How to Strengthen Your Achille's Heel

Achille’s tendonitis causes pain on the back of your heel. It is often exacerbated by long runs, new exercises and aging. It starts as a bit of a throbbing at your heel and progresses to a sharp stabbing pain that can be debilitating. This pain is a result of minor repetitive trauma that causes small tears in the tendon. As the tendon is used again and again you can cause the tears to become inflamed and undergo acute inflammation. However, the injury can be fixed before the tendon progresses to a full rupture. One way to do this is through exercises to strengthen your Achilles tendon.  The following exercises can help you to do this, but as with other exercising, it is all about consistency.

1.       Calf Raise: Stand on the edge of a stair and raise your foot to where you are standing on your toes. Lower yourself slowly until you feel the muscle stretching. This is your gastrocnemius and your soleus that attach to the Achilles tendon. It is important to do one foot at a time to maintain stability. Make sure that you do both feet so that you are strengthening both tendons.

2.       Resistance Band: While sitting, loop a resistance band around your foot and point your toes. Then pull the resistance band towards you while keeping your toes pointed. This will also increase your strength.

These two exercises will quickly strengthen the muscles in your calf and will therefore increase the strength of your Achilles as well. You should notice changes relatively quickly, but it is important to halt your exercise routine while you are strengthening the tendon. After you have been cleared by your podiatrist to start training again, it is safe to return. However, should you feel pain again; you should seek medical attention for further treatment.

Posterior Tibial Tendon Rupture

Your posterior tibial tendon runs along the inside of the back of your heel and down onto the bottom of your foot. Many times, this tendon will be injured as a result of someone being overly aggressive with a new workout plan. The tendon will become irritated and inflamed and if the person does not heed their body’s warnings, then the tendon can actually split in half. The tendon can also rupture due to people who have flat feet or are obese. In both of these cases excessive pressure is being placed on the tendon and it eventually is compromised due to the stress of the pressure. If you do not notice a sharp pain, because not all people will, you may notice that your foot is more flat or that your foot rolls inward where it did not in the past.

Treatment for this condition ranges from bracing to surgery. The steps that are taken are all dependent on how far the injury has progressed. In individuals who did not notice the pain initially, their ligaments can stretch causing the foot to flatten out even more. The bones will eventually shift and the entire foot may change shape from its original form. In all patients, x-rays and ultrasound can be performed to help decide what treatment needs to be done.

For the early stages, a brace can be used to hold the tendon stationary. This will allow the tendon to reconnect and prevent further inflammation from occurring. Orthoses can be used to correct the flatfoot and hold the foot in a more stable position. For people who have progressed to a more severe flatfoot, casting may be able to be used, but for some people, the foot will not be able to reach the more stable position because the ligaments have gotten tighter. This tightness prevents flexibility and the foot is not able to be moved out of the flat position. For these people surgery can be used to reattach the ligament and realign the bones that are causing the flat foot and the pain associated.

The key to any injury is a fast reaction time. It is important that as soon as you notice a change in your foot from the way that it has always been that you seek medical consult from your podiatrist. The quicker that you come in for a consult, the faster we can nip the problem in the bud and get you back on your feet.

Sever's Disease

Is your child suffering from heel pain? Well, it is possible that they may be suffering from a condition termed Sever’s Disease. This condition normally starts around age 10 to 16, but may occur earlier or later depending on your child’s growth. When your child is born, the majority of their bones are actually made of cartilage. As your child develops, this cartilage will be replaced with bone to give them the skeleton that we are all used to seeing. This process takes many years though and some of their bones will not be finished until they are around 20 years old. In the heel bone, there are two different areas that the bone originates from, in the middle and where your Achilles tendon attaches. When these two areas meet up, they may start to rub against one another causing irritation in your child’s heel. This is often exacerbated in very active kids because they are moving around much more which causes a greater amount of rubbing to occur.

Some of the things that you can do include limiting your child’s activity and making sure they get plenty of rest. But, let’s be honest, most kids can’t sit still for even five minutes. So, in order to help their active lifestyle your podiatrist has several options that may benefit your child. The first thing that will be done is evaluate them to make sure that there are no other underlying causes of your child’s pain. If it is in fact determined to be Sever’s disease, then we can look into foot orthoses, taping and bracing and shock absorbing shoes for your child.

The foot orthoses are important for some children that tend to have a more pronated foot. This means that when they walk there foot tends to flatten out more causing additional pull on the connective tissue attaching to their heel. It has been observed that there is a correlation between pronated feet and Sever’s disease. So, designing orthoses that fit your child will help to prevent them from flattening out their foot and will often relieve the pain they are experiencing. Taping and bracing can help to limit the motion of the ankle joint during activity causing less irritation to occur. After the symptoms have been relieved, shock absorbing shoes can help to prevent the pain from reoccurring. If your child is still experiencing pain though, the doctor may suggest some pain killers to help offer some relief.

Sever’s Disease is a condition that will eventually go away once your child has finished forming bone in their heel. However, it can be a very painful and self-limiting condition and it is important to seek medical assistance for the matter.

Santa’s Sugar Free Diabetic Friendly Treats

With the holidays coming up, there are candy canes, fudge and cookies to be found in every nook and cranny. For a diabetic though, this can be a season of great temptation and difficult times having to say no to everything they are offered. Luckily, there are many great recipes that have been transformed to sugar free recipes that are just as scrumptious. Below are a few that have been tested and approved.

Pumpkin Pie Cheesecake with a Pretzel Crust

Ingredients

6 tablespoons butter, melted, plus more for the baking dish
1 (6-ounce) bag classic pretzel crisps, crushed into fine crumbs with a rolling pin or in a food processor—these are the flat baked pretzels in the chip aisle
1 cup light brown sugar, divided—Replace with either splenda brown sugar using half as much
2 cups pumpkin purée
2 (8-ounce) packages Neufchâtel cheese
1 tablespoon pure vanilla extract
1 3/4 teaspoons ground cinnamon, divided
1/2 teaspoon ground cloves
1/2 cup heavy whipping cream—sugar free
1/2 cup toasted pecans, finely chopped

Method

1)      Preheat oven to 350°F. Butter a 9- x 13-inch baking dish; set aside. In a medium bowl, combine crumbs, butter and 2 tablespoons brown sugar, and then press firmly into prepared dish to cover the bottom evenly. Bake for 10 minutes; set aside to let cool.

2)      In a large bowl, beat together pumpkin, Neufchâtel, 3/4 cup brown sugar, vanilla, 1 1/2 teaspoons cinnamon and cloves with an electric mixer until smooth and creamy, 3 to 4 minutes. Pour evenly over cooled crust; set aside.

3)      In a large, clean bowl, beat cream and remaining 2 tablespoons brown sugar until stiff peaks form. Drop onto pumpkin mixture in dollops, then use a table knife to swirl the two together. Scatter pecans over the top, dust with remaining 1/4 teaspoon cinnamon, cover and chill for 8 hours, or overnight.

 Sugar Free Peanut Butter Fudge

8 oz. unsweetened chocolate squares “Ghirardelli”

1 cup smooth peanut butter (no sugar added)
3/4 - 1 cup erythritol
1 cup worth other sugar substitute (or to taste)liquid sucralose was the best
1/2 teaspoon vanilla
Pinch salt

Preparation:
1) Melt the chocolate. I like to pour boiling water over it, let it sit for 5 to 6 minutes, and then pour the water off. That way I know I won't burn the chocolate.
2) Mix in the rest of the ingredients, adjusting sweetener to taste.
3) Pack or spread into a loaf pan. Cool to room temperature, or you can put it in the refrigerator. Cut into 18 pieces and serve.

Finally…

Sugar Free Gingerbread Cookies

2 cups of whole-grain wheat flour

1/4 of a teaspoon of salt
1 teaspoon of baking powder
1 teaspoon of baking soda
2 cups of bran
3 teaspoons of ground ginger
1 teaspoon of allspice
1 teaspoon of ground cinnamon
1/3 of a cup of margarine
1 egg
3 tablespoons of orange juice
1 teaspoon of margarine
6 tablespoons of agave nectar

1. Preheat Oven to 350 Degrees Fahrenheit.

2. Mix flour, salt, baking powder and baking soda, bran and spices together, then rub in margarine until the mixture resembles fine breadcrumbs.
3. Stir the Agave Nectar into the egg and orange juice and beat together. Now mix this into the flour mixture.
4. Knead well, and roll the mixture out thinly on floured board.
5. Using a cutter, cut into whatever shape you want and the place on greased cookie sheets.
6. Bake for 15-20 min (or until crisp and lightly browned).

Now all that is left to do is enjoy your diabetic friendly sugar free desserts. Happy Holidays!

The Ligament That Won't Keep You Down

Jonathan Horton, an American Olympic gymnast, injured his ankle a couple of weeks ago. While performing the vault, he landed awkwardly resulting in a torn ligament and two broken metatarsals. As a result, he had to undergo surgery. However, rather than viewing this as a set-back, he has stated that this injury will allow him to perfect other parts of the sport. He feels that this injury will only make him a better athlete.

It is not uncommon for a person to fracture a bone as a result of a ligament injury. Ligaments attach to bones and when they are put under excessive amounts of stress, they can end up pulling off a piece of the bone with them. You can think of it like a tug of war between your ligament and the bone and eventually one gives way to the other. Unfortunately, in this situation, surgery is needed to repair the ligament and the bone.

There are many types of ligamentous injuries though ranging from sprains to tears. Along with the wide range of injuries, there is also a wide range of treatment plans. For mild injuries, it may be sufficient to immobilize your foot with a cast or a walking boot. This will allow the ligament to heal without having further stress placed upon it. Another option is laser therapy. The laser works by increasing cellular ability as well as stimulating growth and repair. This stimulation helps to heal the tissue causing lasting positive effects. The treatment is non-invasive and will allow you long-lasting effects. For the more severe injuries, surgery may be the ultimate option.

With any ligamentous injury, it is important to have imaging studies done to determine the severity of your injury. Through the aid of x-rays, your podiatrist can determine if there is any bone involvement and what approach needs to be taken to heal your ligament. It is important to seek medical attention because an injured ligament can become progressively worse if the proper precautions are not taken. This will result in your treatment plan being both more intensive and longer.

Although each injury is different, the proper treatment plan can be found for you. In no time, you will be back on your feet just like Jonathan Horton.  

Dear Santa: Please Make My Flat Feet Go Away

December marks the beginning of marathon shopping sprees. Everyone is searching for the perfect gift to give to one another; and often times this means endless hours at the malls. Then, you have to see if you can find a better price for the same item. So, to sum it all up, we spend countless hours on our feet running up and down across the mall for what seems like days on end. Unfortunately for some of us, our feet can be in a huge amount of pain by the end of the day. One of the causes could be flat feet.

A flat foot is a result of a flattened arch that can come from injury to ligaments, arthritis, wear and tear and many more causes. The problem with your foot being flat is that some people may experience no pain, while others can experience pain throughout their foot, leg and possibly even into their back. Because of the variety of manifestations, this condition can range from no symptoms clear up to debilitating.

There are some conditions that can give you a greater likelihood of developing a flat foot. These include obesity, diabetes, aging, pregnancy and injury. Some of these you have control over, but others, like aging, happens to the best of us.

If you are experiencing foot pain though, visiting your podiatrist can help determine what is causing your discomfort. If it is in fact a flat foot, there are several accommodations that can be done to relieve your pain. Orthoses are a great way to help correct your foot structure so that when you are walking you have an appropriate arch when your foot touches the ground. Orthoses can either be distributed to you that are a general type for particular foot types or they can be custom made for your foot. After consulting with your physician, they can help determine which one is the best option for you. If your flat foot is as a result of an injury, then steps will be taken to correct the underlying problem first and then determine if further treatment is needed. In some instances with children, their flat foot may be as a result of how their foot was formed. In this case, orthotics may be an option, but depending on the severity, surgery may have to be considered.

A flat foot can be a painful condition, but there is no reason that you need to live with the discomfort. Through the wide variety of treatment options available, your podiatrist can help determine which option is best for you. Then, in no time, you can be back on the hot pursuit for the perfect gift for all of your loved ones.

Ready, Set, Decorate!

Tis the season for present shopping, baking and decorating the house. Did you know that it is also one of the busiest times in the emergency room? One of the causes is many more people using ladders to hang up decorations than throughout the rest of the year. It’s all in an effort to get the star on the highest part of the tree or making the roof of the house look like twinkling snow. Next thing you know, you are reenacting Clark Griswold from National Lampoon’s Christmas Vacation, and you are lying on the ground, not only feeling silly, but possibly in an awful lot of pain. A lot of times, this pain can be in your foot and results from landing on your feet. Because unlike cats; we don’t always land just right on our feet.

In each of your feet, most people have five long bones that are called metatarsals. They serve to connect your toes to your heel. They function in helping us walk and forming the arch of our feet. They also endure a lot of stress throughout our lifetime. For the most part, they take on this stress and handle it without a problem. But every once in a while, the pressure will become to break and these bones will either partially or completely fracture. When jumping from a high place or falling off of a ladder, these bones are prone to injury because they cannot absorb that amount of stress.

Visiting your podiatrist can help determine what mode of action should be taken to alleviate your pain and fix these bones. Depending on the severity of your injury, they may opt to give you a walking cast, a brace, or if it is severe enough, you made need surgery. Through x-ray imaging, your podiatrist will be able to visualize the injury and determine which of these options will work the best for you. Make sure though, that in the time leading up to your office visit, that you are icing your foot and taking anti-inflammatories to help relieve the swelling in your foot.

The holidays are a busy part of the year, but it is important to take the time to make sure that you and your family can have a healthy and safe holiday season. So, stop by and let us help you get back up on your feet.

Kristen Stewart Can Handle the Super Natural and Aching Feet

Kristen Stewart injured herself several days ago while shooting her new film “Snow White and the Huntsman.” She claims that it happened when she was running around the set. This did not stop her from wearing high heels down the red carpet at the premier of her new “Twilight” movie. However, she chose to slip into some more comfortable sneakers for her interviews, saying that her feet were really hurting from wearing her heels.  

Our feet bear the brunt of our day to day activities, whether this is standing on them all day at work, running errands around town or doing our latest workout routine. Regardless of the activity, our feet function as the shock absorber to our daily routine.  For many of us, we switch between several different pairs of shoes throughout the day. There are the sneakers that we wear for our work out, the dress shoes when we go to work, the slippers to pick up the paper and the times that we are barefoot in our house. Each of these different types of footwear, or lack thereof, provides a different level of support to our feet.

There are many different things that can contribute to foot pain. One of the factors that we often overlook though is our shoes. Did you know that most women wear their high heels a half size smaller than what they should? This is because the design of the shoe requires you to; otherwise, your shoe would be slipping off of your foot with every step. The problem with this is that your feet are being cramped into a smaller space. This leads to blisters on your heel from the shoe rubbing up and down the back of it, blisters on your toes from them rubbing against each other and the shoe, and calluses on the bottom of your feet due to the additional pressure. All of these components combined lead to one unhappy foot. No wonder Kristen Stewart wanted to change into the more comfortable pair of sneakers.

It is important that you get your foot measured at least once a year, allowing you to see if your foot size has changed. This can occur due to a number of things, including weight gain or loss, pregnancy, and aging. Your shoe size is not going to be the same that it was when you stopped growing as a teenager; so it is important that we determine if our shoe size has changed. You may require a different size shoe due to the bone structure of your foot. If you have longer toes than typical, you may need a larger shoe, so that your foot can bend at the proper place for walking. This is something that your podiatrist can help you determine. They will also be able to suggest particular brands of shoes that will fit your shoe needs the best. This will allow you to give those little piggies all the space they need to be happy and pain free!

The Bump That's Got You Stumped

So, you are feeling pain on your heels when you wear your tight dress shoes or you go running. The discomfort you are feeling could be due to Haglund’s Deformity. It earned its nickname, because it often hurts the most when women are wearing their high heels. However, this is not a condition that only affects women. This comes from an enlarged bone on the heel that is irritated when your shoe rubs up against the enlarged bone. This deformity can cause pain in the area of your Achille’s tendon, swelling, redness and tenderness. Often times, you will find that wearing backless shoes will relieve the pain. This is because there is nothing applying pressure to your heel. However, for most of us, we can’t wear these shoes all day long.

With many other foot issues, this results from particular foot types. These include walking on the outside of your foot, a high arch and an inflamed Achille’s tendon. After years of repetitive walking on this part of your foot, the Haglund’s deformity will form and cause a broad spectrum of pain for the individual. This can be a condition that can limit your activity.

Your podiatrist can help relieve this pain through several different treatment plans. These depend on how large the bump is. This can be determined through X-Ray and from this a treatment plan that will best suit you can be determined. This can range from padding to surgery.

Choosing to work through the pain can lead to additional injury. The deformity can cause the bursa between the tendon and the bone to become inflamed. This leads to a condition called bursitis. By seeking immediate medical attention initially, you can prevent these other complications from occurring.

Since this condition is a result of a foot type, it is important to correct the underlying issue. Orthotics can be used to prevent you from walking on the outer edge of your heel. Your podiatrist can make an orthotic that matches your particular foot and can be made for the type of shoes you wear day-to-day. By correcting your foot type, it can help to prevent this problem from occurring in the future.

The Prosthetic that Saved a Young Elephant's Life

In recent news, it was reported that a young elephant, Chhouk, in Cambodia has received a prosthetic foot. After being found in a trapper’s patch, the elephant’s leg was severely injured and required 6 of the 8 inches of his leg be removed. With his new leg, he has been given a second chance with childhood and has been able to run through the forest and play with the other elephants. It is a sweet ending to such a terrible event.

Prosthetics are a medical breakthrough that has allowed many people to get back up on their feet again. Amputation, although often looked at as a terrible outcome, is a way to save a person from the dead tissue of their body extending further upward eventually affecting vital organs and resulting in death. Tissue death can result from many complications, including frost bite, ulcers, and trauma. The ability to be mobile is a requirement for many of life’s daily activities. For some, this is achieved by use of a wheelchair or a scooter, but for many, this involves walking on your own two feet. It allows us the ability, like Chhouk, to go running through the woods.

We have all seen the amazing stories of the young kids who will get two prosthetic legs and then complete marathons, play soccer, and live out their dreams. However, these are not the only type of prostheses. There are partial foot and total foot prosthetics available. This is because not all amputations require the leg to be taken off up to the knee. The podiatrist you are working with will work to conserve as much of your leg as possible giving you the quickest recovery possible.

There are also different types of prosthetics that allow different levels of range of motion. Depending on your activity level, the prosthetic that will help you maintain your daily routine will be selected. An important thing to remember is that through working with a podiatrist, many amputations can be avoided, especially those from ulcers. Your podiatrist knows the importance of your foot to you and your lifestyle and is committed to exhaust all other options before suggesting an amputation. In the case of Chhouk though, it was necessary, and modern medical science has saved his life.

The Not So Great Escape

Lindsay Lohan’s father may have broken his foot when jumping from a third story balcony to escape from the police. He has been arrested for making a harassing call to his girlfriend.

Broken bones can occur from many different types of injury including heavy impact, crush and freak accidents. There are 28 bones in the human foot which leads to many different locations that a fracture can occur. In some instances, the broken bone may give a person very little trouble and not affect their life in any major way. However, in other cases, the fracture can leave a person relying on crutches or even a wheelchair to get around. In either circumstance, a person can experience a great deal of discomfort from the injury.

It is important that if you suspect you have broken a bone that you seek medical assistance. With as many bones as there are in the human foot, there are also many nerves, arteries and veins that run close to these structures and can be injured as a result of the trauma. If this happens, many other structures can be affected including the muscles and tissues that rely on the arteries for blood supply and the nerves for signals from the brain. If these problems are allowed to persist, the foot can undergo much more damage than the initial traumatic experience.

With a fracture, it is important to set the bones so that they can heal properly. In some breaks, bone pieces will become misaligned and the bone will heal incorrectly. If this is caught right away the cure is much simpler than if the bone is given time to heal in the wrong place. The foot is also not as stable if the bones are not properly aligned. You can think of it like a building. If the trusses of a roof are not placed in the correct pattern, then the roof will be weak and will break down over time.

By visiting your local podiatrist, x-rays can be taken and further diagnostic studies done to assess the extent of your injury. Steps can then be taken to get you back on your feet as soon as possible. So, the moral of the story is always seek professional help in the case of an injury, and don’t jump off of a third story balcony.

Waking Up On The Wrong Side Of The Bed: Plantar Fasciitis

The beautiful fall weather is upon us.  This means colorful leaves, apple picking and cooler weather ideal for running. Runners are athletes that are prone to many different types of injuries due to the repetitive pounding of their foot against the ground throughout their stride. Some of the foot problems that occur can be a result of the individual’s foot type. One of these is known as plantar fasciitis.

Plantar fasciitis is a condition that results from doing the same motion over and over pulling and stretching a band of tissue on the bottom of your foot connecting the heel to the toes and contributing to your arch. This has been known to happen in construction workers that are standing on a roof all day, soldiers spending the day marching in formation and athletes who are constantly stretching and relaxing this band. It is a condition that is very common in middle-aged people, but is all present in younger people that are on their feet a lot.

For patients that have a flat foot type, where there is a constant stretch on that band of tissue, it becomes irritated over time and causes a great deal of pain. People will notice that their heel will suddenly be really sore when they first get out of bed or after they have been sitting for a long time. This pain can range from just enough to be annoying to being severe enough to cause debilitation. The condition is a relatively straight-forward one to treat, and something that a podiatrist sees on a regular basis. Often, the pain will be temporarily treated to get you back up on your feet, but for a long lasting effect, orthoses can be designed for your specific foot type. Orthoses give you long lasting relief by correcting your foot allowing it to avoid this flat position and prevent the constant stretch of your fascia. These orthoses can be designed to fit in any good quality running shoe and will in no way hinder the athlete. It will actually help you to get back out there and enjoy the sport without the pain that has been holding you back.

A common mistake is to try and push yourself through the pain. With this condition and many others, not treating the cause will lead to a greater amount of damage and a longer recovery time. For a runner, this means more time sitting out from your sport. In extreme cases, surgery could be necessary. So, to help prevent this, it is important to seek podiatric care as soon as you start to notice that something is not right. One of the many perks of being an athlete is that you know your body well, so make sure that you treat it right!

Why Can't I Feel My Feet: Diabetic Neuropathy

The holiday season is fast approaching, and with it comes all of the decorations, parties and cheer. There is also grandma’s famous fruit cake, mom’s delicious fudge and dad’s fireside s’mores. Once we get started with Halloween, it’s just one delicious treat after another. Let’s not forget the important ingredient that is in all of these delights though, sugar, and lots of it. Now anything is good in moderation, but for a diabetic, this is can be a difficult time of year.

Diabetes is a condition that plagues 8.3% of our countries population, and the numbers are steadily rising. We’ve all seen the scary pictures of the diabetic patient, but the good news for you is that diabetes is something that can be controlled. It is also a topic that has had a large amount of research put into it and there have been several quick tests that can be done by your podiatrist to monitor the condition.

An important thing that we are concerned about in people with this condition is Diabetic Neuropathy. This is just fancy medical terminology to say that the nerves of the foot are not working properly and you can’t feel something touching your foot. As a result, you can’t feel pain in your foot. So, your first thought is great! Nobody likes pain, but pain is your body’s warning sing that something isn’t right. Think about when you are walking down a trail and a piece of gravel gets stuck in your shoe. It’s annoying, but it’s not a big deal, because you’ll just stop, remove it and be on your way. For a diabetic patient who doesn’t feel the gravel, they will keep it in their shoe because they don’t even know it is there. This can lead to blisters and ultimately open sores on their feet that they won’t even know are there.

This is where a podiatrist comes into the picture. Through several quick, non-invasive tests, a podiatrist can determine if the patient has lost sensation in their foot and determine how far up their leg it extends. Then, through periodic check-ups, a close eye can be kept on the person to make sure they don’t develop ulcers. If they do, then the podiatrist will be able to take quick, aggressive actions to heal the wound as quickly as possible and prevent drastic surgeries. New data has shown that diabetic amputations can be prevented 85% of the time through working closely with your podiatrist to maintain the health and well-being of your feet and legs.

Diabetes is a long-term disease that requires a significant amount of teamwork between the patient and their physician. However, this does not have to be a condition that controls your life. The sooner that you form a partnership with your podiatrist, the better your results will be.

Salma Hayek Does "The Twist"

The acclaimed actress, Salma Hayek, has reportedly injured her ankle. While promoting her new movie “Puss in Boots,” she was seen wearing a bandage on her right ankle. The how? and when? of the accident have not been explained, but the actress has had to trade in her high heels for flats for the time being.

Most of us have twisted our ankle at one point or another. You are out for a run and you land improperly or you are running your errands and step off the curb the wrong way, it happens to the best of us. In the immediate aftermath of your injury, it is important to ice the area (20 minutes on and 20 minutes off) to decrease swelling and immobilize the joint with either taping or bracing. Once this is done, it is very important to get it examined right away.

Ankle sprains, also referred to as twists, can actually be divided into grades 1-3 each with a different form of treatment. These conditions commonly occur as a result of either an inversion (majority) or an eversion injury. Inversion refers to when the sole of your foot turns inward and you roll onto the outside edge of your foot, and eversion is the exact opposite with the bottom of your foot rolling to face outward, away from your other foot. In some people that experience these types of injuries frequently, it can be a result of their foot structure naturally being inverted or everted, and the way that the body compensates to allow us to walk and do their daily activities. As a result, it does not take much for their foot to shift even further into a more everted or inverted position and cause an injury. For these individuals, an orthotic custom designed by a podiatrist to their specific foot type can help correct for this and prevent further injury.

Spraining your ankle is something that should not be taken lightly. Ligaments can be torn or stretched resulting in long term damage that can affect your daily lifestyle. Many people will use pain killers to block the body’s warning sirens; they then zoom through the yield signs and end up causing more injury than what they started with.

Through seeking medical attention, the level of your sprain can be determined and a plan can be made for your recovery that will get you back to your normal routine. Statistics show that the number one risk for a sprained ankle is having had a previous sprain (80%). This statistic is due to a patient not having the stability they once had due to improper healing. Through seeking medical help, you can take the necessary steps to help prevent future injury.

Achilles Heel Strikes Again

Nigel Lythgoe, the executive producer of several reality tv shows, tweeted on September 24^th that Alex Wong, a fan favorite of "So You Think You Can Dance", has auditioned for “American Idol.” Alex appeared on season 7 of “So You Think You Can Dance,” but had to leave the show due to a ruptured Achilles tendon.  He was due to return to the show as an All Star for season 8 but was unable as a result of rupturing his other Achilles. After his many setbacks, it would seem that Alex is a believer of the saying “third times the charm” since he is ready to give television another shot.

So, what exactly is a ruptured Achilles tendon? The Achilles tendon is composed of the tendons of both your Gastrocnemius and Soleus muscles. The most common forms of Achilles injuries are Achilles tendonitis, Achilles Tear or Achilles rupture. These injuries tend to occur in long distance runners, sprinters and middle aged individuals starting a new workout regimen. Achilles tendonitis, or inflammation of the tendon, is typically characterized as a soreness or tightness on the back of your heel. A total Achilles rupture can sometimes occur with an audible popping sound and is a debilitating injury. An Achilles tear is often difficult to discern from a rupture or inflammation. By pinching the tendon lightly between your fingers, you will be able to elicit pain suggestive of inflammation.

Treatment for these conditions include a night cast to passively stretch the tendon, orthotic shoe inserts for patients with a pronated foot type, K-laser therapy (a non-invasive, pain free therapy) to stimulate tissue regrowth and healing, and as a last result, surgery. It is important to seek medical care from your podiatrist for this condition, so that the injury does not progress.

Are You At Risk For Falling?

As we get older our balance changes causing us to become unsteady and increases our chances of falling.  Many elderly patients come to our practice and have no idea that they are at a very high risk for falling.  Often our patients are frail and need to hold on to countertops and railings so that they don't fall in their home. Other patients come to us after they have a stroke and lose the use of an extremity.  

There are many contributing factors to patients becoming unbalanced.  One major factor is when they don't see well. Not being able to see where you are landing is a big problem. Hearing impairments affect the way we balance ourselves.  Muscular strength both in the foot and ankle area, as well as the upper extremities, can cause balance issues.  Seizures and stroke also can precipitate a fall.  Many of the patients that walk through our door are on medications that when taken together can also have effects on balance. 

At our office we can assess whether a patient is at risk of falling through an evaluation.  We evaluate simple things such as how a patient walks and how the patient gets out of their chair. How a patient turns and changes directions while walking can give us a good amount of information.  Gender and age also play a role in risk for falling.  We also have an in depth podiatric examination of the foot ankle to determine risk of falls. 

Patients who fall are at risk for possible fracture of the hip, which will require extensive hospital stays. There were a reported 15,000 fall related deaths last year. Of the people who are at risk for falls, 70% of them will fall within their home. Once a patient falls, the risk of a second fall becomes much higher.

As a podiatrist there are a number of exercises and modalities that we can provide to our patients.  I provide specialized bracing, which helps to support and stabilize the foot and ankle. With this brace when a patient stands they feel where the foot and ankle are inside the shoe.  We also do shoe exams on our patients to decide whether their shoe gear is contributing to their imbalance.

If you know someone who is unstable when walking, or a person with a history of falls, please have them contact us for an exam. We can make a difference in their lives and prevent falls and injuries in the future. 

Alex Trebek Jeopardizes His Ability to Walk

Alex Trebek, the famous Jeopardy host, tore his Achilles tendon Wednesday morning after chasing a burglar from his hotel room.  He jeopardized his ability to walk due to a sudden foot injury.  He tore the achilles tendon with a severe injury that will keep him off of his feet for a while. This type of foot and ankle injury can take a long period of time to recover from. 

 The Achilles tendon is the strongest flexor of the body. Its main action is to plantarflex the foot or to pull the foot in a downward motion.  It is the combination of two large muscles that do this: the gastrocnemius muscle and a small muscle called the Achilles. The two muscles originate from the back of the leg and knee area and join to form the strong Achilles tendon.  This tendon travels to the back of the heel bone known as the calcaneus.  The attachment is at the back of the heel bone. 

Achilles tendon injuries can be very hard to treat and the recovery time can be lengthy if not treated by a specialist such as a podiatrist. The initial feeling of this injury is as though someone took a bat and hit you in the back of the leg.  The injury can sometimes be seen as a visible gap in the back of the foot and ankle area.  Foot injuries such as this will usually have swelling and black and blue discoloration.  The other form is a rupture or a partial rupture.  Partial ruptures do not tear the entire portion of the Achilles tendon with a through and through rip.  With partial ruptures of the Achilles tendon you usually don't see a gap in the achilles tendon. You may not even see swelling or bruising. 

A quick treatment plan by a specialist, such as a podiatrist, can evaluate the patient with x-rays and possibly a diagnostic ultrasound.  It might  also be necessary to order an mri to better evaluate this type of foot and ankle injury.  Treatment totally depends on severity.  Treatment options range from casts, ankle or leg braces, custom bracing and sometimes surgery.  In most cases a foot specialist can evaluate and effectively treat this type of injury without surgery.

If you or someone you know suffers from pain in the Achilles tendon area and possibly has a traumatic injury, please feel free to contact us. We always have emergency slots in our schedule for problematic foot and  ankle injuries such as this. 

Juvenile Bunions Are More Common Than You Think

Boney prominences on the sides of the big toe are known as bunions. It is quite common to see these children. Bunions are partly due to shoe gear, pressure on the toe and the patients foot type. Bunions are also hereditary. The foot type that you have can increase your susceptibility to bunions. If a child has moderate flatfoot the possibility of having juvenile bunions increases moderately. 

Bunions develop on the side of the big toe joint on the foot. When a child wears a shoe there is an increased pressure on the side of the big toe. The pressure of the shoe on the bone you will get increased deformity at the site over time. Unfortunately if you have flatfoot this causes the patient to overpronate, which is the downward motion that occurs in the foot and ankle when we land. The other problem with flatfoot and bunions in children is that it causes the big toe joint to become unstable. This increases the possibility of more deformity at the site. Flat feet increases susceptibility to bunions, but there are several foot types that can cause a patient to develop bunions. There are other conditions where ligaments are loose that will eventually cause problems. When the ligaments are loose they do not restrict motion in the foot and cause bunions in children. 

Treatment plans vary for every patient. Conservatively treating juvenile bunions is the main concern. They should be wearing wide sneakers with a soft leather to decrease pressure on the bunion sites. An orthotic should be made, which is a custom made device that goes into the shoe or sneaker. The orthotic will decrease the pronation, or the way that we land, which in turn stabilizes the big toe joint. Orthotics will change where the big toe lies in the shoe, so we can decrease pressure at the big toe joint. If changing the shoes and using orthotics does not relieve the pain, surgery or bracing are the next options. Latex splints sometimes may be used on the foot to change the alignment of the big toe in the shoe, similar to a soft tissue manipulation. Soft tissue surgery is also a possibility. Surgery should only be considered as a last resort. 

Are Flip Flops Ruining Your Feet?

Although flip-flops may make you feet cool in the summer they are extremely bad for your ankles, knees, hips and even your back. Over time these injuries can lead to serious bone, tendon, and joint damage. Flip flop wearers tend to grip the flip flop with their toes, causing a shorter stride and have increased force when their feet hit the ground. This means a powerful force is transferred up our legs, putting additional stress on your lower body.  The way flip flops are made with a lack of arch support causes the feet to roll inward towards each other and cause pain and injury to the arch. If you do not have flat feet to begin with, you can become flat footed just from wearing flip flops.

These are not the only problems you can have when wearing flip flops. It is very dangerous being open toed. This causes a higher risk of stubbed toes, cuts, bruises, bug bites and dirty feet! If you want to wear open toed shoes, pick a healthier one. Start by looking for support. Choose sandals and flip flops with arch support, as well as an indent heel cup to hold the heel in place to prevent accidental slips. We have a line of sandals with great arch support with a built in orthotic. You can wear flip flops for a short period of time if you are going to the beach or walking around your house. It’s not too late to save your soles. If you are experiencing pain, stop wearing rubber flip flops. Change your shoe gear and if that doesn’t help see a podiatrist!

Why Do My Feet Go Numb When I Run?

Runners frequently complain of numbness in their feet while running.  This could be due to a number of reasons.  The most common reason for numbness is improper sneakers that may not be sized correctly.  Other reasons may be that the sneakers are laced to tightly. Lastly the patient may have a disease such as diabetes and a neurological issue has begun in the feet. 

The first way of treating numbness in the foot and ankle of a runner would be to be evaluated by a specialist. A podiatrist can take a look at your shoe gear and see if it is a proper fit. It is very important that your foot fits correctly inside the shoe. It’s also important to evaluate the way that a patient walks. We also feel the bony prominences of the foot in the sneaker to make sure that the patient fits correctly into the shoe/sneaker.  In our practice we have a shoe store where we will measure the foot correctly and recommend a choice of sneakers and footwear depending on athletic ability and deformity of the foot. 

The next possible problem that we encounter is shoelaces that are too tight. This is easily treated but there are some sneakers that cause moderate irritation on the top of the foot. This is because of where the shoelaces enter at what is called the eyelets.  The eyelets are the metal circular openings on each side of the shoe where the laces weave through.  Sometimes just changing the style of shoe where the eyelets are can achieve comfort for the patient. 

Lastly if there is numbness, burning, or pins and needles, the runner may have a secondary neuropathy.  Neuropathy is typically caused by diabetes, but can also be drug or alcohol related.  Neuropathy is extremely important to be evaluated for. It can cause a permanent loss of sensation that occurs in the foot and can be extremely painful.  The first step would be to see a foot specialist who can evaluate the problem effectively. In our practice we can effectively diagnose if a patient has neuropathy with a skin biopsy.  This is a very definitive test that we rely on to diagnose this problem. There are a multitude of treatments to treat this problem including medication, physical therapy, and pain management with a take home therapy treatment. 

So in review, numbness or tingling sensations noted in a runner can be caused by several factors. The most popular being shoe gear, which can easily be evaluated.  In our practice we routinely measure and evaluate patients for proper shoes and/or sneaker. Lastly, do not run long periods with numbness. It is a sign that something is happening to your foot and ankle and should be addressed by a foot specialist.

Running is Killing My Nails! What Can I Do?

Running is a great sport for cardiovascular strength, stamina and health, but the reality is it can cause a lot of harm to the feet.  When we walk, the big toe extends and helps to hold up the arch.  A myriad of nail problems can occur in the runner. When we run we accentuate the pull of the big toe in a shoe and can increase stress.

As a podiatrist one of the most common problems I see is a blood clot, or hematoma, under the nail.  This problem is very common because of the trauma to the nail when it hits the top of the shoe. If the hematoma is covering greater than 75%, I will elect to remove the nail entirety.  The reason for this being that if the nail has greater than 75% blood, the nail will de-roof at some point anyways. Our worry is that pus will develop under the nail. Trauma caused by running often results in infected nails, also known as paronychia. This is a collection of pus under the nail often seen on the sides of the nail, but it can occur anywhere. Sometimes trauma will cause the nail to grow in irregular ways. The way it grows will cause infections.  Treatment is aimed at getting rid of the infection. Typically what we will do is numb the toe with anesthesia and remove the side of the nail that is causing the infection and write a prescription for an antibiotic.  Soaking instructions are provided to the patient to facilitate proper healing. We try to remove the entire margin of the nail permanently, so that the patient does not have a chronically ingrown infected nail.  Treatment for runners who want to be on their feet and exercising daily is taken into consideration, so that painful conditions don’t recur and cause any slowdown in runners’ ability to exercise.

Thick discolored nails, which is a sign of fungal infection in the nail bed, is also very common in runners.  Onychomycosis, or nail fungus is a caused due to injury in many athletes.  Runners can get nail fungus from their shoes and sneakers being too narrow or not having enough depth. Treatment options are multiple for nail fungus.  The most common approach for nail fungus is topical medication that kills the fungus by penetrating the nail.  Other options are removing the nail and having a new one grow back. A topical antifungal cream is applied until a new one grows back. Other avenues for treatment are oral antifungals, but the risk of liver damage is high and I question the true effectiveness.  One option that is available, but rarely use, is total and permanent removal of the nail.  One of the more popular trends for fungal nails is laser treatment that kills the nail fungus where the nail begins to grow.

For runners the most important evaluation for preventative measures is addressing shoe issues. Crowding of the toes, foot, and ankle can cause a multitude of problems in the running population.  Evaluation by a podiatrist can determine what type of shoe gear a patient will need according to their running style, stride and endurance.  Many of the above nail conditions can be treated effectively with proper sneakers.  For runners with nail fungus, not only does the shoe need evaluation, but also it is important for the foot specialist to treat the cross infection from shoe to the foot.

Dr. Wachtel on Athlete's Foot

Why Are High Heels Bad For Your Feet?

Wearing high heels may be fashionable and make you feel taller and sexier. However, they are not only bad for your feet, but also can cause problems with the rest of your body. In your posture it can cause increased pressure on your toes, which will cause you to adjust the rest of your body to maintain your balance. The lower part of your body leans forward and the body’s response is to decrease the forward curve of your spine to help you keep in line. Also high heels can cause your upper body to lean backwards, which is not a normal standing position.

High heels also cause pain when you are walking. When you wear high heels your hip flexor muscles and your knee muscles are working harder then normal, which can cause discomfort. Balance is one of the most important things that are affected by heels.  High heel shoes cause your foot and ankle to move in a suppurated (turned outward) position causing risk of falling and spraining your ankles.

Your back is another part of the body that you can hurt while wearing high heels. Your back is in the form of an s-shape that acts as a shock absorber and reduces stress on your vertebrae. Wearing heels causes the lower part of your spine to flatten and causes displacement of your head and mid-back spine.  Poor alignment can lead to overuse in your muscles and cause severe back pain.

As for your hips, the hip flexor muscles are located on the upper front part of your thigh. When you wear high heels its causes your hips to work harder and longer to help you walk. While wearing heels your feet are being held in a downward position and have reduced your power to move forward. If your flexor muscles are overused it can cause major pain and lead to flattening in your lower back.

Did you know that osteoarthritis is twice as common in women? Some of that is due to wearing high heels! The knees stay flexed and the shinbone turns inward when wearing heels. This position puts a force on the inside of the knee. If you already have osteoarthritis I would stay away from wearing high-heeled shoes.

With your foot in a downward position it can cause an increase in pressure on the bottom of your foot. This causes foot deformities including hammertoes, bunions, and neuromas. The narrow part of high heels can also cause corns, calluses and blisters. Have you ever seen a babies foot and compared them when an adults foot? The babies’ toes are spread apart and an adults’ toes are squished together. Harmful shoes could cause this.

When it comes to a special occasion its okay to wear high heels, but don’t wear them on a daily basis. It’s in your best interest! You don’t want your body to ache and your feet to hurt now do you?

Does Duct Tape Treat Warts?

Most people have heard the old wives tale that duct tape is an effective treatment for warts. If you understand in full how warts come to be and what they are caused by, you can easily understand that this is just a story. Warts are a surface virus that we routinely see in our practice.  Plantar warts are caused by contact of the skin on a moist surface.  The name of the virus is the Human Papilloma Virus.  If someone touches a moist surface with an exposed wart and you contact that surface within a short period of time, you can wind up developing warts.

Warts appear in many ways. Most commonly you will see a thickness of skin on the bottom of the foot, but the wart can be seen elsewhere on the foot.  Typically you will see a little black specks under the lesion, which are small capillaries or vessels.  These lesions are typically painful to walk on. The problem with warts is if they are not treated by a specialist, such as a podiatrist, the possibility of another outbreak with many other lesions developing over time is a possibility.

Duct tape has long been thought of as a remedy for warts.  Of the hundreds, if not thousands of warts I have seen I have never seen this as a cure.  There are multiple studies that have disproved this treatment.  Simple debridement of a wart by a foot specialist with application of a strong acid is our first treatment choice.  Patients are sent home with a home care kit of a special antiperspirant (moisture control agent) for the foot and an acid treatment.  We recommend patient apply it twice a day.  Moisture control is of  paramount  importance in treating plantar warts because warts love moisture.  Within a few short visits to our practice we usually see resolution of the annoying painful lesions.  If conservative care fails we will provide surface laser treatments to our patients.  Surface laser is relatively new and requires no anesthesia or injections and works on disturbing the blood supply to the warty lesions.   Other treatment options are excision of mass with a scalpel and complete destruction the wart with another type of laser.

As you can see there are a multitude of ways a podiatrist/foot specialist can provide care to this pesky problem. Ways to avoid warts are always to wear shoe gear, whether it be a shoe or a sandal.  When going into public showers always wear flip-flops to decrease possibility of skin contact.  When diagnosed with a wart by your foot doctor make sure you bleach your floors, especially in the shower area.

Is My Child's High Arch Normal?

Children who are born with a high arch foot face many challenges.  Cavus or high arch foot tends to have a c shaped foot.  Over time cavus foot can lead to a host of problems from the foot ankle and leg, all the way up to the hip and back.  Due to the high arch it causes the foot to be inverted. Inverted feet tend to cause imbalances in the foot, which cause children to walk on the outer aspect of their feet.  This foot type can cause chronic ankle sprains because of the way the patient lands while walking.  The Achilles tendon, which connects the back of the foot to the heel bone, may be affected as well.  Another common pediatric problem is in-toeing, or the toes pointing towards the inside of the foot. There are some patients that develop tendonitis on top of the foot or on the outer aspect of the foot which are all caused by the rotation of the foot.  Some patients develop pain on the bottom pads of their feet called metatarsalgia. This is caused by the rotation or downward rotation of the long bones of the foot called metatarsals.  There is a natural fat pad we are born with, which deteriorates because of how far down the heads of the bones are. Other parts of the body besides the ankle and foot are affected; the knee can be rotated out, causing strain on the knee, hip and back.  

When a child begins to walk, parents should note what their feet look like and how they are walking.  If you notice they are walking on the outside of their foot and suspect a high arch foot we recommend you seek a podiatrist.  A foot specialist who treats children regularly in their practice can notice problems in structure, the way they walk.

These foot problems can be noticed in newborns. If deformities are seen one and appear severe, which is rare, some patients are put in casts to change the actual shape of the foot. Another way of way of treating a high arch foot is through orthotics put in the shoes that change the way the foot is positioned.  As the child begins to walk the best way to treat a high arch is with a custom orthotic.  A custom orthotic will support the foot correctly and decrease pressure on the different parts of the foot. You decrease the possibility of spraining your ankle and the foot is put in a position where it can act in a more stable position.

Patients with this foot type should be evaluated regularly, especially with children to make sure the orthotic fits the foot correctly and is doing it's job.  The other part of using orthotics in a child is for the podiatrist to evaluate shoe gear to make sure the orthotic fits and is supported correctly.  If the problem is severe enough there are surgical procedures that a foot specialist can determine to be necessary.  Some procedures used for cavus or high arch foot is an actual cut in the heel bone to change the angle of the heel bone. There are also implants used to change the ankle joints position.  As always surgery is a last option.

If you notice this type of deformity; c shaped foot- the first thing that should run through your mind is the thought that this type of deformity can lead to a multitude of physical problems for your child as they grow into adulthood.  Please consider a podiatrist for an evaluation.

Laser Therapy in Podiatry

Laser therapy has come along way in the profession of podiatry. Lasers in medicine have a multitude of uses.  In a podiatry practice there are several uses for a laser. There are various lasers for wart therapy. Laser treatment for wart therapy are classified in two categories. The first is needing to excise or remove the warty lesion. There are two types of lasers that can treat this type of wart. One is a surface laser, which does not require injecting the patient to treat the wart.  Surface lasers for warts on the foot and ankle are performed in an office or hospital setting, depending on the case.  Surface laser is provided in multiple treatments. With surface lasers, in addition to no injection or numbing, the patient also has no postoperative healing period.   The other form of wart therapy starts with excising the wart on the foot or lesion with a scalpel blade and then using the laser on the affected area.  This is a one shot deal where after you excise the wart, it is eliminated.  When removing a wart with a laser on the foot; the postoperative course depends on how big a lesion is and how many.  Sometimes if the area removed is very large the postoperative healing can be considerably longer.  With this type of laser you can also remove scars that develop in different parts of the foot and ankle.

 The other form of lasers podiatrists use is a laser used for fungal nails.  Fungal nails are also known as onychomycosis.  Years ago there were not many affective remedies. These included completely removing the thick fungal nails permanently, taking liver toxic antifungal medications, and a daily application of topical medication that never truly penetrated the nail to kill the fungus.  In this new technological age many foot doctors are using this kind of laser to eradicate nail fungus. Patients typically have to come in for about 3-5 treatments.  The laser has a beam that sweeps over the toenails and pours oxygen into the nail and nail tissue.  Lasers oxygenate the tissue, which effectively kills the fungus in the toenail.  Podiatrists specialize in the care and treatment of toenails and have found that this is a safe and effective way of treating onychomycosis. 

Other things that need to be considered are shoe gear that is too tight or does not have enough depth for the toes to lie comfortably inside.   Evaluation by a podiatrist can help to ensure that the shoe you are wearing lets the foot rest comfortably in the shoe. If the foot is too crowded in the shoe it is likely that the toenails will get damaged.  The main reason for nail fungus is trauma, so if we remove the trauma that the shoe inflicts on the nail, we have a better chance of stopping recurrence of the nail fungus. 

Lastly there are a few other things that a podiatrist can give to their patients to put inside their shoes.  Feet sweat constantly and the sweat that builds up can cause fungus in the skin. It is important to treat the shoe and prevent the spread of fungus from the skin to the shoe and back to the skin again. As you can see it is quite important to have a qualified podiatrist evaluate your nail problems completely.  In our office we evaluate the nail, the skin of the foot, the shoe gear,  and the inside of the shoe gear to effectively treat onychomycosis of the toenail. To date laser is the most effectively nontoxic way of treating nail fungus. 

My Child Has Heel Pain. Is This Normal?

Heel pain in a child, contrary to popular belief, is not  normal and should be evaluated by a podiatrist promptly.  Heel pain in a child is usually due to an injury  in the heel. As a child grows the heel bone is not completely fused.  The area of injury in the heel bone is where the two pieces of bone fuse to become one. This is where injury occurs for children.  Typically, heel pain in children occurs in girls between 8 and 10 and in boys at 10 to 12 years of age. It is not until an adolescent turns around sixteen that the area completely fuses.  When an adult presents with this type of pain, it is more of an inflammation of the heel area and not a disruption or injury to the cartilage in the heel bone area. 

Sever’s diseases or  calcaneal apophysitis is often the cause of heel pain in children.  The typical pain is around the the sides of the heel, back of the heel, and on the bottom of the heel.  We will note if the pain increases with activity; especially during sporting activities.  The pain  will lead to tightness of various muscles because the body is compensating for the heel pain.  Achilles tendonitis commonly occurs along with the heel pain in the foot . The Achilles can get so tight that pressure of this extremely strong tendon against their heel  bone can traumatize the bone. This causes an injury of the growth plate of the foot. 

Treatment promptly by a podiatrist is necessary for heel pain in children. This will decipher whether there is an interruption in the growth plate or a real fracture, which is quite rare.  A foot specialist will take an X-ray and evaluate the bony structures of the foot and ankle area.  Once they are diagnosed with Severs disease or osteochondritis; the main focus is to decrease activity.  We typically don't recommend a complete cessation of activity but a decrease in physical sporting activity.  Icing the heel area for intervals of twenty minutes three times a day is very helpful.  Heel cups which are shock absorbers may be of some benefit.  In our practice we recommend custom orthotics  for this, which if casted correctly will effectively control the foot and ankle motion and decrease pressure in the heel area. Custom orthotics can also effectively decrease the pressure of the Achilles tendon on the heel bone.

Dr. Oz Talks Feet

On January 25, 2011 Dr. Oz did a piece on nail fungus. This is probably because nail fungus is becoming a very common problem.  Nail fungus occurs in the toenails of the foot.  Nail fungus in toenails can be identified in many ways. The toenail may be thick and turn white, yellow, and brown. Fungal infections in the nail are called onychomycosis.  Many patients develop nail fungus in the nail, and if not treated effectively all of the nails can become infected.

The problem with nail fungus, or onychomycosis, is that if it does go untreated the thickness of the nail can cause ingrown nails or an infection of the nail.  Many times patients who are diabetic and have onychomycosis can have complications, such as infection, just from the thickness of a toenail. Patients that have diabetes or other patients that may be compromised, sometimes have a hard time healing from infections caused by the nail.  This is why it is so important to treat toenail fungus to prevent further progression.


There are multiple causes for nail fungus or onychomycosis.  The most common reason for nail fungus is trauma.  Trauma occurs either by the actual bumping of the nail against a surface, like stubbing your toe, or more commonly tight shoe gear. Fungus grows from inside the shoe and cross infects the skin. It can be an ugly cycle of shoe to skin and skin to shoe fungal infections.  Lastly instruments that are not properly sanitized may play a role.

Dr. Oz mentioned treatment with vinegar for onychomycosis, which we feel is a myth. Oral medications for nail fungus are quite toxic for the liver and should be prescribed with caution.  Some of the newer, more effective treatments include mechanically cutting the nail and thinning it out. This should be performed professionally by a podiatrist.  There are very effective topical treatments for onychomycosis.  A new topical medication called Formula3 is a very effective way of treating nail fungus. This medicine penetrates through the nail to the nail bed to kill the fungus.  The new technique for eradicating onychomycosis is laser treatments, which are effective and safe.  Podiatrists are now providing laser treatments from their offices.  You can see the results anywhere between six to twelve months from the end of the treatment.  One other problem we see in most patients is improper shoe gear. This occurs because we walk with the toes extending upwards, which hit the top of the shoe. It would be wise to have a foot doctor evaluate the shoe gear and prescribe a shoe that has enough width for the sides of the toes and enough depth for where the toes extend (extra depth shoes are useful).  Lastly treating the shoe is just as important as treating the nail infection to prevent recurrence of the nail infection.   There are devices that can irradiate the shoe to prevent fungal infection.  Moisture control of the skin of the foot should be evaluated as well.  The best clinician to evaluate these problems would be a podiatrist.