Better Boot Buying

Hard to believe, but it’s already December. Where did the year go? Anyways, as we get closer to winter, the boots start to make their way out slowly but surely. Ladies, this means everything from rain boots, to cowboy boots, to snow boots make their way outside. Gentlemen, I know what you’re thinking. Why does she have snow boots? It’s Texas. Well, they were either a) on sale, b) look good, or c) see choice A. For this week’s blog we’ll look at a few of the different boot styles and look at the pros and cons of each. For next week’s blog we’ll share some tips on what to look for when you’re out there boot shopping.

Riding boots:
The good: Natural materials like leather allow airflow that keeps your feet dry.
The bad: Synthetic materials do the opposite. Heat & moisture build up leading to odor.

Rain boots:
The good: Eh. Wear cushioned insoles in these to get something in the “good” category.
The bad: The rigid shape of these limit natural foot movement & gives no arch support.

The Cowboy boot:
The good: Wear only for a short period of time and allow the toes to stretch
The bad: Cowboy boots bad? In Texas? Yeah right. But seriously, watch out for a narrow toebox area than can rub the foot the wrong way and cause a blister.

Snow boots:
The good: Get a rubber sole with deep grooves for proper traction….if it ever snows.
The bad: The sole can become slick and lead to trips or falls……if it ever snows.

Trendy ankle boots:
The good: Pick a pair with a heel no higher than 2 inches to avoid balance issues.
The bad: Lack of ankle support + a high heel can lead to imbalance.

These are just a few examples. Next week we’ll look at some other buying tips.

Cellulitis and Your Feet

Rashes can come in all shapes and sizes. They can start with as something as small as a bug bite, and range to something more widespread like poison ivy. It’s important for you to make sure that a rash from out of the blue is properly checked out. Cellulitis is a type of skin infection that affects the deep tissues. It’s commonly seen on the legs. This appears as redness in the area with an increased temperature of the skin and swelling of the leg. There aren’t any clear boundaries to it and there can be a streaking appearance. This can also be accompanied by fever and chills. It could be a warning of a more serious condition and shouldn’t be ignored.

Cellulitis can be caused by a number of things, such as bacteria seeping into a break of the skin like an ulcer or heel fissure. It is also commonly contracted as a secondary infection to Athlete’s foot. Cellulitis can also arise without a break in the skin, as such in thrombophlebitis. So to summarize it can be caused by many different factors, but ultimately it’s a bacterial infection. Those with weak immune systems (i.e. diabetes, AIDS, chemo patients) are more susceptible to cellulitis.

So how can your local friendly podiatrist help you out? Well it depends on the severity of the infection, but most of the time an oral antibiotic is prescribed. Remember with antibiotics, you want to finish the entire prescription, even if you feel better before it’s up. Otherwise this could lead to something called rebound phenomenon where the cellulitis can return with a vengeance. Locally the cellulitis can be treated with a topical agent and a dressing. The dressing serves as protection during the healing process to prevent re-infection. Your podiatrist will also address the direct cause of the cellulitis if possible, for example taking care of the Athlete’s food if the dry skin led to cellulitis. For this rash and any other shade of red of your feet, come by and see Dr.Grimm or Dr.Pattison at Foot Associates of Central Texas.

Exercise or Toning Shoes

Walking is one of the most effective exercises you can do. It strengthens the heart while also burning calories. Walking is also good for any age, and any level of athlete. Even the most active people can get a quality workout from a brisk walk. So why is it so effective? Walking involves a number of different groups of muscles, it improves circulation, decreases your stress level, and almost anyone can do it. An upbeat walk can burn up to 500 calories per hour. And since it takes about 3,500 calories to lose a pound, you could expect to lose 1 pound for every 7 hours you walked. One hour per day of walking is recommended, but this should be achieved in a gradual manner. Beginners should start by walking 5-10 minutes at a time, moving up to 30 minutes a walk. It’s best to add no more than 5 minutes at a time so your muscles and heart can catch up to the change in activity.

The only real equipment you need for this effective workout is a good set of shoes. Try and not underestimate the importance of this. Shoes are built with the activity in mind. Basketball shoes come up higher for more ankle stability. Tennis shoes are built for side to side motion on a court. Running and walking shoes are made for heel to toe movement. Playing tennis in running shoes gives you a lack of stability and could lead to injury. Even if you plan to only walk, running shoes are great for this. They are actually built with more cushioning technology than a walking shoe because running puts more impact on your joints. Remember if you have been prescribed a set of orthotics; try them on with your new athletic shoes to ensure a good fit. If you aren’t sure of your needs, come see your local podiatrist. If your feet are stopping you from this effective workout, be sure to see Dr. Grimm or Dr. Pattison of Foot Associates of Central Texas.

Pediatric Fractures

You see it all the time. Little Jimmy is crutching around school with a lime-green cast. All his friends are signing it. He’s out of soccer for four weeks. According to a recent journal article, pediatric fractures are on the rise. However children are more agile and actually able to avoid more injuries than adults can. Children have different biomechanics as well as increased elasticity (returns to shape) and plasticity (stays bent).

Broken bones can show up in the young athlete, especially when the intensity of the training changes. In kids under 10, acute fractures can result from just jumping 3 or 4 feet off the stairs or couch. Also, be weary of a child that thinks they “sprained” an ankle. Straining the ligaments on the outside of the ankle is hard to do for children, and is more likely to be a fracture of the fibula, the outside leg bone.

Bone fractures can be tricky with children due to the presence of growth plates. These serve as the area where new bone is formed and is how many of our bones increase in length. Sometimes these can be damaged with certain fractures and may lead to partial or complete growth arrest, with a possible angular deformity. There’s a system for these known as the Salter-Harris Classification. This rates the fracture as well as its involvement with the growth plates.

To diagnose a pediatric fracture, your podiatrist will want to obtain a careful history and thorough physical. They will also want to examine x-rays of the foot and leg to evaluate the condition. If further studies are needed, a bone scan, CT scan, or MRI may be ordered. Depending on the fracture, the area of interest will be put in a cast or brace. For your children’s foot and ankle needs, be sure to come by and see Dr. Grimm or Dr. Pattison.

Nail Polish

As winter approaches, it’s almost time for vacation. Maybe not for you, or even the kids in school, but for those toenails you’ve been overworking all summer. Guys, you can skip out and read up on past blogs because the women are guiltier of this one. With women in Texas wearing nail polish on those open toes almost year-round, their toenails take quite a bit of abuse. Nail polish has a chemical called formaldehyde in it. This is the stuff they use in new car glues and cadaver preservative. It dries and damages your toenails. Nail polish remover has acetone in it, which is a chemical that also damages toenails. And this damage isn’t microscopic either. You can see it in the form of white spots on the nail’s surface. These are points of weakness that make them more susceptible to infection.

The point of all this nail weakness talk is to help prevent against fungal infections from forming. So as it gets a little cooler, your podiatrist recommends giving your nails a breather when you’re covering them up with closed toe shoes anyway. No one will see them, I promise. This gives your toenails a bit of a recovery period. That means no base layer either. The clear layer is just as bad as the hot pink one.

There is such a thing as good polish however. They are made from natural elements and lack the threatening chemicals. Some women have said they aren’t as effective as the real deal but it beats fungus infecting your toe nails. If you suspect that your polish is causing problems, come by and see Dr.Grimm or Dr.Pattison for your footcare needs.

Sever's Disease

Heel pain is never normal, even in children. Many people write this off as “growing pains,” which can be true, but each case should be individually examined. One of the most common causes of heel pain in young growing athletes is Sever’s disease. This is an overuse and repetitive injury to the growth plates in the calcaneus, or the heel bone. The calcaneus is one of the first body parts to fully mature and this happens around early puberty. When this happens, bone is growing faster than muscles or the tendons that hold the muscles to the bone. This causes the muscles to become tight.

Symptoms of Sever’s Disease can include a painful or tender heel, discomfort when the heel is squeezed, the young athlete limps, or the pain can is more severe during the sport. This is directly related to the overuse of bone and tendons in the heel. This may show itself at the beginning of the season, and may be more common in those children that are overweight, as well as those who over-pronate.

Your podiatrist will recommend R.I.C.E (rest, ice, compression, elevation) for the initial pain. Upon examination, they will look at the child’s gait and possibly an x-ray to make sure no other fracture is responsible for the heel pain. Orthoses may be recommended to prevent the over-pronation. The disease can be self-recovering, meaning it will go away when the bone finishes growing. In the meanwhile the condition could recur until then. However your podiatrist take a look so they can ease the symptoms as your child grows. And remember, for this and any other foot condition your child may have, let Dr. Grimm and Dr. Pattison of Foot Associates of Central Texas take a look.

Black Toenails

Whether you just finished running a marathon, or came back from a walk with the dog, you may have noticed a little surprise when you took your shoes and socks off. That toenail looks blue and black. And it’s not from any cold weather. Who put that there?

Black toenails usually form from the toe hitting the end or top of the shoe. This can happen in avid runners, occasional walkers, and soccer players just to name a few. If shoe gear is too small or too roomy, the end of the toe repeatedly slides forward and hits the end or top of the shoe. This again stresses the importance of not only the right type of footwear, but the right size too. For athletic shoes, many specialty running stores can help you in this process as well as recommended a lacing technique to help your foot from sliding forward.

So a black toenail is pretty much bruise under the nail. Blood from small capillaries leaks out and develops a bruise or blister. Sometimes this can be enough blood to lift the toenail up or cause pressure under the nail. This is usually the part where you pay more attention because this is what can cause pain. Your podiatrist may want to evaluate it to make sure the blister doesn’t become infected with bacteria or fungus. The doctor will possibly proceed to pierce the nail to drain the fluid. In some cases the nail may need removed to hopefully grow back as a normal nail again. This lessens the chance for an infection and it relieves the pressure and therefore the pain. It may take about 5-6 months to grow back as toenails grow longer around 1 mm per month. For this and any other concern, remember to come by and see Dr. Grimm or Dr. Pattison at Foot Associates of Central Texas.

Pregnancy and Your Feet

There’s a lot going on in a woman’s body during pregnancy. One change that may not be apparent until it happens is the effect on the mother’s feet. Many women complain about their feet throughout their pregnancy. These changes can impact the feet in a few different ways, but can all lead to conditions like overpronation and plantar fasciitis.

One part of the problem is the sudden weight gain women undergo when they become pregnant. This lowers their center of gravity and adds more force on their knees and ankles. This can manifest itself as pain in the feet, ankles, knees, or back. This sudden change can also lead to overpronation (flattening of the arch). Excess pronation can then put more of a strain on the plantar fascia and lead to that dreaded plantar fasciitis. Overpronation is also common in people who already had flexible flat feet before they become pregnant.

Another component adding to foot pain is the hormone changes. The natural pregnancy hormones that cause pelvic ligaments to relax can also cause the foot and ankle ligaments to relax and stretch out a bit. This takes away from the support structure of the foot and can also cause pain.

But there is good news in all of this. There are a few ways to prevent or minimize the effects. Elevate your feet as much as possible. Make sure you are wearing proper fitting shoe gear that is also supportive in nature. Orthoses can also help support the flattening of the arch. Wear seamless socks that don’t constrict circulation. If after pregnancy you still have foot pain, come by and see Dr. Grimm or Dr. Pattison. Remember that foot pain is never “normal,” even after pregnancy.

Cracked Heels and Fissures

As the fall approaches in Texas, it’s time to start treating those abused feet from the long summer and prolonged use of flip flops. Cracked heels, or fissures, are gaps in the dry skin around the back of the heel that can be painful. These are also known as rim calluses. Usually these are caused by the repetitive friction and pressure forces of our feet moving around in a shoe. This can be caused by prolonged standing on hard surfaces, being overweight because the pressure is increased on the fat pad under the heel, open back shoes because they shift pressure to the sides of the heel causing the skin to crack, or some skin conditions such as psoriasis. They can also be caused by a fungal infection such as Tinea Pedis.

If these fissures are left untreated, they can bleed, become deeper, more painful, and infected. There are a few things your podiatrist can do to help. Your podiatrist will try to find the cause of the problem to help direct the treatment. Removal of the thick hard callus will help promote healing to the area. Over the counter special creams or socks may be used help moisturize the area. Also, a pumice stone can be used to eliminate the thick callous. It does so without the use of a needle or chemical. Advice on footwear may be recommended to help prevent further fissures. To treat those summer feet or any others, come by and see Dr. Grimm or Dr. Pattison for your podiatric concerns.

Raynaud's Phenomenon

As we eagerly look forward to the fall season and its cooler temperatures, let’s take a look at a condition that could be showing up at the same time. It’s called Raynaud’s and it comes in two forms: a disease and a phenomenon. Raynaud’s is considered a vasospastic disorder, meaning that the smaller blood vessels fluctuate between becoming narrower and then wider. This shows itself as an attack with color changes to the fingers and toes that are usually brought on by stress or the cold. When the blood vessels vasospasm, less blood is getting to the fingers and toes, causing a blueish appearance. When the blood rushes back in, this causes a reddish appearance. And when a normal state returns, this shows a white appearance. Usually pain isn’t associated with this condition.

So what’s the difference between the disease and the phenomenon? Raynaud’s disease occurs more often in females under 40 and shows up on both sides of the body. There is also no ischemic change, or signs of a systemic disease present. Raynaud’s phenomenon occurs more often in males, over 40 and can show up on both sides or just one side of the body. There are ischemic changes and a systemic disease present with the phenomenon. So the phenomenon is a symptom of a bigger disease whereas Raynaud’s disease is a stand-alone condition.

Treatment of this can be difficult. If you are a smoker, then quitting can help due to smoking causing vasoconstriction of vessels. Avoiding stressful situations or the cold can also help this condition. This is less frequent in Texas but I have seen it in several patients every year. This may include wearing gloves and more insulating socks. Medication could also be recommended that would open up the blood vessels in the extremities. This is less frequent in Texas but I have seen it in several patients every year. Evaluation by your podiatrist of this condition is important to determine if it’s a stand-alone disease or a symptom of a more serious condition. Be sure to check with Dr.Grimm or Dr.Pattison for this and any other foot and ankle concern.

Cortisone Injections

A rather common treatment in podiatric care is the cortisone injection or in general terms a steroid injection. This is also known by other trade names like Celestone, Kenalog, Dexamethasone Phosphate, and Depo-Medrol and is a close version of our body’s own cortisone hormone. Our bodies naturally produce cortisone, however in a relatively short-acting form. The synthetic form that podiatrists inject targets a specific site and can last up to a several weeks.

Cortisone injections are used for a variety of conditions, but the overall theme is that they are very good at suppressing the immune system. By doing so, this reduces the inflammation, pain, and swelling at the site of injury. Cortisone is not a pain-reliever, but if the foot pain is caused from inflammation then it will result in relief. Some conditions that can be treated by a cortisone injection include plantar fasciitis, Achilles tendonitis, bursitis, neuroma pain, and other inflammatory conditions. For tendon inflammation, your podiatrist may want to inject around the tendon, but not directly in it because this can cause further weakness of the tendon.

The big question among kids and adults alike…Does it hurt? Well it can be slightly painful, but it depends on the needle size and where the injection is targeted. In our office we commonly use a cold spray topically to ease the pain of injecting the medication. Numbing medication, such as lidocaine, may also be injected with the cortisone to help provide instant relief. Depending on your condition your podiatrist may need to do a second, and possibly third round of a cortisone injection to effectively knock out the pain. Often podiatrists don’t want to give more than 3 in a time frame. And as always if you have any problems with your feet, come by and see Dr.Grimm and Dr.Pattison at Foot Associates of Central Texas.

Deep Vein Thrombosis (DVT)

A deep vein thrombosis, more commonly known as a DVT, is a condition that can affect the lower extremity. It involves the formation of a blood clot in a deep vein. This can present no symptoms, but in many cases the affected leg will be red, swollen, and painful. This condition could lead to a serious complication involving the clot becoming dislodged and traveling to the lungs, known as a pulmonary embolism.

Several conditions can lead to a DVT, such as trauma, cancer, infections, smoking, obesity, pregnancy, or a period of prolonged immobilization. This is where your podiatric care can come in. If you have any kind of procedure where you will be immobilized for a while during the healing process and are put into a cast or brace, it’s important to let your podiatrist know if you feel any sudden discomfort. This would be a feeling that the cast has become too tight and painful, indicating swelling of the leg. Your podiatrist will want to make sure this is not a DVT and not expected pain of the procedure performed. This can be done by a blood test for D-dimer levels or by an ultrasound.

There are a few ways to prevent a DVT caused by immobilization. Your surgeon may administer something called a low molecular weight heparin (LMWH) or another type of blood thinner. This lowers the chances of the blood clotting together. It’s also helpful to walk and proceed in therapy as soon as you get clearance from your physician. Also ask your doctor about alternative exercises which may help like aquatics, or knee and hip extensions. When you walk, your calf muscles help blood that pools in your leg make its way back up to the heart. This also lowers the chances of forming a clot. For these and other concerns of the lower extremity, feel free to contact Dr.Grimm and Dr. Pattison at Foot Associates of Central Texas.

Posterior Tibial Tendon Dysfunction

Tendons are what attach our muscles to our bones. Sometimes with an overuse injury you can get something called tendonitis, which means inflammation of a tendon. For the foot and ankle this is most commonly found in the Achilles tendon, and the posterior tibial muscle. We have discussed the Achilles here before so let’s take a look at the other muscle problem, posterior tibial tendon dysfunction.

The posterior tibial tendon starts in the calf, runs down behind the inside of the ankle and attaches to bones in the middle of the foot. This orientation helps hold your arch up and gives you support as you walk. Any injury to this tendon may have you feeling pain on the inner ankle and your arch may progressively fall, leading to flatfoot. Other symptoms could include heel pain, pain upon weight-bearing, especially when walking or running. You may also have instability when standing on your toes and tenderness over your midfoot. So who’s at risk for this? This occurs more often in women over 50 and also can affect those that are obese, diabetic, hypertensive, or a have history of an inflammatory disease.

Your podiatrist can diagnose this through a series of clinical tests and by looking at your foot structure. They may also possibly get an x-ray, ultrasound, or MRI. To treat this painful condition your podiatrist will look at how far along in the condition you are. In the early stages this can be treated by anti-inflammatory drugs, rest, and immobilization. For later stages, custom foot orthoses may be recommended to correct the biomechanical deformity of the foot. And for severe cases, surgery may be needed to treat the dysfunction. Posterior tibial tendon dysfunction can lead to other foot ailments so be sure to see Dr. Grimm or Dr. Pattison before this condition gets worse.

Diabetic diagnosis.....now what?

Diabetes is a disease in which a person has a consistently high blood sugar, either from the body not making enough insulin to counteract it (Type 1 Diabetes), or because the cells don’t react to the insulin that is produced (Type II Diabetes). As of 2007 there are 23.6 million children and adults with diabetes. That’s almost 8% of our population. It’s also the 7th leading cause of death. So its numbers are rapidly growing and the disease itself can lead to a number of complications in the body.

Long term effects of diabetes can include poor blood flow to the legs. This poor blood flow affects the muscles, bones, and nerves. Diabetics can also be more prone to infections and tend to heal slower than someone without diabetes. This presents a problem with even the smallest sore because due to the poor blood flow that would normally bring healing agents, the wound becomes at greater risk of infection. This is where your podiatrist can save the day. Any sore or callus should be examined by your podiatrist to evaluate the seriousness and apply any aid needed to heal. Fixing these wounds by yourself could lead to an infection. It’s also important for diabetics to do daily inspections of their feet to make sure there are no abrasions.

Your podiatrist can also recommend some tips to stay out of trouble. Shoewear that’s more accommodating can be recommended to diabetics so they stay active to keep their sugar in control. It’s important to make sure the foot type is paired with the correct shoe to avoid any blisters or sores that would heal slowly. Diabetic socks could also be recommended. These socks have no seams and help control moisture which helps avoid wrinkles. This helps reduce pressure and blistering in the shoe. These are just a few of the ways that podiatrists are vital to the care of diabetics in avoiding amputation and other complications of diabetes. For diabetic concerns with your feet come by and see Dr. Grimm or Dr. Pattison at Foot Associates of Central Texas.

Podiatrists Decrease Limb Amputation

Continuing our talk on ulcers of the lower extremity, a recent study found that podiatric care decreases the instances of limb amputation. Up to 25% of those with diabetes will develop a foot ulcer. If that ulcer becomes infected and isn’t properly cared for, this can lead to an amputated limb and possibly death. With diabetes affecting 21 million people in the US and 189 million across the globe you can see how this presents a problem.

The study looked at records for 29,000 patients with diabetes, ages 18-64, and compared the risk factors for those who had seen a podiatrist and those who had not. The researchers had found that care by a podiatric physician, which was defined as at least one visit before an ulcer was diagnosed, was associated with a 15% lower risk of amputation and 17% lower risk of hospitalization. Podiatrists are trained to assess your level of risk for an ulcer and make the appropriate prevention plans. This can include offloading pressure on the foot that’s causing the ulcer in the first place.

And this study also points out that podiatrists not only save limbs. After a major amputation, 50% of patients have the other limb amputated within 2 years. And the 5 year mortality rate after limb amputation is at least 50%. This is worse than many types of cancers. So podiatrists can save lives as well as limbs. For concerns about your ulcer or anything else about your feet, come by and see Dr. Grimm or Dr. Pattison of Foot Associates of Central Texas.

Ulcers of the Foot

Ulcers are sores of the skin that are usually accompanied by the disintegration of tissue. They are quite common in the world of podiatry and they can have some difficulty healing unless medical or surgical intervention is taken. When an ulcer goes untreated, this can lead it to becoming infected which brings in a whole new set of problems for the patient.

So how do you get these? The cause of an ulcer can be varied but the main cause is impaired blood circulation. Chronic wounds and ulcers can be caused by cardiovascular issues or external pressure from a wheelchair or bed. Other causes include bacterial infections, viral infections, fungal infections or cancers.

How do I know if I have one? An ulcer is any open wound so close daily inspection will detect an ulcer either by sight or feel. If it’s infected there will be some swelling, redness, and fever with it. If neuropathy is present, then you may not feel the wound which is why a regular foot inspection is quite important.

What can a podiatrist do for this? Prevention of ulcers focuses on patient education and offloading pressure points in the foot. High pressure can break down the skin in that area and develop into an ulcer. Your podiatrist will use orthoses, shoewear modifications or padding to accommodate the foot. An x-ray may be done to evaluate the bone structure. Fixing the cause of an ulcer is an important step in the treatment plan. Ulcers constantly have their dressing changed and are debrided. Your podiatrist will want to cut away the dead tissue to allow for the healing process to continue. Some medications also help expedite growth of the wound area. If an ulcer is infected, antibiotics may be recommended as well as a hospital stay if it’s serious enough. If you have a wound in question or any other concerns with your feet, don’t hesitate to visit Drs. Grimm and Pattison at Foot Associates of Central Texas.

Podiatric Surgery

A recent article in the Wall Street Journal looked at an increasing trend among women to request cosmetic foot surgery. The article discusses women going to extreme surgical measures to fit into their high heels without pain. The problem with this is that the true function of podiatric surgeons is to relieve pain and correct deformities. Their training doesn’t really focus on procedures to allow women to fit into a narrower shoe. Those that support the procedures claim that by doing these surgeries before joints become arthritic, they are preventing future deformities from occurring. But any surgery carries a risk with it of course.

So what falls under the umbrella of podiatric surgery? Patients that complain of joint and ligament problems are offered a plethora of surgical solutions to fix their muscles, bones, and joints.

These can include:

-Debridement –removing dead tissue or foreign material from and around a wound to expose healthy tissue.

-Bunionectomy –the procedure of removing a bunion, which is a misalignment of the joints causing appearance of an enlargement of bone and soft tissue, at the joint at the base of the big toe.

-Tenotomy –the cutting of a tendon. This and other related procedures are also known as tendon release, tendon lengthening and heel-cord release of the Achilles tendon.

-Fasciotomy –a procedure to cut away the fascia, a thick band of connective tissue, to relieve tension or pressure.

These are just a few of the foot and ankle procedures that your podiatrist can perform. For these and any other questions about surgery and your foot care, come by and see Dr. Grimm or Dr. Pattison.

Flip-Flop Front

Now that we have looked at what the summer sun can do to your feet, let’s talk about what sandals can do to them. With the warm Austin weather, some of us wear sandals year-round. A recent article in USA Today discusses the research of Justin Shroyer, a kinesiology professor at the University of Louisiana-Lafayette. He studied more than 100 people that wore flip-flops to observe how their legs and feet were affected. Some of his findings included:

-Flip-flops cause the muscles on the front of the shin to work harder, in effort to grip the shoe in place. This prolonged use could lead to other deformities of the toes later on.

-Flip-flops shorten your stride length and can cause pain in the lower leg

-Flip-flops with heel cups and arch support help induce a more natural walk

The mistake most of us make is wearing sandals as our daily shoe. They are mainly made to go to the pool or beach. Yet we run errands, walk the dog, stand up all day, or walk all over campus in sandals. You’re better off wearing a shoe with good support that stays on your foot. If you must wear sandals more often than that there are a few things you can look for. Avoid the thong-type sandals. Opt for a wide strap across the foot, and preferably one that goes around the heel to help the sandal to stay in place. Also look for a heel cup and good arch support. The American Podiatric Medical Association has put out a list of sandals with a “Seal of Acceptance” if you need help in the right direction.

http://www.apma.org/MainMenu/RecommendedProducts/SealofAcceptance/Seal-Flip-Flops.aspx

For any of your foot concerns, come by and see Dr. Grimm or Dr. Pattison for your foot care needs.

Accessory Bones

There are some bones in the human body that don’t come as standard equipment for each of us. Those that are inconsistent with our development are known as accessory bones. They can occur at a number of places in the foot but there are a few hotspots where they commonly appear. This includes the Os Trigonum, Os Vesalianum, and Os Tibialae Externum. Os Trigonum is located in the back of the heel, on the outward portion of the talus bone. Os Vesalianum is located on the base of the fifth metatarsal and Os Tibialae Externum is located under the navicular bone, on the inward part of the foot.

For most of these accessory bones, they mainly go undetected however a few do become symptomatic and can be identified by x-ray or CT imaging. The Os Tibialae Externum can become inflamed and is known as Accessory Navicular Syndrome. This extra bone lump along the arch can be a bother because of how it rubs on shoewear. Also, feet with this condition are invariably flat. It is this flat-footedness that usually brings patients in for an evaluation. So how can your podiatrist help you? First your doctor may treat the inflammation with medications, rest, ice, compression or elevation. Once the inflammation goes away, a specialized orthotic can be constructed to support the flat foot and to pad or protect the edge of the accessory bone. For more severe cases, surgery may be recommended to correct the problem. For problems with these or any of your other bones, come by and see Dr.Grimm or Dr.Pattison.

"Toasty" Feet

Now that it has reached close to 100 degrees in Austin it has reminded us it is time to address the sun and how damaging it can be to the feet. Some of us even wear sandals all year long in Texas making this a very important topic. We won't necessarily address the biomechanics of wearing sandals and how the wrong type or sandal or materials may be hurting you in other ways. Today we want to address the issue of exposure of sun on your feet.

The feet are probably the most neglected part of the body when it comes to applying sunscreen. And why is that? Sandals don’t offer much protection. Most of us only consider using sunscreen when we are going to a beach or laying out to get a tan. We sometimes are so concerned with our faces and upper body that we tend to neglect our lower extremity. Even the bottoms of the feet are susceptible to burns when lying in the sun.

The best way to protect yourself is to apply sunscreen on your feet just as often as you do the rest of the body. Make sure you use a compound that blocks UV-A and UV-B exposure. UV-A rays are associated with aging while UV-B is associated with burns, however UV-A causes the long-term damage. A sunburn of the feet can cause swelling, blistering, pain, and can limit the ability to put on a closed-toe shoe come Monday morning. If you’re feet appear sunburned, but you haven’t been outdoors, you may have another type of skin condition and should see your podiatrist to be properly evaluated. For toasted feet and any other lower extremity problem, come by and see Dr. Grimm and Dr. Pattison at Foot Associates of Central Texas.

Workout sneaker or passing fad?

A recent article in the USA Today looked at a growing trend with consumers to purchase rocker bottom shoes. Companies such as Sketchers and MBT are marketing these as a way to tone muscles, promote healthy weight loss and improve the posture of those who walk, work, or shop in them. But what’s the truth behind these funny-looking shoes? The article has input from a couple of podiatrists. They express concerns about the risks that accompany changing someone’s gait. Someone with a borderline problem they never knew about could start presenting symptoms. They can also cause balance problems, which many elderly people already deal with day to day. Another podiatrist claims that some of his patients who aren’t in the best of shape have an inflamed Achilles tendon after wearing these shoes.

Shoes with a rocker sole are nothing new. Shoes have been modified with prescription rocker soles to help alleviate conditions such as hallux limitus, ball-of-foot pain, ankle arthritis and midfoot arthritis. Depending where on the foot the rocker is placed on the shoe, it can offload that joint and alleviate different types of pain. These shoes certainly aren’t for everyone but if you think you could benefit from these or have any other concerns about your feet, come by and see Dr.Grimm or Dr.Pattison at Foot Associates of Central Texas before making an expensive mistake.

This Blistering Heat

The foot is a common place for blisters, which usually stem from some kind of friction against the skin. Athletes, hikers, and those in the military know about these all too well. Blisters happen when a tear occurs between the top layers of the skin. The bottom stays intact and fluid from your capillaries fills in between the layers. The friction that causes this can come from a few places such as socks, insoles, shoes, or the ground itself. As for the feet, they tend to show up on the back of the heel, the ball of the foot, and your toes.

Your podiatrist is the specialist who will be able to properly diagnose the cause of your blister. They can be caused by tight fitting shoes, hyperhidrosis, or by a structural deformity like a bunion or hammertoe causing more friction against a shoe. There are a few ways to prevent these. Make sure your shoes are properly sized. For athletic shoes make sure there is a little slippage in the heel so the shoe isn’t rubbing too strong. Sockwear can also help prevent blisters. Make sure they are moisture-wicking as this will decrease friction too.

There are different sizes and severities of blisters but your podiatrist will examine the cause to prevent further instances. Remember that popping or tearing a blister isn’t the greatest idea as this could potentially lead to infection. For these and any other question about your feet, come by and see Dr. Grimm or Dr. Pattison.

Shin Splints

Continuing our segment on the World Cup, another common injury that soccer players suffer is shin splints. It shows up as pain on the front part of the lower leg during exercise, usually after a period of relative inactivity. Many other types of athletes get shin splints too, especially runners and sports that involve more running activities. So what causes it?

The exact injury is not quite known, but the pain appears to stem from inflammation due to injury to a tendon in the front of the outer leg. This is commonly described as an overuse injury. A sudden increase in distance or intensity of a workout can be associated with this inflammation. Other factors can cause shin splints, such as a tight Achilles tendon, weak ankle muscles, and a tendency to overpronate the foot. Some have even stated that athletes with worn-out footwear have shin splints due to the shoe’s inability to absorb the shock of the ground.

So how can your podiatrist help you with your shin splints? Usually this diagnosis can be made with a careful patient history on the details of their exercise routine. For an unclear diagnosis, a bone scan or x-ray could be implemented to separate this from a stress fracture. After your podiatrist properly narrows down the condition, they will decide the best treatment plan for the athlete. For shin splints the best medicine may be rest from the activity. This could also include switching to non-weight bearing activities until the condition is healed. Your podiatrist may also recommend ice or medication to reduce inflammation, an Ace bandage, and strengthening and stretching exercises. For this and any other sports injury, be sure to come by and see Dr. Grimm or Dr. Pattison.

Turf Toe

In continuing with last blog’s theme of the World Cup in South Africa, we’ll take a look at another soccer injury that podiatrists see. Turf toe is becoming increasingly common as more complexes and even high schools are installing some form of an artificial playing surface. However, this doesn’t mean that it has to be a sports-trauma injury or occur solely on turf.

Turf toe occurs when the first metatarsophalangeal joint (MTP), or the big toe, becomes hyperextended. This results in a joint capsule sprain or potential tear of the capsule and ligaments. Usually this occurs when the heel is off the ground and the front of the foot is planted. An outside force then comes along and forces that big toe to bend even further, hyperextending the joint. Patients with turf toe complain of swelling, redness, pain or misalignment of the big toe during or after a traumatic event. The best form of prevention is to make sure your footwear is activity-specific and fits correctly.

Your podiatrist can treat turf toe a number of ways depending on the severity. Initial treatment consists of rest, ice, and elevation. A shoe with a stiff sole can help reduce motion of the injured toe while walking. Physical therapy may be recommended. An orthotic device could also be used to better align the foot structure and decrease the strain on the bottom of the joint. In the case of dislocation, your podiatrist may recommend surgery to properly align the joint. And as always, for this soccer injury and all the others with it, come by and see Dr. Grimm or Dr. Pattison for all your foot and ankle needs.

Ankle Sprains around the World

It’s been 4 years waiting, but after all the construction, planning, and qualifying games, the 2010 World Cup is finally here. In the last week there have been a number of injuries to some of the world’s best soccer players, most notably to Jozy Altidore of the American team. He suffered a lateral ankle sprain, but is listed as day-to-day. So why are these so common, especially on the outside of the ankle?

An ankle sprain is a stretching of the ligaments that hold the ankle joint together. There are a few reasons that lateral ankle sprains are more common. The architecture of the joint itself makes this possible as well as the ligaments. There are 5 ligaments on the medial side (towards your midline) and 3 on the lateral (outer side of your body). So the outside of the ankle doesn’t have as much protection as the inner side. Your foot structure type could also make you more prone to ankle sprains.

How can your podiatrist help? Well an ankle sprain usually occurs with trauma and presents as pain when walking, with swelling, redness, or bruising. However a number of other injuries of the foot present with these symptoms as well such as tendonitis, a bone fracture, tendon rupture, capsulitis, and a few other conditions. So it’s best to see your podiatrist to properly narrow down the condition. They will want to run a few tests and x-rays to look at your foot structure and move forward with treatment. This can range from RICE (rest,ice, compression, and elevation), anti-inflammatories, crutches, orthoses to correct the underlying foot structure problem, physical therapy to help recovery, and possibly even surgery if the sprain is severe enough. If you’re hurting for the World Cup or any other reason, come by and see Dr.Grimm and Dr.Pattison of Foot Associates of Central Texas.

Ingrown Toenails

Summer has arrived. And your swimsuit isn’t the only thing seeing the light of day more. Those toenails are coming outside more too. However podiatrists see your toenails come year-round, usually as an ingrown toenail. This painful condition occurs when the edge of a nail grows down and into the skin of the toe, or when the skin enlarges and the folds cut into the nail. This usually presents with pain, redness, and swelling around the nail.

You can suspect you have an ingrown toenail if you start having pain along the side of a toenail and it becomes extremely painful to the touch. Infections can also form here and show up with pus if the nail pokes through the skin. While part of this can be genetic in cause, how you cut your nail can also affect it. Be sure to cut straight across or gently curved if you allow your nail to stay longer. Also avoid improperly fitting footwear.

If you suspect you have an ingrown toenail you should come see Dr.Grimm or Dr.Pattison. They may start with an antibiotic and soaking the foot to prevent an infection from occurring. To correct the nail, a podiatrist can trim the nail border in hopes of the nail growing back straight. Ingrown toenails do have a high probability of coming back, in which case your podiatrist may recommend the nail border of the whole nail be removed. This surgery is very common and can be performed with a local numbing anesthetic in your podiatrist’s office. And as usual, for this or any other foot problems, come by and see Dr.Grimm or Dr.Pattison at Foot Associates of Central Texas.

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.

Why You Shouldn't Step On A Frog

Why You Shouldn’t Step On A Frog

Warts are a funny thing. As a kid, you hear how you shouldn’t play with frogs because warts will grow on your hands. If you’ve ever had one, you know they don’t feel like any other part of your skin. If you’ve ever ripped one, you know they seem to bleed forever. Warts (or verruca) can be rough, but spongy when you press on them. The truth is that warts not only grow on hands, but can show up on the face and of course, the feet. Common ones are plantar warts that show up on the bottom of your feet. They are caused by the human papilloma virus and can be contagious. Warts can spread to other areas of the body and particularly children and those with weak immune systems are susceptible to the virus.
So how do you know if you have one? Warts on the bottom of the foot will typically look like a small round callus. There are a couple of ways to help differentiate a callous from a wart. If you squeeze a wart from side to side, it will hurt, where a callous will not. Both a callous and a wart may be painful to walk on. A second way to help determine if it is a wart or a callous is the appearance. A wart will have tiny black spots throughout the wart. Warts are commonly mistaken for a number of other skin conditions, so the best way to be completely sure is to have it checked out by your podiatrist.
There are a few ways to avoid plantar warts. Try not to go barefoot in the public hotspots, including gym showers, locker rooms, or around the public pool. This is when it is a good idea to wear sandals or flip flops to help protect the feet. So what if you have one? First your podiatrist will want to properly diagnose the skin condition. If you do have a wart then there are a few treatment options. As discussed, a wart is a virus and they can be difficult to treat. Most treatments work by trying to induce the body’s immune system to fight the wart. Podiatrists do this by irritating it with a topical acid compounds, freezing it, lasers, or surgical excision of the wart. If you have this, or any other concerns with your feet, come in and see Dr. Grimm or Dr. Pattison at Foot Associates of Central Texas.

Uggs

As we come to the beginning of spring, there are still a few cold days that merit winter clothing. And one thing I have noticed throughout the winter is the fad that hasn't yet gone away; Ugg Boots. Now whether you think that stands for Ugly or you actually own and love the pair, there is an agreement to how they are treating your feet.

Many podiatrists are concerned with how often and how many young adults are choosing these types of shoes. The ligaments and bones of these young girls are still moldable. Ugg boots do not provide the proper support your feet need, especially when they are still growing. As you foot slides around inside the shoe you have unusual wear and tear to your feet. This can lead to many foot problems like blisters, joint pain, plantar fasciitis, or other tendon injuries. Since your body alignment is connected head to toe, this can throw your entire body all out of whack. Your feet and ankles can turn inward during gait (your walking cycle). This leads to knock-knees as well as pressure to your low back. If your ankles are in the wrong position then your tibia, fibula, and femur are misaligned causing hip issues. So the bottom line is if you choose to wear Uggs or any other shoe that lacks support, wear them like slippers-rarely and for short periods of time. They shouldn't be worn for long periods of times or for long distances. Remember that if you do have any of these conditions call Dr. Grimm and Dr. Pattison to take a look at your feet and discuss options to modify your shoes or gait cycle.

Southerner's Foot

Well it’s getting to that time of year again. The sun is staying out longer, the temperature is climbing towards 80 degrees, and you’re excited about coming out of winter hibernation. Whether it’s a jog down the road or just being outside all day, you feel as nothing can stop you from enjoying the warmer weather…well almost nothing. If your feet become itchy and red, with some scaly skin you could have a condition called Athlete’s Foot.
So what causes Athlete’s Foot? It’s actually a fungus (Tinea pedis to be specific) that lives on our feet and feeds off the dead skin our body makes. Moisture is one of the main contributing factors for this condition and the dark, warm, moist environment that our shoes create during warm temperatures is like a Thanksgiving feast for the fungus.
And it’s the south. And it stays pretty warm most of the year. So how can you prevent Athlete’s Foot? Make sure you’re wearing moisture-wicking socks, and if you’re exercising, wear shoes that will breathe and keep your feet dry. Avoid going barefoot in places like the gym, public shower and around the swimming pool. You should also wash your feet daily with soap. This helps remove the dead skin from between your toes that the fungus feasts on. So let’s say you didn’t read this blog yet and think you may have Athlete’s Foot. You should come in and see Dr. Grimm or Dr. Pattison to confirm it as there are a plethora of skin conditions this could resemble fungus. Treatment can be as simple as a few creams or washes that serve as an anti-fungal agent or an antiperspirant to control the moisture of your feet. But to make sure you’re feet are at their best, come by and see your local Podiatrist to get you back for the springtime weather.

Give Your Feet the Gold Medal

With the recent Winter Olympics, everyone gets excited about their favorite ski-resort activity. Whether you enjoy the adrendaline rush of skiing down the slopes or a more relaxed cross-country ski, it is a great way to stay active. Before you hit the slopes during your vacation, there are a few Olympic-quality tips to keep you and your feet happy.

1. Be sure to stretch thoroughly before you venture into the cold whether.
2. Wear the right shoes for your activity. Make sure ski boots are the proper size to allow good blood flow and nerve sensation to the feet. If you wear orthotics, be sure to have enough room to accomodate those as well.
3. Wear the right socks. You want to keep moisture away from your feet to prevent any blisters. This can be done with moisture-wicking socks made of smart wool, polypropylene, or acrylic fibers.

While cross-country skiing is an excellent aerobic activity there are a few foot risks to watch out for if this is a regular activity. The repeated stress of pushing off the skiis in a straight inline motion causes the big toe to stay bent at its hinge. Over a long period of time, this can lead to a condition called Hallux Rigidus, where a bone spur forms on top of the big toe joint and there is a slow destruction of the joint. Instead, change your technique by using a V-style glide and edge motion, similar to ice skates or roller blades. This puts less stress on the big toe. Hallux Limitus/Rigidus is a form of arthritis, an inflammation of the joint. This comes along with swelling and tenderness during and after skiing. If you have any foot conditions bothering you before or after, you may want to check in with Dr. Grimm or Dr. Pattison for an evaluation to get you back to going for the gold.

Cold Weather can be Hazardous to your Feet

The Olympics are one of sport's greatest events. This year's games in Vancouver have been no exception. The remarkable display of athleticsim can be easily overshadowed by their ability to make it look so easy. But if you take a minute to stop and notice that skiers are flying down the mountain at 90 mph, or landing long jumps with a force greater than six times their body weight, you can really appreciate the limits they are pushing the human body. To top it all off, they can do this in the cold weather.

Why does the cold weather change how the bodies act? Whenever it's cold outside your body wants to keep blood warm. So it constricts blood vessels in your extremities, like the feet, and sends blood towards your vital internal organs. This is why you are more likely to get a condition known as frostbite in your fingers and toes instead of your chest. If this goes on for too long, extremities like your toes cannot survive without blood flow and can suffer permanent damage.

So how do Olympians get around this? They wear thick socks to keep their feet as warm as possible. However some Winter Olympic sports aren't the most accomodating with their footwear. It may be hard to wear thick socks in tight-fitting speed skates. Or it may be difficult to keep your socks from sliding around in bulky ski boots. But remember it's imperative to find socks that are moisture-wicking to keep your feet dry and your socks in place. The smallest wrinkle can lead to a nasty blister.

Whether it's skiing, speed skating, or hockey, all the Olympians (okay, may be not the curling team) are putting their feet through a remarkable amount of pressure. From a podiatry point of view, it's amazing to see how their bodies endure the intense physical demands asked of them. Remember that your Podiatrist is trained to treat all of these issues and more, regardless if you're an Olympic medalist or the weekend warrior.

NBA Stars suffer from Plantar Fasciitis too.

Fans of the NBA may have noticed that the Chicago Bulls have been suffering during their last few games. This is because one of their star players, Joakim Noah, has been out with pain in his left foot. Headlines on ESPN read "Noah faces 'lingering issue' in plantar fasciitis." So what does that mean? Well first off, what is a plantar fascia? The plantar fascia is a thick band of connective tissue that runs from your heel to the ball of your foot. Think of it like a strong rubber band on the bottom of your foot, holding all your joints and muscles in place. Bruising or overstretching this band can lead to inflammation (aka plantar fasciitis) and heel pain. The causes of this overstretching can include a weight gain, improper footwear, or an injury. It can also be caused by something called a heel spur. During pronation, you can have a different pull of the fascia from the heel bone, causing a growth to form. This growth, or spur, can cause pain by putting pressure on a nearby nerve or bursa. Symptoms from this condition can include severe pain after walking or standing for an extended period of time, as well as difficulty in walking after waking up in the morning.

So how do you get rid of such a thing? Well our doctors at Foot Associates of Central Texas like to stress prevention first. This means wearing the proper footwear with an orthotic device to fix the biomechanical or pronation issue if that is the underlying problem. Podiatrists will also want to keep the ligament stretched out by performing exercises and wearing a night splint. Medical treatments would include an anti-inflammatory drug as well as a local anesthetic to reduce the swelling and decrease pain. Surgery may be needed to release the fascia or remove the heel spur. Rest is also important with an injury like this, especially with althetes such as Joakim Noah. They want to return back to competition as soon as possible. This type of injury must be taken seriously so it does not linger around. If you are having these or any other concerns with your feet, come by and see Dr. Grimm or Dr. Pattison to get you back on the court!

Taming Tarsal Tunnel Syndrome

Ever experience a combination of numbness and sharp, burning pain around your ankle? Did it feel similar to that crazy sensation you get when your feet fall asleep, yet more intense? If this sounds familiar, you could have been experiencing compression of either your posterior tibial or deep peroneal nerves which caused tarsal tunnel syndrome.

Tarsal tunnel syndrome is very similar to carpal tunnel syndrome. The only difference is that tarsal tunnel syndrome involves the ankle and sometimes pervades into adjacent parts of the foot. The posterior tibial nerve running along the medial aspect of the ankle is more frequently affected since it rests in a narrow canal, bundled together with an artery and vein. The neurovascular bundle is surrounded by tendons that all run behind the medial malleolus as they traverse from the lower leg down into the foot. Excessive pronation causes more pressure along this canal, and entrapment of the nerve can result. Trauma suffered from an ankle sprain may also cause compression.

Conservative treatment measures are primarily taken to relieve the pressure surrounding the nerve. An orthotic is often prescribed to relieve the pressure that may be caused by excessive pronation. Shoe gear is assessed to ensure it isn’t too tight, and consults with a neurologist may be necessary to rule out other causes of the symptoms. Surgical treatment is explorative in nature, and involves releasing the tissue surrounding the nerve.

Numbness, tingling and burning pain in your feet can also be caused by a variety of other conditions such as diabetic peripheral neuropathy, peripheral arterial disease, charcot-marie-tooth disease, hypothyroidism, chronic kidney disease, HIV, vitamin deficiency anemia, and alcoholism. While your foot-jerk reaction may be to self-diagnose the problem, it’s important to allow your podiatrist to investigate the sensations instead. We’ll go the extra mile to ensure the true underlying cause is treated!

Don't Sing the Blister Blues

Whether your feet have suffered in the past from shoes that are too tight or from increasing your running mileage, we’ve all suffered from blisters at one time or another. Bothersome and often painful, they can set you on the sidelines if not treated properly. The dilemma as Shakespeare would describe it becomes to pop, or not to pop - that is the question.

Blisters on the feet may be caused by wet friction, sunburn, frostbite, and viral or fungal infections. Most frequently caused by wet friction, they are often the result of socks or shoes rubbing against an excessively moist foot. The areas most commonly affected are the ball of the foot, sides of the heel, and tips of the toes. Blisters are easily preventable by breaking in new shoes and wearing shoes that fit. Taking precautions such as wearing sweat wicking socks and breathable shoes while engaging in sports will keep blisters at bay as well. If prone to hyperhidrosis of the feet, use of an antiperspirant such as Neat Feat will help minimize friction by keeping them dry.

Ideally, treatment of a blister is best achieved by eliminating the cause. Blisters should not be intentionally popped if it can be helped, and measures to offload the pressure by surrounding them with moleskin may alleviate some of the discomfort. Popping a blister with an unsterile object may lead to infection, and there have been cases where infected blisters have led to cellulitis. The best thing to do is to leave it alone, especially if it is a blood-filled blister since these are even more prone to infection. Should a blister burst on its own and the underlying skin is not yet healed, protect the area with some antibiotic cream and a bandage.

If you find yourself with multiple blisters on your feet with no obvious cause, it’s important to refrain from commencing a "popping palooza." Podiatrists are trained to differentiate between friction blisters and vesicles caused by fungal infections. They will nail down the cause in no time. Ultimately when it comes to blisters, the best offense is a good defense.

Tackle Troublesome Big Toe Pain

New year equals new you! This is a very general resolution. A lot of people make them, and 2010 is unique since we’ve just begun a new decade. Resolving to change our behavior in one of the areas that will improve our health in the pursuit of increased vitality and longevity is universal. Have you ever made goals in the past to lose weight, walk more, or run a certain number of races and been hindered by a big pain in the toe?

Big toe (hallux) pain can be attributed to many things such as gout, bunions, stress fractures and ingrown toenails; however, one of the most frequent causes is a condition called hallux limitus. Essentially, it is limited range of motion of the hallux characterized by pain, stiffness, an enlarged toe joint in later stages, and occasionally swelling with heightened activity levels. It’s caused by biomechanical and structural abnormalities such as a dorsiflexed first metatarsal secondary to excessive pronation and hypermobility of the first ray or a long first metatarsal relative to the second metatarsal. Muscle imbalances including a weak peroneus longus, overpowering of the tibialis anterior, and contracture of plantar fascia and intrinsic foot muscles may also contribute to decreased hallux range of motion.

Conservative treatment ranges from casting the feet for orthotics in order to minimize some of the excess of pronation to prescribing a plate fitted for shoes that may not be rigid enough to counter the hallux hypermobility. Hallux limitus left untreated may eventually progress to hallux rigidus. Hallux rigidus is characterized by an even greater restriction of motion in the hallux and is a sign of degenerative arthritis in the big toe joint. Surgical treatment to decrease the pain is often necessary when the big toe deformity has progressed to hallux rigidus. Surgical treatment options include cleaning out the joint space, implanting a joint, and fusing the first metatarsalphalangeal joint.

Runners are generally are more susceptible to developing hallux limitus since the foot endures stronger forces when pronating during running as opposed to walking. Therefore, it’s important to see your podiatrist sooner rather than later so that conservative measures can be taken to preserve the joint. Don’t let a pain in the big toe prevent you from achieving your resolutions!

Athlete's Foot Awareness

Whether you’ve added swimming to your winter cross-training routine, made a New Year resolution to start going to the gym or simply have been wearing socks more often due to the cooler weather, it is important to take measures to keep your feet from picking up this uncomfortable fungal infection.

Athlete’s foot, otherwise know as tinea pedis, is a superficial fungal infection of the skin. It most occurs more frequently in adults, targeting the web spaces between the toes and soles of the feet. The fungi thrive in warm, moist environments that may be present in socks, old running shoes, around indoor pools and in fitness center showers. Symptoms of tinea pedis include itching, redness, scaling and occasionally blisters. There are many different types of fungi that cause athlete’s foot, and superficial bacterial infections of the skin can present with identical symptoms. Therefore, it’s important to distinguish a bacterial from a fungal organism causing the skin infection prior to commencement of treatment. Below are some tips provided by the American Podiatric Medical Association for avoiding superficial skin infections of the feet.

Avoid walking barefoot; use shower shoes.
Reduce perspiration by using talcum powder.
Wear light and airy shoes.
Wear socks that keep your feet dry, and change them frequently if you perspire heavily.

Whether you describe yourself as an athlete or not, we’re all susceptible to an attack of athlete’s foot if we don’t take proper measures to keep our feet dry. If the above tips fail to prevent this fungal infection from attacking your feet, don’t hesitate to schedule an appointment with your podiatrist. They have the training to differentiate between bacterial and fungal infections with noninvasive tests and will get you on the road to recovery in no time.

The Truth About Bunions

One day as you slip on your favorite pair of dress shoes, you notice a bit of discomfort. You’ve had the shoes for years and they’ve always fit properly in the past, so you continue to wear them. Over time, as you continue to wear those shoes, the discomfort gradually turns into pain. All of a sudden you notice a bump on the side of your big toe, and the pain has become so unbearable you cannot wear your dress shoes anymore. The painful bump is a bunion.

A bunion is a deformity of the foot otherwise known as hallux abducto valgus. It presents as a bump on either the medial side of the big toe (hallux) at the first metatarsal phalangeal joint or the lateral side of the fifth toe at the fifth metatarsal phalangeal joint. The metatarsal head is subluxed medially at the joint while the big toe is deviated laterally. Retrograde forces from muscles that attach to the metatarsal and proximal phalanx in the hallux then cause the first metatarsal to drift medially.

Contrary to common belief, shoes do not cause bunions. They merely exacerbate symptoms, and it’s been suggested that those with narrow toe boxes may accelerate the bunion formation process. Bunions are primarily caused by abnormal biomechanics at the first or fifth metatarsal phalangeal joints, abnormal pronation with a hypermobile first ray. They may also occur secondarily to trauma, arthritic diseases, amputation of the second toe, neuromuscular disorders, and congenital disorders.

Treatment for correction of bunions requires outpatient surgery that may involve immobilization of the foot anywhere from four to six weeks depending on the procedure performed. At your pre-operative appointment your podiatrist will either take radiographs of your foot have you get them in advance. The results from the information obtained from the radiographs combined with a thorough biomechanical analysis of the foot, will then dictate the types of procedures best suited for correction of your bunion. You can expect your podiatrist to discuss all the treatment options with you, and together, you will develop the best treatment plan to achieve an optimal outcome.