Exercising and Foot Gear

Over the past few weeks and months with the warmer weather out, I have been trying to get more and more exercising in. Usually that will be with bike riding, the elliptical machine, and running. One of the good habits that I have developed as a Podiatrist is constantly looking at ones feet or shoe gear. Its more apparent in the Summer months when people wear sandals and flip-flops.

As I talk about different shoes in this blog I would like to mention that I have no affiliations with these company's and I do not get paid for recommending their shoe gear. Its all from personal experience.

I have been amazed that when I went to the gym a few weeks ago what people are working out in. Or even cycling on trails. I have noticed a lot of sandals. They may feel fine while working out in them but it will catch up with them later. They will eventually develop foot problems. Sandals and flip flops offer no support at all. When exercising, your heel and the arches of the foot need to be constantly supported. There also needs to be some shock absorption as well. If not the knees then take a lot of that shock absorption. People will develop plantar fasciitis, arch pain, callouses, and knee pain as well.

Now i know there are a ton of different shoes and sneaker company's out there but not all have the APMA seal of acceptance. I will also post a link for them as well. As for shoes and sneakers I will recommend they are as follows:
Sneakers: New Balance, Asics, Saucony, Brooks, Mizuno, Aetrex
Shoes: Aetrex, Rockport, Ecco, Clark's, and Merrell's

And for a list of the APMA seal of acceptance for shoes and sneakers please see the following link:
http://www.apma.org/MainMenu/RecommendedProducts/SealofAcceptance/ProductsbyCategory.aspx#FOOTWEAR


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Fractures

The foot has 28 bones. Fractures can occur in any of these types of bones. There are different types of fractures that people can sustain. Recently in the sports world, Yao Ming the basketball player for the Houston Rockets, had suffered a fracture of his navicular bone. He also has a history of different foot ailments. The Dr that is treating him had mentioned that the injury he has recently sustained "could end his career'. Very scary. So what is the navicular bone and why is this a problem for him.

The navicular bone has many different ligamentous attachments to it. It also has a main insertion attachment for the Posterior Tibial Tendon (PTT). One of the main functions of the PT tendon is to hold up the arch of the foot. The bone is the main corner stone of the arch of the foot. The navicular bone, also has a very poor blood supply to this area. When bones have a poor blood supply, it takes longer for them to heal. A CT scan was able to pick this tiny crack that he had in the navicular. Now, Yao's options include either conservative or surgical intervention. Conservative treatment would include casting, bone stimulator use, physical therapy, and most certianly orthotics to control his foot. Surgical intervention would consist of fixing the fracture.

So only time will tell to see how Yao's Dr's figure out a treatment plan for him. Yao's injury continued to get worse. That is why it is always important to consult your Podiatrist should you notice any foot pain.

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Numbness and Tingling in Toes?

Are you having any numbness and tingling in your toes at all? Do you feel like you are walking in a pebble or a stone? If so, this maybe an early sign of a neuroma. Neuromas are a thickening and scarring phenomena as the nerve travels in between the Metatarsals which are the bones located right behind the toes.
The nerves get pinched causing a numbness, burning type pain. Some people will even mention a feeling of a wrinkled up sock in their shoe. They can occur by having bunions, hammertoes, flat feet, high arched feet, and poor shoe gear. Anything that compresses the front part of the foot can tend to pinch the nerve. The most common location is between the 3rd and 4th toe and this is caused Morton's Neuroma.
Treatment options vary from cortisone injections, sclerosing injections, padding, and orthotics. If conservative treatment options fail, then surgical intervention is usally required to remove a portion of the nerve.

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Shock Wave

I thought it was pretty interesting to find out that one of the Chicago White Sox (baseball) players was undergoing a treatment for chronic heel pain, Extracorporeal shock wave therapy or ESWT as it is commonly called. Carlos Quentin is the player that had undergone it for his chronic plantar fasciitis. So what is so great about this ESWT treatment?

Well for one, its non-invasive. That's very important not only for athletes but for patients as well. Most people would like to have a procedure done on their feet that gets them back to their daily activities right away with out having to worry about being non-weightbearing or using crutches or a walker for support. ESWT works by sending high pressure shock waves to the tissue in the body and promotes new healing to occur from these shock waves. The tissue will then grow new blood vessels which aid in tissue healing of the plantar fascia.

Typically the procedure can be performed in the office or in a surgical center. Patients require a local anesthetic to numb the foot so it is not sensitive. The procedure lasts usually about 30 mins. Everyone is different in their response to the ESWT. Some patients may feel immediate relief and some it may take several weeks to months. Some people may feel a bone bruise to their heel after it has been completed. After the procedure one can expect to complete their normal stretching exercises they normally do with plantar fasciitis to help in the healing process.

Not only can can ESWT be used for Plantar fasciitis but it can also be for Achilles tendinitis. For more information please check out the website and consult your Podiatrist.


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Sandals and Flip Flops

Sandals and flip flops can vastly increase foot problems. If you are already having foot problems and continue to wear these, then you are at risk for more foot injuries and continued pain and discomfort. Sandals offer very little benefit to the foot and ankle. There is no support in the heel and the arch area.

Not only can you aggravate your foot, but you are also at risks for skin breakdown, cuts, bruises, and broken toes.

The only time I usually will recommend a sandal or flip flop is around hotel rooms, pools, and locker rooms. This is great to avoid other things that we have talked about such as warts, and athletes foot.

I am going to include the APMA's guide "Ten-Tips-To-Avoid-A-Flip-Flop-Fiasco" here. I think its very important to read and understand this to avoid any problems from happening. Some I will typically include are to get a sandal made of soft leather rather than plastic. Also to make sure that your feet do not hang over the edge and there is room for the baby toe, so that it is not aggravated by the edge of the sandal. Another important tip is to look for the APMA's seal of acceptance.

Here are the tips below:
Visit APMA’s Seal page at
www.apma.org/seal.
Tips to Avoid a ‘Flip-Flop Fiasco’
• Do shop for a flip-flop made of high-quality, soft leather. Leather minimizes the potential
for blisters and other types of irritation.
DO’S:
• Do look for flip-flops that hold APMA’s Seal of Acceptance, such as Sole Platinum
Sandals. Evaluated by a committee of APMA podiatrists, these products are shown to
allow for the most normal foot function and promote quality health.
• Do gently bend the flip-flop from end to end, ensuring it bends at the ball of the foot.
Shoes of any kind should never fold in half.
• Do wear a sturdy pair of flip-flops when walking around a public pool, at the beach, in
hotel rooms and in locker room areas. Walking barefoot can expose foot soles to plantar
warts and athlete’s foot.
• Do ensure that your foot doesn’t hang off of the edge of the flip-flop.
DON’TS:
• Don’t re-wear flip-flops year after year. Inspect older pairs for wear. If they show signs of
severe wear, discard them.
• Don’t ignore irritation between toes, where the toe thong fits. This can lead to blisters and
possible infections.
• Don’t wear flip-flops while walking long distances. Even the sturdiest flip-flops offer little
in terms of shock absorption and arch support.
• Don’t do yard work while wearing flip-flops. Always wear a shoe that fully protects feet
when doing outside activities such as mowing the lawn or using a weed-eater.
• Don’t play sports in flip-flops. This practice can lead to twisting of the foot or ankle, as
well as sprains and breaks.
Donning flip-flops to enjoy warm weather? Follow these “do’s” and
“don’ts” from the American Podiatric Medical Association (APMA):

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Blood Clots

Its amazing how you can just pick up ideas on what you want to blog about in our daily travels. This weekend I take a little road trip with my friends and it got me thinking on what else we can talk about. Even though my trip was not too long, it got me thinking about longer trips. One of the things I wanted to briefly talk about are blood clots.

Now why would I be talking about blood clots in a foot blog or about trips? Blood clots or DVT (Deep Vein Thrombosis), can occur from both. There are many different risk factors for them which we will talk about.

Clots can form in vessels and break loose. If this happens its a serious condition. That clot can travel to your lungs, block flow, and even cause death. Clots can form not only form in the lower extremity's but also in the upper extremity as well.

So what can cause these blood clots? One is a long period of immobilization. If you are in the car for a long period of time or on a long flight it is very important to make sure you walk around for a few minutes. Blood can be stagnant if one is not moving for long periods of time. This increases the chances (of course with other risk factors) for a clot to form. By walking, or moving around, your calf muscles will work to pump blood flow back to the heart to be recirculated throughout the body. How about those other risk factors you say? Here is a list of other risk factors:
Abnormal blood clotting (can be in inherited), family history of clots, being overweight, cancer, any type of surgery, injury, pregnancy, age, birth control pills, smoking, varicose veins, and history or heart attack or stroke. So as you can see there are many risk factors for blood clots.

So what are the symptoms? Increase in swelling in the lower extremity, redness, increase in warmth, pain with the calf muscle,. Tests that can be done are an ultrasound, blood work, or a venography (where dye is placed in the body). Treatment ranges from medicine to either filters placed in the body.

So now that we know a little more about blood clots how can we prevent them? I already alluded to the fact that if you have a long trip planned, make sure you walk around for a few minutes. On long flights move your feet around every half hour. Others include calf and leg exercises before surgery, stop smoking, elastic stockings, and special compression devices.

As always if you have a family history of blood clots or think you may have, please consult your primary doctor right away. It is especially important to tell your Dr this before having surgery.

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Broad Street Run

Congratulations for those who participated in the Broad Street Run.
Even though it was raining there was still a great turnout for the annual event. An amazing 22,913 people were able to finish the race. Kenya's Linus Maiyo and Jane Murage were able to win the race. Both were able to do it under 50 minutes.

Things I would like to mention that can occur in such a wet environment is Tinea Pedis, or Athletes Foot. Fungus lives in a warm moist environment. If you work in conditions where your feet are constantly wet or run in a wet environment this can happen to you. Things to look out for are dry scaly skin, itching between the toes, redness, burning, and maceration between the toes (See picture). Untreated maceration between the toes can be serious. This can lead to a secondary bacterial infection which can cause a cellulitis and a serious infection in the foot. So athletes foot is no joke and should be treated when symptoms first begin.

Treatment options can range from topical anti-fungals to oral anti-fungals if its severe enough.

Blisters are also common after these runs and in wet environments. Blisters should NOT be de-roofed. The roof of the blister helps prevent infections from occurring. Treatment for blisters can include Second Skin and covering the area with moleskin. If in question with what to do, please see a Podiatrist. Preventative measures include applying Vaseline to the areas that can get blistered, not wearing 100% cotton socks, and applying moleskin to the problematic areas.

As always please check out a website for more info. Happy Running!!

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Foot Health Awareness Month

April is about to come to a close. The warmer weather is just around the corner. April is also known as Foot Health Awareness Month. But why should just one month be dedicated to Foot Health Awareness, when it should be all year long. We should always take care of our feet, to help us constantly go that extra distance. Everyone should always check their feet routinely for any cuts, bruises, skin lesions, and new lesions. Some of the most common areas to check are in between the toes and on the bottoms and backs if your heels. Yes, I know you are saying that this is difficult to see. If it is, grab a mirror or have someone check this for you. Check before you go to bed each night.

Foot pain is not normal and one should see a Podiatrist for care. I am also going to include a link to the American Podiatric Medical Association website that has a walking guide. It talks about the benefits of walking and exercise. It is very useful material. It will also discuss how often one should exercise per week. Its a great resource so be sure to check it out....as well as our web page for new information and updates.
http://www.apma.org/MainMenu/Foot-Health/FootHealthBrochures/Walking-guide.aspx

As always before going for that walk make sure you are in the proper shoe gear. Many people will wear that old pair of shoes, or those loafers that feel comfortable for their walks or exercise. Sure it may feel great during that time, but in the long run you are only harming your feet and preventing yourself from future activities. Invest in a good pair of shoes and it will surely pay off.

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Plantar Warts

Not only will we talk about heel pain, but we will also discuss other foot conditions as well. One of the more common things that we see are plantars warts, also known as verruca plantaris. These warts can occur at any time of the year but they are more common during the warmer months.

They are called plantar warts because they occur on the sole or plantar aspect of the foot. These warts are caused by a virus called the human papilloma virus (HPV). People can pick these up at hotels, pools, locker rooms, gym floors, mats and showers. If someone steps on one of these surfaces that has or had the virus and has a small cut in their skin, they can too pick up the HPV virus and develop the plantars wart. More people will tend to use swimming pools and walk barefoot in the summer time. That is why sometimes there is an increase in the amount of warts seen during the warmer weather. If you have sweaty feet, you also are at a risk of picking up the virus.

Plantars warts may or may not hurt. A lot of it will depend on where it is located on the foot. If it is on a weight bearing area, chances are they will hurt.

Treatment options vary depending on where the wart is located. Usually we may start off with topical acid therapy which is very effective and sometimes we may have to excise the wart.

Some ways to prevent warts is to avoid walking around barefoot, changing socks reguarly if they sweat a lot, and keeping your feet clean and dry.

As always its very important to see your Dr if you have any questions regarding warts. Its important to assess what treatment is best for you.

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Still Being Active With Heel Pain

One of the secrets to a healthy lifestyle includes being very active. Depending on your condition and the nature of your heel pain, it is still possible to be active with certain exercises when at home or going to the gym. A lot of our patients still want to go for that walk or be at the gym with their Plantar Fasciitis pain.

If the plantar fasciitis is under control the best forms of exercise include the elliptical machine, spinning (or cycling), and any type of water aerobics. The first two machines, put less stress on your plantar fascia while still being able to get a great workout.

Notice how I did not mention anything about the treadmill. Depending on the speed that you are running on the treadmill, it can have a high impact on your feet and knees. Not having the proper support in your shoes can lead to heel and knee pain while running on the treadmill. If you are noticing this type of pain after using the treadmill it is important to see your doctor. The treadmill is not going to help with the plantar fasciitis, only make it worse.

Now if you are having any type of heel pain and it simply is not getting better with some of the things we have talked about earlier in the blog, then it is strongly advised against any type of physical activity. Having pain and being on your feet is only going to make the problem worse and not any better. Arch supports, cortisone shots, a period of immobilization, or physical therapy can help you get back on your feet for a healthy lifestyle.

Dont forget, you can always view our webpage for more information

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Kids and Heel Pain

Heel pain not only affects adults, but it can also be prevalent in kids. A common condition we see in kids is called calcaneal apophysitis or Sever's disease. The age range we see this is between 10-14. The cause is an inflammation of the secondary center of growth of the heel bone called the calcaneus. The Achilles tendon which inserts into the heel bone can cause the disturbance that kids typically will feel in the bottom or the back of their heel. So what are the causes? The majority of the time its an overuse injury. Many kids will typically be very active and participate in a number of activities. The constant pulling of the Achilles tendon at this growth center leads to their pain. It also is caused by poor shoe gear, tight calf muscle, and the shape of the foot. These conditions where tendons pull on other growth centers are also common at other parts of the body including the knee and hip. The X-Ray you are looking at is the back part of the heel bone (calcaneus). The area that is separated is the secondary center of growth.

OK so how do we go about treating this? The majority of time is to reduce the amount of physical activity. Ice, anti-inflammatory, stretching, and orthotics or inserts for your shoes are all effective measures as well to help reduce the inflammation that is occurring. A change in shoe gear is important as well. In rare cases a child may need to be casted if the pain is severe enough and the above measures are not helping.

Preventative measures include orthotics and daily stretching.

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Its that time of the season....

For warmer weather to finally arrive. More and more people will be active this time of the year to be outside and play. One of the biggest concerns that we see is the Weekend Warrior Syndrome. What is that you may ask? Well that is if you have not been active and just get right into an activity that you have not prepared yourself for in years. Example, you used to play basketball as a teenager. Now you are in your 40's and want to play that pickup game again with your friends. You have not stretched or done any physical activity in years. You start that pickup game without stretching or warming up your body. You then make that run at the end of the court, as your teammate dishes off that pass to you and you pivot the wrong way and you hear a pop sound. This actually may have been your Achilles Tendon that had ruptured. And depending on the severity of that rupture, it can take you a full year time frame of recovery to get any better. So please, make sure you are not the typical Weekend Warrior and remember to stretch and slowly progress into activity if you have not done so in a while

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Stretching Exercises

Lets talk a minute on some of the stretching exercises for heel pain. This is one of the most important things that needs to be done on a consistent basis to feel better. We tell our patients that its a lifestyle change. One of our favorite stretching exercises is to take a water bottle, put it in a freezer so you have a frozen water bottle. Now, while you are sitting down, watching TV or reading a book, roll it under your heel and arch area for 10-15 minutes. Try and do this at least twice a day. Another easy exercise is to to have a towel on the floor and practice curling your toes to pick up the towel. Still have that pain first thing in the morning when getting out of bed? Try this one, the towel stretch. The key with this is to make sure that your knees are straight so that you can feel the stretch in your calf muscle. Hold this stretch for 10 seconds and repeat it 5 times. Another one to do as much as you can is the wall stretch. The key with this one is to make sure that both heels are on the ground and your toes are pointing to the wall. Hold this for 10 seconds and repeat it 5 times. Its ALWAYS a good idea to stretch out both calf muscles. What may happen with one side hurting, the other limb gets more pressure with walking and the weight shifts to your other side. This can actually cause foot pain to begin. So start with these to try and help relieve some of that heel pain. Remember, 90% of heel pain can be treated conservatively.
For more information please visit the following website:
http://www.podiatrycarespecialists.com/

Camwalkers

If anyone watched Dancing with the stars they had a quick look at a Cam walker boot on one of the contestants. Cam walkers, depending on the foot and ankle condition, are taking the place of fiber glass casts. They can be used from simple strains and sprains to stable fractured bones in the foot. The pros of the Cam walker boot are that they can be easily removed during the day, not as bulky as a cast, can prevent skin irritation and breakdown, can allow for various increments for range of motion, and a rocker bottom design for easy walking. Some of the cons for the Cam walker boot are compliance with use, and limb length discrepancies. Due to the elevation of one limb, it can cause opposite limb problems such as knee, and low back. This generally can be resolved with a lift in the other shoe. Other uses of Cam Walker Boots include:
Stable fractures of the foot, Achilles Tendon problems, Peroneal tendons, acute ankle sprains, posterior tibial tendinitis, sports injuries, post op courses and more. As always please visit our website for more information
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Dancing With the Stars

Wow 3 people were out for Dancing with the Stars. Wondering if it could be foot or ankle related. Remember, having foot pain is not normal. There are a number of different things that can be done to eliminate these problems if you are having them. Be sure to check out: http://www.podiatrycarespecialists.com/ for more info

College basketball

I bet all those Syracuse and U Conn players are dealing with a lot of heel and foot pain after their 6 overtime marathon last night. Luckily for them and other people, there are ways to get rid of their heel and foot pain.