Don't be Scared to Take Care of Your Health Needs even with Covid-19 Still Present!

"I can still bear weight, so it must just be a bad bruise" said my friend when she sent me this photo of her painful, swollen and bruised foot resulting from a pancake griddle catastrophe over a week ago!  So many things wrong with this statement!

First of all, just because you can bear weight doesn't mean there isn't a fracture.  Some bones of the foot and ankle do not bear weight so they may not be very painful when you stand on them.  Some bones fracture where the tendons attach so they may only be painful when you walk, not when you stand.  And some bones break in places that are only vaguely painful.  BUT if there is an injury that has swelling and bruising after a week, you must get an x-ray to rule out a fracture!

Cute Sandals!

Why do you need to rule out a fracture if there is no pain you ask?  Because not all fractures will heal properly on their own, especially in the feet because your feet support your full body weight and are subject to many different forces.  Because some fractures may not heal at all if they are in an area that does not have adequate oxygenation.  Because some fractures heal in abnormal positions that will affect the function of your feet (and ambulation) down the road.  So don't wait!

Yes, we are all worried about contracting Covid-19, but many podiatry offices are open for urgent and essential needs.  Injury is considered an essential health care need.  So PLEASE see a podiatrist if you have an injury, especially one that results in swelling for more than a few days!

Dancing in the New Year! Resolutions Your Feet Will LOVE

As the countdown to the New Year fades and we retire the "special event" heels for another year, it's time to think about what resolutions you can make to start the year on the right foot!

Okay, on the left foot too.  After weeks of holidays and parties, the start of the year is a perfect time to give your feet a rest.  Below are five resolutions to help give them the pampering they deserve.

Give your toenails a breather.
Unless you have a mid-winter warm weather trip planned, January is the perfect time to evaluate the health of your toe nails.  Remove the polish and let the nails breath!  Look for any white spots or yellow discoloration.  Fungus often hides behind the veil of polish and it's important to identify the infection early for the best chance of successful treatment.  Laser treatments, combined with topical treatment, will give you the best odds of getting rid of the fungus in time for summer.

Protect your fascia from the strain and gain!
The plantar fascia is the tissue that lies on the bottom of your feet running from your heels to the balls of your feet.  Strain and stress on the tissue is common with preparations for holidays including extra shopping and cooking. Speaking of holiday cooking, stress is also increased with the weight gain that may come along with it.  Plantar Fasciitis is the common term used for strain of the fascia and presents itself as heel or arch pain.  At home treatments including stretching and wearing shoes with supportive heels but the pain can be stubborn and used to require surgery.  Good news is there are now many new less invasive treatments if your heel pain doesn't go away on its own!

Have your other resolutions be supported by your foot wear!
If you have resolved to be more active, make sure you are wearing the proper foot wear.  Running is the easiest sport to take on but its important to make sure you are wearing running shoes which are designed for heel to toe motion.  Running shoes are also the perfect shoe for athletic walking because they padding and provide ample room for the toes.  Court sports, however, require shoes that allow for side to side motion so tennis shoes have a defined purpose and are not just a type of casual foot wear.  Finally, for those that take to the hoops, basketball shoes are designed with added stability for the ankle.  As you begin your new sport, remember:  foot pain is never normal.  Increased activity can result in stress on the bones and tendons, and ligaments are prone to sprains.  Get checked out if pain remains after a day or two of rest, elevation and icing an injury.

Give your high heels a break.
The best part of winter is that many styles of boots are either flat or with a lower heel.  High heels put constant pressure on the ball of the foot - over seven time the normal pressure with heels as low as three inches.  Wearing shoes with lower heels will allow the balls of the feet (specifically the metatarsal heads) a chance to rebound from the stress and strain that is placed on the soft tissues surrounding the area.  Common injuries to this area due to high heels include bursitis, torn ligaments, displacing the natural padding and stress fractures.

Give your own heels a break.
Winter brings on dry, cracked heels.  Partially due to the dryness of the cold winter air; but also due to friction that occurs on our heels in boots and other shoes that may not provide enough heel support.  Treating dry cracked skin is important before the cracks deepen and develop fissures which may become infected.  I recently read a beauty tip to crush aspirin to use in a lotion.  It sounds crazy but aspirin has acetic acid and acids are used to help get through the dryness.  A much better solution is to treat the skin with a prepared acid-based lotion including those with lactic, salicylic or hyaluronic or glycolic acids.  These lotions and creams will exfoliate the dry skin to different degrees.  As always, be sure to discuss any treatments of the feet with your podiatric physician to make sure they are appropriate - especially if you are a diabetic or have circulatory problems.

Here is to a starting the New Year with Health Feet!

Heel Pain - Why Some Shoes Help and Others Don't!

Millions of people suffer from heel pain - most of which (although not all) is due to plantar fasciitis/heel spurs/plantar fasciosis.  Some people swear by their Vionics/Birkenstocks/Oofos/Chaos sandals and most podiatrists will tell you to wear a closed heel shoe such as a running shoe for stability.  So which shoe is right for you and why??

First of all, let me tell  you that not only am I a podiatric physician, but I also suffer from plantar fasciitis (PF) on and off.  I have personal experience as well as professional experience and knowledge of the anatomy and biomechanics of the lower extremities.  The simple answer is:  What works for you may NOT work for someone else!

The more complicated answer comes down to foot type, foot structure and the reason for your plantar fasciitis and how long you have had it.  These individual factors become especially important in controlling re-occurrence which is common with PF.

First of all, it is so important to get rid of PF before it becomes chronic. Acute PF is thought to be inflammatory but chronic is not.  Chronic PF is a topic in of itself; but for now, know that steroid injections often fail because chronic PF progresses beyond inflammation producing scar tissue or tears within the fascia itself.

There are two important parts to controlling most acute PF - control of your rearfoot (heel and subtalar joint) and allowing the tight tissues to stretch.  Heel control is an integral part of treating acute PF because it helps control the motion of the heel causing inflammation.  Shoes with a stiff heel counter (the back of the heel) such as running shoes are a very important part of resolving heel pain.  I tell all my patients to wear them 24/7 "for now" to control the heel.  It's not necessary once the pain subsides, but until then it is a must!

Rearfoot control is also achieved with most types of custom orthotics. (This is how they differ from over the counter arch supports sold as "orthotics"). There are many factors if prescribing custom orthotics based on your shoe wear, foot type and associated anatomy.  Even if the orthotics prescribed by your podiatrist don't help the acute pain, they are important in controlling the heel to prevent re-occurrence!  Hopefully your podiatrist explained this to you, but if not,  don't be upset if they don't help get rid of the acute pain because they are still very important!

Both flat feet and high arch feet can develop PF due to tightness of the fascia, but also can develop from tightness of the Achilles tendon and even the hamstrings.  Vionics and Birkenstocks help people because they have a negative heel (where the heel sits lower than the toe box) which helps to stretch the Achilles tendon. While those sandals may help with the pain while wearing them, they often don't improve the condition overall because they don't provide heel control.   I think they are great once the pain has subsided and for those times that you absolutely can't wear sneakers, but sneakers with heel control are much better at getting the problem under control quicker.  Running shoes that have a negative heel are a great tool in allowing stretching of the Achilles as well as providing heel control.

Finally, a few words about those sandals that I mentioned and others that are heavily marketed to the public for heel pain.   Whenever anyone talks about heel pain, recommendations for these sandals are given quickly but the success of specific sandals is based on individual foot type!  Oofos, for example, provide extra shock absorption so they may be great for a high arch foot type but not for those that need a negative heel.  Vionics (based on personal experience) seem to provide rearfoot control further back in the arch as opposed to the high mid-arch support found with  Chaos which is a different type of control.  I know for myself and my foot type, this makes a huge difference.  It is important to make sure you have a discussion with your podiatrist on which sandal might be best for YOU once you get the PF under control.

Controlling PF goes beyond the control of shoes and sandals; but with so many people making recommendations to their friends on which of these costly shoes to buy I felt compelled to write about the differences between them and why YOUR foot may need something different than your friends.  Please see a podiatrist well versed in PF if your heel pain persists for longer than 4-6 weeks to be properly evaluated for YOUR individual treatment and shoe recommendations!

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!!

 

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.