You’ve Lost That Lovely Feeling, Part II

In continuing last weeks blog discussion on neurological disorders of the foot we should discuss neuromas. It is a very common condition we see in our offices. A neuroma occurs when there is inflammation of a nerve sheath, which is the protective covering for your nerves. You could think of this like speaker wire. If you pull 2 speaker wires apart, that sheath that makes them one wire splits into 2. The usual suspect for causing a neuroma is actually structurally based. Bones can rub together and impinge on a nerve, or severe pronation can cause a shift of your foot bones that will rub on the nerve as well. The most common hotspot for a neuroma is between the 3rd and 4th toes. This condition has its own name being a Morton’s neuroma.

Patients with a neuroma will complain possibly of a burning or tingling sensation and say it feels like they are walking on a rock rolled up in their sock. There may also be a popping or clicking sound heard which is the nerve rolling between the bones of the foot. I know this sounds pretty painful, and it is, but it’s comforting to know there are treatments and preventions. The best way to prevent a neuroma is to make sure your foot is structurally sound. This includes orthotics and footwear to address pronation. Make sure you have a nice wide toebox in your shoes so that your bones aren’t squished together and impinging on your nerves. Also metatarsal pads placed in the shoe to alleviate pressure on the forefoot can do a great deal of relief. Once our doctors diagnose you with a neuroma there are a number of treatments available. Anti-inflammatories can be used to reduce the pain and swelling but the doctors will also properly evaluate your foot structure to determine the underlying problem. If conservative efforts don’t work, there is surgical help that involves removing part of the nerve. To get advice on your feet, come by the Foot Associates of Central Texas.

You've Lost That Lovely Feeling

As the number of diabetic patients rapidly increases in our country, the symptoms and ailments that are associated with it are too becoming widespread. Peripheral neuropathy is a neurological disorder that is caused by damage to peripheral nerves. Because of the nerve length in the leg down to the foot, these are often targeted first in the body. Diabetic neuropathy causes are varied and can include metabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and low levels of insulin. Blood vessels that give nutrients to the nerves become compromised and cause them to die off.

This all sounds kind of scary, so how do you know if you have it? Well often patients experience sensory and motor deficits. The main symptom is partial or complete loss of sensation in the toes, foot, or ankle. Patients also describe a burning, tingling, or prickling pain. This loss of sensation can lead to other problems of the foot and ankle, such as ulcers. If you can’t feel your feet, you also can’t feel them if you are damaging them. This could be from a sunburn, stepping on a nail, or a shoe wear issue. A sore or cut could then progress to a serious wound infection. And this is where the nice guys at a Foot Associates of Central Texas come in.

If the patient is a diabetic, your podiatrist will try to prevent the neuropathy and advocate for good diabetes management. If the neuropathy cause is from a compression force, they will want to remove that force impinging on the nerve. Also make sure that your shoes have a wide toe box to accommodate your toes to prevent any sores. And as always, for this or any other foot and ankle problem, come by and see Dr.Grimm or Dr.Pattison.

Smelly Feet

Hypothetically, let’s say you’ve been keeping up with the blog. You’re wearing your orthotics, stretching before you exercise, running with the right shoes, but now you have a new problem. Your feet smell…terrible. And it’s still the spring, so the real heat wave hasn't begun. Odorous feet are quite common. And it makes sense, right? You wrap them in a sock, stick them in a shoe and trap them all day long. There are many sweat pores on your feet and there is a lot of normal flora (regular everyday bacteria that is on your skin). It is this bacteria on the skin that causes them to smell. Bacteria loves perspiration, especially in a dark enclosed environment. The smell is just part of their waste product.

Hyperhidrosis is a condition where you may have excessive perspiration. No worries as there are a number of treatments. They start with good hygiene and managing the amount of sweat. Be sure to change socks and shoes each day. Make sure they are clean and do not share with the guys from the gym. Avoid a shoe that’s not going to breath. If it’s your running shoes, stick to mesh. A foot powder can be used and be sure to wipe between those toes to avoid any missed areas. Topical antiperspirants can also be helpful. Stay away from drinks with a high amount of caffeine too, that includes coffee, tea and cokes. Caffeine and stress are two factors which will fire up the sweat glands more often. If all these are still leaving you damp or smelly, come in and see Dr. Grimm or Dr. Pattison for the next stage of treatment solutions.

Joint Pain

It seems like their is an increasing number of television commercials showing an ad for a new medication to help with joint pain. They always show someone climbing Mt. Everest, or running the Boston Marathon and talking about how they can resume extreme athletic activities without their pain. But what about the average Joe who has the aches and pains?

Joint pain of the foot and ankle can be caused by a number of things such as arthritis, gout, fractures, and infection. First your podiatrist will want to ask a series of questions to narrow down the list. Inflammation would also be noted by asking about redness or swelling. Most often joint pain is caused by the loss of cartilage between two bones. Let’s use your car as an example. The more miles you tack on, the more your brake pads wear out. Eventually you hear a terrible squeak when you brake indicating that it is metal on metal grinding. Cartilage is like your brake pads and the metal brakes are like your bones. The cartilage acts like a cushion for your joints much like the brake pads were protecting the metal. When the cartilage wears down the joint becomes painful causing arthritis.

Treatment for painful joints wound depend on the underlying cause that would need to be fixed first and foremost. This could include joint replacement, antibiotics for an infection, therapy, orthoics or shoe modifications. There are different types of medications that can be helpful depending on the type of arthritis that can act in suppressing your immune system so it doesn’t attack the joint, leading to pain. If your feet are painful to walk on, come by and see the podiatrists at Foot Associates of Central Texas for an evaluation.

Orthotics

The general public may not know the full scope of practice of the modern day podiatrist, but they do know two things. They work on feet and they talk a lot about orthotics. But why? What’s so good about them? Orthotics are molded casts of the feet in a particular position that can serve many purposes. You place the molded insole into your shoe and walk on them as if they were your stock insole. This now supports your foot inside of the shoe in a way that is more beneficial to the foot and ankle.

Your podiatrist may recommend orthotics for a number of therapeutic uses such as redistributing weight to different parts of the foot, control abnormal motion of the ankle, to better align your lower leg, and to help dissipate the shock forces generated through the foot, leg, and spine. Many people use the term “arch supports.” While they do this, their primary function is to control your foot during its gait cycle.

Most athletes will ask, “Do I really need these orthotics?” The more important focus should be “Can I benefit from this?” Often orthotics can make the athlete less susceptible to injury as well as help the performance. They should be thought of as a preventative weapon rather than a crutch-after-injury. While no magic bullet can prevent injury, prescription orthotics certainly reduce wear and tear, help prevent over-use issues of the foot, ankle, leg and spine, as well as boosting performance of the athlete. If you are ready for these positive effects come by and see Dr.Grimm or Dr.Pattison to get your alignment checked.

Stressed Out

You can’t watch ESPN without hearing about it. You probably know someone that has gotten one. We're talking about stress fractures. They occur often in athletes and those in the military. So how is it different from a regular break? A normal (acute) fracture is the result of a traumatic experience, such as a collision or a fall. A stress fracture occurs when repetitive forces act on the bone and overload it. Let’s use the leg as an example. For runners, their leg and foot muscles are constantly working to move and absorb shock. These muscles work by shortening (contracting)from their bony attachments creating a pulling force. After a long time these muscles tire out and your bones become the shock absorbers. Those who have excessive pronation (functional flat foot)are also susceptible to these types of fractures.

How do you tell if you have one? Stress fractures usually occur very gradually. You likely won’t remember the exact day it happened but that the pain has gotten worse. While it’s hard to name only one prevention for stress fractures, there are a few ways to play defense. Make sure you are getting enough calcium and vitamin D for bone development. If you are a runner, especially one trying to get back into it after a long hiatus, try to follow the runner’s rule. It states that you shouldn’t increase distance by more than 10% per week to allow your bones and muscles to adapt. Also make sure you are wearing proper footwear. Runners should change their shoes about every 400-600 miles depending on brand and grade of shoe. I know you may say your shoes are clean and you’ve taken care of them. But the midsole is the part doing the work and if it can’t absorb shock anymore, then your bones take the hit. If you think you may have a stress fracture come by and see your podiatrist. Treatment ranges from rest from activity, to a cast or boot to keep the bone immobilized. Orthotics may also be used to correct the pronation that can cause these. Come by and see Dr. Grimm or Dr. Pattison to get a break from life’s stresses.