What Is Wrong With My Foot?

Skin Problems

Bottom of your feet
Problem: It feels like you are walking on pebbles
You may have: plantar warts


Heel or ball of feet
Problem: Thick tough skin on the heel or ball of the foot
You may have: a callus, corn, blister or skin growth


Toes
Problem: Red, peeling, cracking, burning, and itchy skinYou may have: Athlete's foot or shoe dermatitis


Toenail
Problem: Red, swollen and painful skin
You may have: ingrown toenail or an infection


Soles
Problem: red, swollen, painful soles of the footYou may have: bacterial infection

Joint Problems

Toe Joints
Problem: rapid pain, redness, swelling, and heat
You may have: gout or an infection


Problem: swelling or bump at the base of the big toeYou may have: a bunion


Problem: swelling or bump on the outside of the little toeYou may have: a bunnionette


Problem: joint pain, stiffness and swelling
You may have: arthritis, lupus, or gout

Numbness or Tingling

Between Toes
Problem: pain, burning, tingling or numbness in the 3rd and 5th toes, or ball of the foot
You may have: Morton's neuroma

Back & Leg
Problem: pain, numbness, and tingling that begins from the back all the way down the leg to the foot
You may have: pinched nerve


Foot & Ankle
Problem: numbness or pain in the foot or ankle, or a weakened foot
You may have: pinched nerve in the ankle or back


Feet
Problem: burning, numbness or lack of feeling
You may have: poor circulation or PAD

If you have any of the above problems, make an appointment with my office for a diagnosis. The above are generalized & does not constitute an official diagnosis.

Citation:
Image by Praveen Tomy. (2006). Pebbles. Retrieved from http://www.flickr.com/photos/praveenmt/3220243348/

When to Examine Children's Feet

As a new parent, have you wondered when you should start examining your child's feet and what you're looking for when you do examine? Here's a general guideline to get you started.

Birth - Newborns should have their foot and legs examined for any potential problems. Podiatrists look for abnormalities such as clubfoot, overlapping toes, web toes, and extra toes. If there is any limitation of motion or problem, it will be addressed immediately.
4-6 mo - Next evaluation should be done at four to six months of age, right around the time that children are beginning to stand. Podiatrists will make sure that the child is developing normally and will have no problems in the upcoming months learning to walk.

1 yr - Around the one year mark, the child begins to walk. Podiatrists will look for conditions like flat feet, bowlegs, knock knees, leg length differences, and any ankle problems.

Annually - Checkups are essential for proper foot care and prevention of problems. As the body changes and grows, so do the feet. This will help identify and allow treatment of most conditions without letting them get too advanced.

Aside from regular checkups, if a child is experiencing any of the following, make an appointment to have their feet look at right away.

• shoe wear is uneven
• lumps or bumps are evident on the feet
• pain in the feet or legs exists
• tripping and falling occurs
• skin or toenail problems are present

Citation:
Image by 5 flip-flops Earl. (2012). Kaitlin's foot. Retrieved from http://www.flickr.com/photos/pics2enjoy/807017660/

Detecting Foot Problems in Children

Feet and ankle problems often go unnoticed in children. If not caught early, problems can escalate and make treatment difficult. In between checkups, parents can help reduce or eliminate problems by inspecting the child's shoes and feet.

Let's start with the foot inspection:

1. What is the size of each foot? Don't just measure one foot and assume the other one is the same size. Most people have one foot that is larger. Have feet measured at the store, which unfortunately means you have to bring the child with you to the store. 
2. Do you notice any blisters, bunions, corns or spots that are just plain red and irritated? 
3. Do you see any large patches of excessively dry skin? 
4. Give your child a foot massage and watch for signs of pain or cramping. 
5. Make note of any problems that necessitate a visit and make an appointment. 

To determine if shoes need to be replaced and not break the bank doing so, inspect current shoes prior to purchasing new ones.

1. If shoes are snug and too small, purchase new shoes. Shoes that are slightly too big can be worn as long as they will not hinder the child's walk. 
2. What does the sole of the shoe look like? Was it thin to begin with? Is it thinning due to use? 
3. Is either heel loose? 
4. Does the child have adequate toe room? Are there places where the shoe rubs and causes friction against the skin? 
5. Evaluate the child's walk in the shoes compared to how they walk barefoot. 

Depending upon the answers, some shoes can be repaired instead of replaced. 

Citations:
Basson, Kent. Disabled World towards tomorrow. (2008). Healthy Feet for Children. Retrieved from http://www.disabled-world.com/artman/publish/child-feet.shtml#ixzz22z0oUAd8
Image by Gramody. (2008). Feet! Retrieved from http://www.flickr.com/photos/gramody/2362085621/

Bump On Your Foot?

A bone spur is a bony growth formed on a normal bone. Most people think of something sharp when they think of spur but actually a bone spur is smooth. A spur can cause wear and tear or pain when it presses or rubs on other bones or soft tissues such as ligaments or tendons. Common areas for spurs on the foot are the toes and heel.

A spur is formed by the body trying to repair itself when rubbing, pressure or stress is experienced. Most commonly these occur as part of the aging process. As we age the tissue called cartilage that covers the ends of the bones within joints breaks down and wears away. Over time this leads to swelling and in some cases bone spurs.

Bone spurs can also form in the feet in response to tight ligaments. Activities such as dancing and running as well as pressure from being overweight can put additional stress on your feet. A heel spur can form on the bottom of the foot as the ligament becomes stressed or tight, and it can pull on the heel causing the ligament to become inflamed. As the bone tries to heal a bone spur can form.

Many people have bone spurs without even knowing it, because most cause no symptoms. However, bone spurs in the foot can also cause calluses when tissue builds up to provide added padding over the bone spur. An X-ray can be taken to evaluate whether a spur is causing the issue or not.

Bone spurs don't always need to be treated unless they are causing pain, discomfort or damaging other tissues. Treatment can be directed at the cause, symptoms or the spurs themselves.

Treatment at the cause of bone spurs include:

• Weight loss
• Stretching the affected area if it is the heel
• Ultrasound
• Deep tissue massage

Treatment directed at the symptoms include:

• Rest
• Ice
• Stretching
• Ibuprofen
• Changing footwear
• Orthotics
• Padding to the affected area
• Steroid injection
• Surgery

Citation:

Photo by Debra Roby. (2007). Toe pre-surgery. Retrieved from http://www.flickr.com/photos/darinhercules/348105594/

5 Tips for Running in the Cold

With winter fast approaching, even though it might not seem that way with the 70 degree weather we've been having here in Chicago, runners will soon be turning to their treadmills instead of facing the cold wind and temperatures. Keep in mind that runners can still run in the cold, they just need to take a few precautions to keep warm and safe.  We do live in Chicago where the weather can change multiple times a day. Don't get stuck in the cold. Follow these tips to keep your feet warm during cold weather running.

• Wear the right socks. I know its tempting to grab your regular old cotton socks, but they don't wick away moisture. Wicking socks are made of fabrics like acrylic or wool.  Use two pairs of socks. Saying Chicago can get pretty cold is an understatement. If it is really cold, wear one lighter sock made of synthetic material and then a thicker wool sock over the thinner sock. Be advised that your running shoes may not fit properly with two pairs of socks. In that case, purchase a second pair of running shoes 1/2 size bigger than you normally wear.  
• Use hand warmers in your running shoes. Put them inside your sock on top of your toes. Once your feet are warm, they can be taken out as to not overheat.  
• Avoid puddles, slush, and snow. Use a little common sense!
• Choose the right shoes. For running in cold weather, choose a shoe with little mesh since that is where water and cold can get through.
• Wear a hat. What do hats have to do with feet? You can lose up to 40% of your heat from your head. To keep the rest of your body warm, wear a hat.  

Citation:
Image by Jennoit. (2008). Winter run. Retrieved from http://www.flickr.com/photos/benandjenn/2337822453/

Take Care With Basic Care

Feet should be frequently inspected for changes, but diabetics need to be diligent in their foot care.

Feet are not that large and don’t change that much, so what do you look for when inspecting feet?

• puncture wounds
• bruises
• pressure areas
• redness
• warmth
• blisters 
• ulcers
• scratches and cuts 
• nail problems

Some areas of the feet may be difficult to inspect by yourself. Ask a family member for help or use a mirror to inspect feet daily.

Here's some basic advice for taking care of your feet:

• “Always keep your feet warm.
• Don't get your feet wet in snow or rain.
• Don't put your feet on radiators or in front of the fireplace.
• Don't smoke or sit cross-legged. Both decrease blood supply to your feet.
• Don't soak your feet.
• Don't use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet.
• Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, contact our office.
• Use quality lotion to keep the skin of your feet soft and moist, but don't put any lotion between your toes.
• Wash your feet every day with mild soap and warm water.
• Wear loose socks to bed.
• Wear warm socks and shoes in winter.
• When drying your feet, pat each foot with a towel and be careful between your toes.
• Buy shoes that are comfortable without a "breaking in" period. Check how your shoe fits in width, length, back, bottom of heel, and sole. Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. Wear new shoes for only two hours or less at a time. Don't wear the same pair every day. Inspect the inside of each shoe before putting it on. Don't lace your shoes too tightly or loosely.
• Choose socks and stockings carefully. Wear clean, dry socks every day. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toes socks will not squeeze your toes. Avoid stockings with elastic tops.”

Citation:
Vittori Foot & Ankle Specialist. (2012). Diabetes and your feet. Retrieved from http://www.vittorifootclinic.com/library/1800/DiabetesandYourFeet.html

Image by Matthew T. Rader. (2008). My feet. Retrieved from http://www.flickr.com/photos/infinite-magic/497036269/

Diabetics Need a Team of Physicians

Diabetes affects almost every family these days. The statistics are profound. Take a look at this staggering infographic that the American Podiatric Medical Association has compiled.

Those recently diagnosed with Diabetes should realize they are not alone. A team of doctors will help keep the disease under control and help guide the individual through medical treatments.  Get to know what each doctor or specialist does to keep diabetes in check.

Primary Care Physician – This is one’s family physician, general physician, or internist. They play the role of coordinator by referring to other specialists. When one is seen by a specialist, progress reports are sent to one’s primary care physician. Primary care physicians and specialists work together and keep each other update on the progress of the patient.

Podiatrists – If you’re reading this blog, you know that we treat lower extremity issues of the foot and ankle. It’s imperative to see a podiatrist at least twice a year to reduce amputation rates by 45 – 85%. Diabetes reduces blood flow to the feet and hinders circulation which is why amputation of the lower extremities happens. Many foot complications occur from diabetes; loss of feeling, burning, tingling, nerve problems, circulation problems, and amputation.

Endocrinologist – These physicians deal with hormones and the changes that occur due to the disease. Diabetes affects the endocrine system and endocrinologists focus on how the body is producing insulin.

Dentist – You might be wondering why seeing a dentist is important, but dentists play a key role in diabetes management. Those with diabetes are more susceptible to gum disease and mouth infections resulting from excess blood sugar.

Ophthalmologist/Optometrist – Diabetes affects the eyes, resulting in diabetic eye disease due to restricted blood flow. Just like managing circulation to the feet to prevent amputation, this disease can be prevented if regular check-ups are done.

Vascular Surgeon – They manage vascular diseases, which increase the longer one has diabetes. It’s important to manage blood pressure, stop smoking, eat right, and exercise to minimize vascular diseases.

Pharmacist – Get to know one’s pharmacist. They check to make sure that all prescriptions prescribed by all doctors won’t counter each other or cause unnecessary problems. They also inform diabetes patients about the risks of each prescription. Even if one is taking over the counter medication, consult the pharmacist first to ensure it won’t react badly with other medications.


Citation:
American Podiatric Medical Association. (2012). Footprints. Retrieved from http://www.apma.org/files/FileDownloads/APMA%20Diabetes%20Special%20Edition%20Footprints_2012.PRINT.pdf
American Podiatric Medical Association. (2012). Diabetes by the numbers. Retrieved from  http://www.apma.org/files/images/kyso12_infographic_800.jpg

Broken Bones: Stabilizing & Medical Treatment

The first thing one should do if they believe they may have broken a bone in their foot or ankle is to stabilize the injury and then elevate it. The second step is to contact your Podiatrist, Dr. Vittori, for X-rays and proper medical treatment of the injury.

Stabilizing the injury:

• Find a splint that will keep the injury from moving around. The splint can be as simple as a pillow wrapped around the foot which can be tied with a bandage.
• Do not wrap the foot too tightly. The injury needs to have blood supply circulating. The signs to be aware of if the injury is wrapped too tightly are if the injury hurts worse, turns blue, or if one is unable to wiggle their toes.
• Elevate the injury by lifting the foot at a level which is higher than the rest of the body. This will reduce swelling and pain.
• Ice can also be used to minimize the swelling and pain. Apply ice that is wrapped in a towel and do not put the ice directly on open skin.
• After the injury is stabilized, contact your Podiatrist, Dr. Vittori, since treatment of broken bones varies depending upon what part of the foot or ankle is broken.

Common treatments of broken bones in the foot or ankle:

• Some broken bones in the foot and ankle require the individual to remain off of the injury by using crutches or flat-bottom shoes.
• Other broken bones require the use of splints and casts.
• The most extreme treatment involves surgery to repair the foot.

Citation:
Image by Matthew Cashmore. (2007). Broken toe. Retrieved from http://www.flickr.com/photos/mattcashmore/515785363/

An Athlete's Worst Fear

A tear in the Achilles tendon is an injury that every athlete fears, as it’s the tendon that is torn the most often. Non-professional athletes are just as likely to tear this tendon or suffer from Achilles tendonitis, which is when the tendon becomes inflamed.  The Achilles tendon is a unique tendon because it can withstand 1,000 pounds of pressure. As the largest tendon in the body, it has to be able to support a person jumping, running, and every type of movement that one can think of. One knows there is a problem when pain occurs after exercising and it doesn’t get better. Pain will be localized near where the Achilles tendon and the heel bone meet. Swelling and stiffness can occur.

There are many ways one can tear the Achilles tendon or get Achilles tendonitis. What should one do if either of these occurs?

First, make an appointment with a Podiatrist to get checked out and get a proper diagnosis. Restricting the movement of the foot and ankle through a bandage or cast along with rest will minimize the pressure that is placed on the tendon. If the Achilles tendon is swollen, anti-inflammatory medication helps to reduce the swelling and minimize pain.

Moving forward, it is often suggested to wear orthotics to help support the muscle and relieve some of the stress that is placed on the tendon while exercising or playing a sport. If the sport or exercise is what is causing severe pain and Achilles problems, one might be advised to play a sport that is not as intense on the limbs, joints, and tendons. Swimming is a great exercise and sport that doesn’t stress the tendons. Proper stretching can’t be stressed enough. Weak muscles can cause tendon problems.

In the case of an Achilles tendon tear, surgery is a treatment option. In those cases, physical therapy is required after the surgery in order to strengthen the muscles groups and tendon. Recovery time of an Achilles tendon tear is much longer than a when the Achilles is inflamed or swollen.


Citations:

Image by Phallin Ooi. (2007). Football. Creative Commons. Retrieved from http://www.flickr.com/photos/phalinn/371857372/
Vittori Foot and Ankle Specialist. (2012). Achilles tendonitis. Retrieved from http://www.vittorifootclinic.com/library/1749/AchillesTendonitis.html

What Tech is Right for Which Ailment?

Podiatrists stay on the cutting edge of technology by using a number of diagnostic procedures to determine a diagnosis and treatment plan. Let’s a look what diagnostic imaging is used for what condition; MRI, X-ray, and ultrasound.

MRI (magnetic resonance imaging) uses large magnet and radio waves to create 3-D images of the foot and ankle. MRI’s are used to look at soft tissues and bones for the following:

• Arthritis.
• Fractures.
• Infections.
• Injuries of the tendons, ligaments, or cartilage.
• Tumors.

X-rays use radiation to look at the bone to determine fractures and the following:

• Evaluate changes in the bones from infections, arthritis, or other bone disease.
• Assess whether a child's bones are growing normally.
• Locate foreign objects (such as pieces of glass or metal) in a wound.
• Determine whether bones are properly set after treating a fracture.

Ultrasounds are not just for determining the sex of a baby. They are used to determine soft tissue problems in the foot and ankle by using sound waves.

• Bursitis.
• Heel spurs or plantar fasciitis.
• Injuries of the ligaments, tendons, or cartilage.
• Morton's neuroma.
• Presence of foreign bodies.
• Soft tissue masses.
• Tarsal tunnel syndrome.
• Tendonitis or tears in a tendon.

Citation:

Image by Liz West. (2004). XRay tech. Retrieved from http://www.flickr.com/photos/calliope/254119847/

Score Your Foot Health - Quiz

Magazines are filled with assessment quizzes. Why not take this quiz from The Foot Health Foundation of America to determine how your feet and ankle are doing and if you should get checked out by a podiatrist. This quiz may pinpoint any warning signs of lower extremity problems. Early detection and preventive measures will keep you up and walking or running longer with no pain. 

To score the quiz, determine which answer best suits you. Add the points associated with each answer. At the bottom of this blog, you will see what the total points mean and if any action should be taken. Please note that this quiz is part fun and part self-assessment. It does not replace a physical exam. 

1.	How much time do you spend on your feet each day?
	a. less than 2 hours	0
	b. 2 - 4 hours	1
	c. 5 - 7 hours	2
	d. 8 hours or more	3
2.	How old are you?
	a. under 40	0
	b. between 40 and 59	1
	c. 60 and over	2
3.	How would you describe your weight?
	a. less than 20 pounds overweight or at ideal weight	0
	b. 20 - 39 pounds overweight	2
	c. 40 or more pounds overweight	3
4.	Have problems with your feet or ankles ever prevented you from participating in:
	- leisure/sports activities
	a. yes	2
	b. no	0
	- work activities?
	a. yes	3
	b. no	0
5.	Have you ever received medical treatment for problems with your feet and/or ankles?
	a. yes	3
	b. no	0
6.	Do you regularly wear heels two inches or higher?
	a. yes	2
	b. no	0
7.	What types of exercise do you engage in or plan to engage in? (check all that apply)
	a. walking	1
	b. field sports (e.g., softball, golf)	2
	c. winter sports (e.g., skiing, ice skating)	2
	d. court sports (e.g., tennis, basketball)	3
	e. aerobics	3
	f. running	3
	g. none (if you chose answer g, skip to question 11)	0
8.	Do you have the appropriate shoes for your sport or sports?
	a. yes	0
	b. no	3
9.	Do you experience foot or ankle pain when walking or exercising?
	a. rarely	1
	b. sometimes	2
	c. often	3
	d. never	0
10.	Do you:
	- exercise in footwear that is more than one year old or in hand-me-down footwear?
	a. yes	3
	- stretch properly before and after exercising?
	a. yes	0
	b. no	3
11.	Do you:
	- have diabetes?
	a. yes	3
	b. no	0
	- experience numbness and/or burning in your feet?
	a. yes	3
	b. no	0
	- have a family history of diabetes?
	a. yes	2
	b. no	0
12.	Do You: (Mark all that apply)
	- sprain your ankles frequently (once a year or more) or are your ankles weak?
	a. yes	2
	b. no	0
	- have flat feet or excessively high arches?
	a. yes	2
	b. no	0
	- experience pain in the achilles tendon or heel or have shin splints (pain in the front lower leg)?
	a. yes	2
	b. no	0
	- have corns, calluses, bunions or hammertoes?
	a. yes	3
	b. no	0
	- have arthritis or joint pain in your feet?
	a. yes	3
	b. no	0
	- have poor circulation or cramping in your legs?
	a. yes	3
	b. no	0

---

Scoring

0-20 Points: Congratulations! Your feet and ankles are very healthy and you can maintain your active lifestyle and/or exercise regimen. With proper attention and care your feet and ankles should remain healthy; however, you may want to schedule an annual exam with a podiatric physician to ensure their long-term health. Furthermore, if you scored points for questions 4, 5, 9, 11 or 12 you should consider visiting a podiatric physician in the near future for a check-up.

21 - 40 Points: Pay Attention. Your feet and ankles are showing signs of wear, placing you in the moderate risk category. Although you can continue your normal activities, you should strongly consider visiting a podiatric physician for a check-up. If you participate in a rigorous exercise regimen on a regular basis or plan to - or if you scored points for questions 4, 5, 9, 11 or 12 - you should visit a podiatric physician soon to safeguard your foot and ankle health.

41 Points or Higher: Caution. Your feet and ankles are at high risk for long-term medical problems and you should contact our office as soon as possible. If you exercise, you should pay particular attention to your feet and ankles until you are seen by our practice. If you have not begun exercising, it is advisable to contact our office before undertaking any type of exercise.

Now that you've assessed the health of your feet and ankles, you are armed with knowledge that will enable you to maintain their health over a lifetime.

Please note: Even if you scored well, this self assessment is not a substitute for a physical exam.

Citation: Vittori Foot and Ankle Specialist. (2012). Self-assessment quiz. Retrieved from http://www.vittorifootclinic.com/library/1925/Self-AssessmentQuiz.html

Prescription Footwear - Not Your Grandma's Shoes

Footwear is nothing to take lightly for diabetics. With 15.7 million people in the United States living with diabetes, proper footwear can be a major factor in keeping the person mobile. Diabetes affects the feet by lose of feeling because blood flow becomes restricted. The impact of diabetes on the lower extremities is profound. Each year, 65,000 limbs are amputated and within three to five years, the risk of another amputation increases to 50%.

Keep moving to keep circulation and blood flowing to the lower limbs to avoid amputation and other complications. Prescription footwear can accommodate, stabilize, and support deformities of the foot. They can also limit the motion of joints in order to decrease inflammation and provide much needed stability. Prescription footwear can also reduce shock and pressure. Pressure can cause ulcers and wounds that may be difficult to treat and close. Open wounds have complication all of their own. But don’t worry; prescription shoes come in many different forms, and can be just as stylish as shoes bought at a department store. Just because one has diabetes doesn’t mean that they have to give up fashionable footwear.

Prescription footwear come in these types:

• “Custom-made shoes. When extremely severe deformities are present, a custom-made shoe can be constructed from a cast or model of the patient's foot. With extensive modifications of in-depth shoes, even the most severe deformities can usually be accommodated.

• External shoe modifications. In these cases, the outside of the shoe is modified in some way, such as adjusting the shape of the sole or adding shock-absorbing or stabilizing materials.

• Healing shoes. Immediately following surgery or ulcer treatment, special shoes may be necessary before a regular shoe can be worn. These include custom sandals (open toe), heat-moldable healing shoes (closed toe), and post-operative shoes.

• In-depth shoes. An in-depth shoe is the basis for most footwear prescriptions. It is generally an oxford-type or athletic shoe with an additional 1/4-inch to 1/2-inch of depth throughout the shoe. This extra volume accommodates inserts, or orthotics, as well as deformities commonly associated with a diabetic foot. In-depth shoes are usually designed to be light in weight, have shock-absorbing soles, and come in a wide range of shapes and sizes to accommodate virtually any foot.

• Orthoses or shoe inserts. Also known as orthotics, an orthosis is a removable insole which provides pressure relief and shock absorption. Both pre-made and custom-made orthotics or shoe inserts are commonly recommended for patients with diabetes, including a special total contact orthosis, which is made from a model of the patient's foot and offers a high level of comfort and pressure relief.”

Citation:
Vittori Foot and Ankle Specialist. (2012). Corrective and prescription shoes. Retrieved from http://www.vittorifootclinic.com/library/1793/CorrectiveandPrescriptionShoes.html

Image by Ephemeral Scraps. (2012). Corrective orthopedic shoe. Retrieved from http://www.flickr.com/photos/biomedical_scraps/6832476313/

Managing Pain of the 3 A's

Feet should not hurt. Time and time again podiatrists, like me, state that if feet hurt, get them checked out to determine cause and diagnosis of foot and ankle ailments and for future preventive measures. That being said, feet do hurt from time to time and the pain can be managed. Let’s look at the three A’s: Ankle pain, Arch pain, and Arthritis.

Ankle pain: Typically ankle pain occurs from a sprained ankle from a sports injury, fall, or accidentally stepping on a child’s toy in the middle of the night. 

• “Anti-inflammatory medications, such as aspirin or ibuprofen to reduce swelling.
• Physical therapy, including tilt-board exercises directed at strengthening the muscles, restoring range of motion, and increasing the perception of joint position.
• An ankle brace or other support.
• An injection of a steroid medication.
• In the case of a fracture, immobilization to allow the bone to heal.”

Arch pain: Typically caused by plantar fasciitis, which is the inflammation of the ligament that attaches the heel bone to the ball of the feet and toes. Pain occurs when the arch is stretched

• “Calf muscle stretching
• Over the counter arch supports
• Orthotics
• Oral anti-inflammatory medication
• Cortisone injections”

Arthritis

• “Physical therapy and exercise.
• Orthotics or specially prescribed shoes.
• Foot soaks/paraffin baths.
• Ice packs.
• Massages.
• Over-the-counter anti-inflammatory medications, such as aspirin, ibuprofen, or acetaminophen products.
• Prescription nonsteroidal anti-inflammatory medications.
• Vitamins B6, B12, and folic acid.”

Citation:
Vittori Foot and Ankle Specialist. (2012). Pain management for specific conditions. Retrieved from http://www.vittorifootclinic.com/library/1910/PainManagementforSpecificConditions.html

Image by Brave Heart. (2007). Foot in b/w. Retrieved from http://www.flickr.com/photos/brraveheart/207335017/

Feet Allergies

When you think of allergies, do you envision puffy, sensitive eyes, sneezing, headaches, and sinus issues? Those are symptoms of allergies, but the skin on your feet can have allergies as well.

There are actually two kinds of skin allergies: primary irritant dermatitis and allergic contact dermatitis. Both are caused from outside substances coming into contact with the skin. The difference between the two is that the primary irritant dermatitis is a non-allergic reaction whereas the allergic contact dermatitis is an allergic sensitization to various substances.

Primary irritant dermatitis occurs by prolonged exposure or contact to various substances like water, chemicals, oils, or other irritating substances. Even though some oils and substances are not harmful if used properly, if used improperly, they can cause the skin to become irritated. One is not necessarily allergic to the substance, it just irritated the skin by too much exposure or improper use.

Allergic contact dermatitis occurs from substances that sensitize the skin. Inflammation occurs every time the skin on the foot comes into contact with the substance. Think of a person who has peanut allergy. When they come in contact or eat a peanut, an allergic reaction happens. People can be allergic to materials in shoes or dyes in socks.

Common items people can be allergic to in shoes:

• Glue
• Leather chemicals
• Rubber chemicals
• Dyes
• Metal eyelets
• Shoe decorations 

Make an appointment to see me for a diagnosis if any of the following symptoms occur, as these may be a sign of a skin allergy or other skin conditions like eczema. I can do a patch test to determine cause of the skin allergy.

• inflammation 
• swelling
• redness
• blisters
• cracks in the skin
• burning
• pain
• itchiness
• skin becomes thick, red and scaly

Citation:
Image by hillary h. (2008). allergy medicine. which to choose? Flickr. Retrieved from http://www.flickr.com/photos/hillaryandanna/2948222108/
Shoe Allergies - a resource for all those allergic to their shoes. (2012). Shoe allergies. Retrieved from http://shoeallergies.50webs.com/allergy.htm
Vittori Foot and Ankle Specialist. (2012). Allergies. Retrieved from http://www.vittorifootclinic.com/library/1754/Allergies.html

5 Podiatry Questions Answered

What’s the difference between a podiatrist, podiatric physician, and podiatric surgeon?

Nothing, they all terms used to describe doctors of podiatric medicine (DPMs) who treat foot and ankle problems.

Podiatrists are doctors, so what type of medical training do they go receive?

DPMs undergo four years of undergraduate education, four years of graduate school education at a medical college, and two to three years of residency training in hospitals and clinics.

Do podiatrists have specialty areas of focus?

Just like other doctors, podiatrists can specialize their practice and focus on areas like sports medicine, pediatrics, geriatrics, primary care, or orthopedics. Most podiatrists treat all foot and ankle problems.

Do podiatrists treat patients who have serious illnesses?

Yes, podiatrists help treat patients who have major medical issues like diabetes, obesity, arthritis, and heart disease. This is why the podiatrists as for a complete medical history upon initial consultation. Major medical conditions can have a profound effect on the feet and ankles and lead to increased problems.

What type of services do podiatrists perform?

• Arch Disorders
• Arthritis
• Bunions
• Burning Pain
• Diabetic Foot Care
• Hammertoes
• Heel Pain
• Heel Spurs
• Infections and Ulcerations
• Ingrown Toenails
• Toenail Fungus
• Neuromas
• Reconstructive Foot Surgery
• Soft Tissue Masses and Tumors
• Sports Injuries
• Tendon and Joint Pain
• Comprehensive care of foot and ankle disorders
• Surgical and non-surgical treatment of athletic injuries
• Reconstructive foot and ankle surgery
• Biomechanical analysis and functional orthotic fabrication
• Diabetic shoes and insoles
• Extracorporeal Shockwave Treatment for heel pain (ESWT)
• Alternative therapy
• Non-surgical treatment of Morton's Neuroma
• Trauma and Athletic Injuries
• Wart

Citation:
American Podiatric Medical Association. (2012). Resources for policymakers. FAQ about today's podiatrists. Retrieved from http://www.apma.org/content.cfm?ItemNumber=1598&navItemNumber=720
Image by Valerie Everett. (2008). Questions? Flickr. Retrieved from http://www.flickr.com/photos/valeriebb/3006348550/

Protect from & Check for Skin Cancer

Cancer, no matter where it is found, can be devastating. Common cancers are breast cancer, colon cancer, kidney cancer, and blood disorders, but cancer can be found in moles and on the skin on the feet and lower extremities.

The last place you might think to look for moles or skin cancer is on the feet, especially on the bottom of the foot. Skin cancer can occur anywhere on the foot and toes, even underneath toenails.

Melanoma Statistics as of 2008:

• 62,480 new cases of skin cancer due to melanoma
• 8,420 deaths associated with skin cancer
• Fastest increase of cancer in young women (ages 15 to 39) in the U.S.
• Survival rate for melanoma elsewhere on the body is 80-85%, but lower extremity melanoma has a lower than average survival rate
• 1/2 of all people diagnosed with melanoma of the foot die within 5 years of late diagnosis (American College of Foot and Ankle Surgeons)

What Can You Do?

Do a thorough foot check every time you cut your toenails:

• moles
• tops of feet
• soles of feet
• underneath toenails
• between toes

Look for changes in:

• Moles
• Freckles
• Spots
• Nail growth
• Nail discoloration
• Skin discoloration
• Sores

Protect your feet:

• Apply sunscreen EVERYWHERE: top, bottom and between toes
• Keep feet covered
• At the beach, wear water shoes to minimize sun exposure
• UV rays are strongest between 10am and 2pm, minimize sun exposure during this time

Citation:
Other health conditions. Foot Care Basics (2009), 2009, p33-37, 5p, 4 Color. Retrieved from Consumer Health Complete. 
Image by MichaelKuhn_pics. (2009). O18_365_Skin cancer. Flickr. Retrieved from http://www.flickr.com/photos/michaelkuhnphotos/3696016449/

Getting A Proper Fit

It’s almost time to start ditching the sandals and flip-flops for boots and closed toed shoes, weather permitting of course. With the change of season, evaluate the shoes currently in the closet. Throw away shoes that have wear and tear from last fall and winter because serious foot disorders can be caused by ill-fitting shoes. When shopping for new shoes this season, shy away from shoes based on how they look and focus on the following tips to help reduce the risk of foot problems.

• Purchase durably constructed shoes.
• If your feet are two different sizes, buy shoes that fit the largest foot.
• Feet keep growing, width and length, as one gets older so measure each foot before a purchase is made.
• Shoes should conform to one’s foot. Don’t force the foot into a shoe. This is a sign that the shoe will cause discomfort and potential blisters.
• The “break-in-period” is a myth. Shoes should be comfortable from the start.
• Try on both shoes. People have a tendency to just try on the right shoe, figuring that the left shoe will fit equally well. Feet can be different shapes and sizes.
• Just because you may be a size 7 doesn’t mean you are a size 7 in every shoe. Manufacturer’s sizes may vary. Try on shoes between the 6 ½ and 7 ½ sizes. Focus on how the shoe feels, not the size.
• Rule of thumb: there needs to be a ½ inch of space from the end of the longest toe to the end of the shoe.
• Purchase shoes at the end of the day as feet swell continuously throughout the day.
• Toes should be able to wiggle in shoes.
• Don’t forget about the heel. Make sure it doesn’t slip out of the shoe.
• Limit high heel height to two inches or less to minimize the amount of pressure applied to the ball of the foot.

Citation:
Vittori Foot and Ankle Specialist. (2012). Getting a proper fit. Retrieved from http://www.vittorifootclinic.com/library/3778/GettingaProperFit.html
Image by Andrew Huff. (2007). X-ray shoe fitter. Flickr. Retrieved from http://www.flickr.com/photos/deadhorse/462921241/

6 Categories of Foot Problems

Foot pain is not normal, under any circumstances. Many blogs have been written about various ailments of the feet and ankle. Foot and ankle problems usually fall into 6 different categories.

Improper footwear causes many common and treatable problems. High heels and ill fitted shoes cause physical stress on the skin, joints, nerves, and bones of the feet. Wearing painful footwear long enough will cause small mechanical changes within the foot, making treatment more difficult. Purchase shoes that don’t need a break in period and the feet will be thankful.

The second category of foot and ankle problems is due to arthritis, which involves one or more joints, caused by many different medical illnesses. The foot has 33 joints, which makes it the most susceptible part of the body to get arthritis when the joints become inflamed by fluid. The pain can be unbearable because it bears so much weight and force throughout the day.

Some foot and ankle problems appear at birth and are genetic. These conditions are called congenital problems. Club foot, extra digits, and webbed feet are just some examples. Flexible problems correct themselves over time, but rigid congenital problems require treatment for a Podiatrist.

Who thinks of the feet or lower extremities when they hear the words tumor or cancer? Feet are just as suscible as the rest of the body. Neoplastic disorders result from abnormal growth tissue and can be either benign or malignant. Skin cancer can also appear on the feet. Don’t forget to protect the feet by applying sun screen.

Infections come in three forms; bacterial, viral, or fungal, and can cause foot problems. Athlete’s foot is an example of a fungal infection. Hand-foot-mouth disease is one of the most common viral infections. Bacterial infection such as pitted keratolysis is associated with warm damp feet. 

Last but not least are traumatic foot problems. Fractures, breaks, and sprains caused by sporting injuries or just a plain old slip and fall. Even stubbing one’s toe can be a traumatic foot problem.

Did you know there were so many ways that the feet and ankle could have so many problems?

Citation:
American Podicatric Medical Association. (2012). Foot health. Retrieved from http://www.apma.org/learn/FootHealthList.cfm?navItemNumber=498
Image by Amy the Nurse. (2011). Sunburned feet. Flickr. Retrieved from http://www.flickr.com/photos/amyashcraft/5712005292/

           

Excessively Sweaty Feet

Everyone’s feet sweat. After all, there are  250,000 glands in the feet. Most people sweat in temperatures like we had in Chicago this summer, it’s just unavoidable when it’s 100 plus degrees. When the body gets warm, it sweats. This is simply biology. The interesting thing is that everyone has their own temperature breaking point when they start to sweat. A wife could start to sweat when it’s 75 degrees outside while the husband thinks this is the ideal temperature and doesn’t start to sweat. Every person’s body has their own temperature “set point”.

But for some, their feet sweat excessively all of the time. By excessive I mean when one’s foot slips and slides around in one’s shoe. The technical term is called hyperhidrosis. The foot may appear whitish in color and look wet. Excessive wetness of the feet can cause foot infections. Skin is durable, but still sensitive. The wetness can cause the skin to break down, causing small tears where infection can take place. Bacteria grow in dark damp conditions and can be a real concern.

Sweaty feet are commonly found:

Men > Women
Young Adults > Older Adults

What does one do for sweaty feet?

1. Wear shoes that breathe.
2. Wear wicking socks.
3. Wear synthetic sock blends vs. cotton socks.
4. Change socks multiple times a day.
5. Wash feet with antibacterial soap.
6. Make appointment for a proper diagnosis & further medical treatment options.

American Podiatric Medical Associaton. (2012). Sweaty feet. Retrieved from http://www.apma.org/learn/FootHealth.cfm?ItemNumber=1951

Image by Brave Heart. (2008). Wet foot prints. Flickr. Retrieved from http://www.flickr.com/photos/brraveheart/2607936114/

Dry Skin - When to Make an Appointment

Dry skin, we’ve all had it at one point or another in our lives. It seems like we’re constantly battling outside forces to keep our skin fresh and smooth. Soap, swimming, hot weather, cold weather, bodily hormones, the socks and shoes we wear, medications, and certain medical conditions can minimize the naturally protective oils on the skin. These oils keep the skin on our feet moist and soft. When the oils are reduced, the skin becomes dry and cracked. Most people turn to lotions as their first line of defense against dry skin, which works the majority of the time.

But how do you know when you need to make an appointment to have your dry skin evaluated by a Podiatrist?

Try this test: Use lotions and moisturizers for two weeks and wash with mild soup during the test phase. If dry skin persists, make an appointment.

Aside from the test, diabetics should be checked at first sign of dry skin. If skin becomes cracked, swollen, red, bleeding, or oozing, make an appointment immediately. Severe and persistent itchiness of the feet or toes can be a number of skin related conditions such as Athlete’s foot, psoriasis, or eczema.

Each skin condition has different treatment options so a diagnosis is imperative to stop the dry and itchy skin. Treatment options can be as simple as using milder soaps, using topical antihistamines or creams. Some conditions require antibiotics and treatments to control the underlying medical condition causing the dry skin.


Image by Lotus Carroll. (2008). Dry patch. Flickr. Retrieved from http://www.flickr.com/photos/thelotuscarroll/2204691159/
Gardner, Stephanie. (2011). WebMd. Ultra dry skin? when to call a doctor. Retrieved from http://www.webmd.com/healthy-beauty/dry-skin-10/medical-treatment

Treacherous Toes

In the grand scheme of limbs, toes are awfully small compared to other limbs on the body. Even though they are small, they provide vital support, balance, and strength for the rest of the foot. If the structure of the toe is compromised, pain and discomfort occurs. It’s interesting to note that toe deformities can result from a problem stemming in another part of the foot or even farther up the leg.

A quick symptom guide of various structure deformities can help pinpoint problems of treacherous toes. For a diagnosis and treatment plan, make an appointment with my office.

Symptoms of Bunions & Bunionettes:

• Bump appears at the base of the big (for bunion) or fifth toe (for bunionette)
• Pain, especially when wearing shoes that press or rub against the bump
• Big toe points toward the second toe

Symptoms of Hammertoe:

• Bending and curling of the second toe, but it can be found on any of the three middle toes
• It’s given its name for a reason… the shape resembles a hammer. The end part of the toe bends down into a claw-like deformity.
• Over time, pain persists on the top of the toe and one will not be able to move the toe.

Symptoms of Osteoarthritis (joint disorder):

• Morning pain that diminishes as the day goes on
• Resting the joints minimizes pain
• Stiffness in the affected joint
• Increased pain after exercising

Symptoms of Gout (joint disorder):

• Jolts of pain in the affected joint
• Possible inflammation in the joint
• Increase in symptoms after eating certain foods
• Pain often starts during the night & is described as throbbing
• Joint becomes red, warm, and tender

Symptoms of Sesamoid:

• Pain in the ball of the foot, beneath the big toe
• Swelling in the ball of the foot
• Loss of range of motion in the big toe & difficulty walking

Image by Janine. (2009). toe family. Flickr. Retrieved from http://www.flickr.com/photos/pinkcotton/3301572765/

Olympic Gymnasts Strive to Keep Feet Healthy

The Olympics have American’s captivated and rooting for their favorite athlete’s. Most of these athlete’s have spent their entire lives working towards winning an Olympic gold metal. That type of dedication has tremendous impact on an athlete’s body; good and bad. The plus side is that each athlete has diligently worked towards optimizing their body to be in the best physical shape of their lives. The down side is that continuous practice, especially in gymnasts, is that they are prone to feet, ankle, and heel pain.

The men’s and women’s gymnastic teams were suffering from foot injuries just prior to the start of the Olympics. McKayla Maroney suffered from a sore right foot and on the first day of the Olympic trials Sam Mikulak sprained his left ankle during a vault run. Podiatrists are part of the Olympic’s medical team, specifically for these reasons. They play an integral part of keeping our athlete’s in peak performance to help them bring the gold back to America.

Because gymnasts don’t wear shoes or braces on their feet that would hinder traction from the map, they perform barefooted. This can lead to a variety of foot conditions; heel pain, arch pain, cracked heel, athlete’s foot, ligament strains, stress fractures, heel bruises, and swollen growth plates. Keep in mind that most gymnasts are still very young and their bodies are growing while they put a tremendous amount of strain on their lower extremities. Their feet support not only their weight, but also have to absorb the amount of force associated with many of the jumps. So how do gymnasts keep their feet healthy?

• Tape feet properly
• Wear specific shoes for specific activates
• Apparatus shoes are used for dismounts.
• Vault shoes have padding on the soles to absorb shock from the hard landing. 
• Ice the bottoms of the feet
• Rest feet after practice & between events
• Stretch feet and lower extremities before & after events

Image by dearbarbie. (2012). DSC_9571. Flickr. Retrieved from http://www.flickr.com/photos/dearbarbie/7675694980/

Gymnastics Rescue. (2012). Shoes and Foot Injuries for Gymnasts. Retrieved from http://www.gymnasticsrescue.com/Shoes_and_Feet.htm

Heel That Pain. (2012). Gymnastics and Heel Pain. Retrieved from http://www.heel-that-pain.com/heel_pain/gymnastics.php

Must Do for Wart Prevention

Warts can be unsightly, potentially painful, resistant to treatment, and reoccur even after various treatments.

The key is to not get warts in the first place. Prevent warts by following these tips.

No Shoes, No Shirt, No Service. Wear shoes everywhere, especially in public places like pools and gym showers. Warts are contracted through a virus that enters the body through small cuts in the feet.

Practice Good Hygiene. Change socks and shoes on a daily basis. If you are prone to sweaty feet, keep extra pairs of socks handy. Viruses thrive in warm moist environments. Keep feet clean and dry.

Self-Check. Evaluate your feet daily or at least weekly for any changes that may occur. At the first sign of a wart, growth, or skin change, make an appointment right away. If you have children, check their feet after yours. Make it a family routine.

Keep hands and feet to yourself. If someone you know has a wart, don’t touch it. Wart viruses can spread by contact.

Be selfish. Don’t share your towel, socks, shoes, or razor with anyone. Even though it may not look like someone has wart, they can still be carrying the virus, which can be passed onto you unknowingly.

Minimize feet irritation. Blisters, dry skin, and small cracks on the soles of the feet allow for wart viruses to be easily transferred into your body. Broken and injured skin is caused when the feet are irritated by rubbing from shoes.

Prevent spreading of warts. Keep warts covered with band-aids and don’t bite nails or cuticles.


Image by M.V. Jantzen. (2008). No Shirt No Shoes No Service. Flickr. Retrieved from http://www.flickr.com/photos/mvjantzen/2349235973/