to control progressive deformities such as bunions and hammertoes, relieve stressed tendons and to prevent additional injuries.

Orthotics can be made from a foam impression (the least accurate method), a plaster cast (the most traditional method) and the way that Family Podiatry Center makes them, from a computer analysis of the way you walk (the most advanced and accurate method). The computer analysis can be used for all types of orthotics - sport, dress or even sandal orthotics!

Patient satisfaction for both our dress and sport orthotics has never been higher! Typically, people relate that they can't believe the difference and can't imagine walking without their orthotics.

Resolution #7: Give your toes a break

Hammertoes are deformities of the digits (toes) that cause them to bend or curve. They can be flexible or rigid and often cause pain, corns or bursitis on the tops of the toes. Severe hammertoes can even cause problems at the ball of the foot and make walking difficult with or without shoes. Changing your shoes can help give them more room to sit comfortably, but often surgery is necessary to “break” the toes to allow them to lie straight to avoid these problems.

When is it time to have your hammertoes corrected? Unlike bunions, hammertoes can be put off as the surgery usually involves destroying the joint sp it is not so necessary to try to preserve the joint. However, that being said; hammertoes are progressive and if treated early, it is possible to save the joint if treatment is during the flexible state.

Resolution #6: Take advantage of new technologies

So many new technologies now exist for treating everything from chronic pain to heel pain to flat feet to lasers for fungal nails.

Stay tuned for more info on lasers for fungal nails in the upcoming weeks!!!!!

Resolution #5: Treat your injuries with the respect they deserve

Each week, I see at least one or two paients telling me they has a previous injury and they are now having related problems! Sometimes it is the same injury or sometimes it is a problem that occured at the same time of an injury that was treated at an emergency room but was ignored by the emergency room staff!


Far too often we hear of people simply getting an ace wrap for an ankle injury! Injuries need to be addressed as soon as possible and need to be given proper attention. Injured soft tissues (ligaments and tendons) need as much support, if not more, than broken bones. If they are not treated properly, re-injury of the tissue is likely in the future and scar tissue and chronic problems can easily occur. If pain persists even after you have been told by an emergency room or other doctor that you didn’t suffer a fracture, please make an appointment at Family Podiatry Center to properly evaluate your soft tissues. Soft tissue injuries including sports injury are a specialty of our doctors.

Resolution #4: Don’t let bunions make you or break you!

Bunions are more than that bump at the base of your big toe. Bunions are deformities of the joint due foot type and bone structure. Bunions are progressive deformities in both women and men. The longer they are left untreated, the more likely they are to develop debilitating arthritis and to interfere with your daily activities. Don’t wait until they are severe to have them corrected! It is best to treat them before they become arthritic. Our surgeons will use X-rays to determine what stage your bunion is in and how best to treat it. Most of our bunion patients are back on their feet within a few days of surgery.

A patient that had surgery right before the end of the year came in for her follow up visit last week and couldn't believe how easy the surgery was. She said she only took two pain pills. Don't be afraid of surgery if it is recommended - certainly feel free to get a second opinion, but be sure that the opinion discusses what procedure should be performed, not just if you are ready for surgery.

Resolution #3: Don’t put off to tomorrow, what you should do today

Foot pain is not normal. Each foot is unique and we all have different foot structures that contribute to most painful problems. Ailments and disorders can occur with any of the 26 bones and 20 muscles in each foot. And don’t forget about the bones, tendons and ligaments of the ankles! Podiatrists are physicians trained specifically in the foot and ankle and have the experience, training and education to diagnose exactly what is causing your pain.

Resolution #2: Never be caught with your shoes off if you have heel pain.

Heel pain is very common and makes up 35% of our practice. Wearing shoes with a firm heel counter is very important in controlling plantar fasciitis, the leading cause of heel pain. If left untreated, this inflammatory problem can progress to a much more severe problem of tearing and scar tissue. Having proper heel support is the first step in controlling the progression of heel pain. Heel pain lasting longer than two months should be evaluated by one of our podiatric physicians. We specialize in chronic heel pain and have been innovative in advanced and noninvasive treatments.

I have my patients start with the basics - no matter how long they have had the heel pain or even if they have been treated elsewhere because I believe in them so much! Proper heel support, stretching of the fascia and the Achilles and education on shoe wear is the basis for anyone with heel pain.

For those with chronic heel pain (more than a few months), there is great hope! I have been using radiofrequencywith great success.

Resolution #1: If the shoe doesn’t fit, don’t wear it!

It’s so tempting for women to buy shoes that don’t necessarily fit - especially if they are on sale or perfectly match an outfit. Do your feet a favor and resolve to only buy shoes that do not pinch, squeeze or slip when you try them on. And don’t just try on a potential new pair of shoes; get off the carpeted area of the shoe store and really walk around in them to determine if they are a good fit.

Other shoe shopping tips to remember:

-shop for shoes at the end of the day so that any naturally occurring swelling has already occurred

-wear the appropriate hosiery for the shoes you are buying

-know your foot type before shopping for athletic shoes - a podiatrist can help you determine your foot type

-know your heel height limit, some women can wear 4" heels, but others may have to settle for 3"

2011 Resolutions to Walk With

There are resolutions for everything from weight loss to self-betterment to political correctness - all intended to take you to a better place in 2011. Why not for your feet? You can’t go anywhere in 2011 without your feet taking you every step of the way!

For the next 11 days, I will post a resolution sure to keep you on track and walking in the right direction!!

Coming on Monday - Resolution #1: If the shoe doesn’t fit, don’t wear it!