Those with diabetes are at an increased risk of developing an ulcer for two main reasons.  The first is peripheral neuropathy.  This common complication of diabetes is a general loss of feeling.  The nerves lose their ability to detect pain, heat, and cold.  If the foot is injured, nerve damage may prevent from noticing the damage.  Poor circulation is the other main reason diabetics develop ulcers.  Blood increases in thickness, slowing its flow, therefore, causing poor circulation.

A foot ulcer appears like a red sore, most commonly found on the ball of the foot or under the big toe.  If the wound is infected, pus and a bad odor typically occur.  It is important to see a podiatrist as soon as an ulcer is noticed.  Untreated foot ulcers can progress into gangrene and may lead to amputation.  Treatment for foot ulcers depend on the severity of the wound.  It typically involves debridement, off-loading, and dressings.  Debridement is the process of removing dead skin and tissue.  Off-loading uses pads or special shoes to take pressure off the ulcer area.  Proper dressing and bandages are important to protect the area and provide an optimal healing environment.  Ulcers may take weeks or even several months to heal.  This depends on the general health of the patient and the severity of the wound.   

To have your feet evaluated for foot ulcers or any other painful foot and ankle condition call 843-449-FOOT.  

By Dr. Joseph Menn

Here are some simple techniques to properly cut the nails to avoid toenail pain.                                                                               

Use appropriate toenail clippers.  Larger nails need larger clippers.  This is why toenail clippers are much larger than fingernails.  Keep your clippers clean by wiping them with rubbing alcohol before each use.

Leave nails a little long.  Cutting nails too short can also cause ingrown toenails.  By doing so, it puts the nail at risk of infection.

Cut nails when they are dry.  Wet nails are more likely to tear, bend, or cut poorly because they soften when wet.

Cut straight across.  Nails shouldn’t dig down on the sides.  Guide the clippers straight across, follow the shape of the nail, and then use the curve on the clippers to cut the nail’s edges.

Nail filing.  If you like to file your toenails, do not drag the file back and forth.  Gently move the nail file in one direction across the top of each nail.  Try using a glass nail file.  This offers more protection and is easy to clean.

Everyone’s nails grow at different speeds, so it’s important to keep an eye on the length of your nails.  Make sure to trim them before they start rubbing against shoes and causing pain.  Clean, well-cared for, and neatly trimmed toenails lead to comfortable, healthy feet. 

If you suspect you have an ingrown toenail, please visit one of our locations in Myrtle Beach, Surfside Beach, Conway or Little River or to make an appointment call 843-449-FOOT.

By Dr. Jordanna Baker

Being trapped in a tiny airplane seat in an enclosed area without much room to move can lead to swollen feet.  The same can be said for long car rides.  The easiest way to prevent swollen feet during travel, is to move around to get your blood flowing.  When you’re sitting, the muscles that help pump fluid out of your legs are not active.  This can lead to blood pooling in your feet and uncomfortable swelling.  The low cabin pressure, combined with dry air circulating in a plane, can also slow blood circulation.  This is because when you are dehydrated, your blood gets a bit thicker and circulation is slowed.  Poor circulation can allow dangerous blood clots to form in the legs, which can travel to the lungs or brain, causing very serious health complications. 

When traveling, it is important to keep normal blood flow.  Below is a list of some tips to promote blood circulation to your feet during holiday travel. 

Watch your diet.  Taking precautions to avoid salt the day of and before travel will help maintain normal fluid levels.  Salt can cause you to retain fluid, which can make your feet swell even more.

Drink water.  Drink plenty of water the day before and day of your trip.  Drinking water will help you prevent dehydration and encourage you to walk to the bathroom.    

Walk around.  When flying, get up several times during the flight to get your blood flowing.  This is especially important on flights over two hours.  While walking around is not encouraged in a car, take an extra five minutes to walk around the gas station or rest stop.

Leave plenty of room for your feet.  If your feet are fighting for space with bags, they will be more restricted and may be placed into positions that cut off the blood supply.  Asking for an aisle seat on a plane, will make it easier for you to move around and give more room.

Exercise your legs.  When you can’t get up and walk around, you can still use the muscles in your feet.  Point your toes up and down and side to side to get your feet moving.  Also, try spreading your toes or using them to pick an item off the ground.

Don’t cross your feet.  Your circulation is already slow when you are sitting for hours; don’t make the mistake of cutting it off even more by crossing your legs.

Wear proper footwear.  Compression socks or hose will help bring blood back to your heart.  Slip-on shoes are great because they can be easily removed and allow you to massage or exercise your feet. 

By Dr. Scott Werter

For most people their feet are the furthest things from their minds, both physically and mentally.  They continually place their feet into shoes with the expectation that their feet will hurt at the day’s end.  The foot’s design allows it to withstand the constant demands ofwalking, running, and for the most part whatever stress we place on them.  It is for this reason that constant foot pain is especially concerning.  Often times, your foot’s health is an indicator of your overall health.  Signs of arthritis, diabetes, nerve, and circulatory disorders can all be detected in the foot.  This is where the doctors at Coastal Podiatry Associates are specially trained to help.  Podiatrists are highly trained physicians and surgeons focusing on the foot and ankleand should be an important part of your healthcare team. 

The doctors at Coastal Podiatry Associates, Dr. Hamilton, Dr. Menn,Dr. Werter, and Dr. Bakerhave each completed years of rigorous foot and ankle training in a podiatric medical school.  This education is an additional four years after receiving an undergraduate degree.  Their schooling and training make them the most qualified doctors to care for your feet.  These doctors have been taught and specialize in wound care, surgery, biomechanics (how the foot moves), geriatrics, pediatrics, diabetic care and dermatology. 

Coastal Podiatry Associates has locations in Myrtle Beach, Conway, Surfside Beach and Little River, South Carolina.  It is important to visit one of these locations if you are experiencing or have diabetes, flat feet, bowed legs, high arches, recent or recurring foot, ankle, or lower leg injuries, sores or infections, circulation problems, or lasting foot pain of any kind.  The foot is a complex combination of bones, ligaments, and muscles.  It is an all-in-one stabilizer, shock absorber, and the initiating force during walking making it essential to overall health and wellbeing.  Feet require expert care, like that given at Coastal Podiatry Associates.

By Dr. Scott Hamilton       

 Diabetes Awareness

Did you know that diabetes is the leading cause of non-traumatic leg and foot amputations?  Or that these amputations and complications can be prevented?  With proper foot care from the podiatrists at Coastal Podiatry Associates the effects of this disease can be managed and treated.  Podiatrists are uniquely qualified to treat the foot and ankle based on their education, training, and experience.

Diabetes has four main types including prediabetes, type 1, type 2, and gestational diabetes.  The American Diabetes Association has a great website at diabetes.org that highlights the different types and symptoms of each.   A diabetic foot ulcer is one symptom that may occur in each type.  An ulcer is an open sore or wound that occurs in approximately 20% of people with diabetes.  Anyone who has diabetes is at risk to develop these open wounds.  People on insulin, overweight, using alcohol and tobacco, or have diabetes-related kidney, eye, and heart disease are at an increased risk to develop ulcers.  Ulcers form to a combination of factors such as a lack of feeling, poor circulation, bone deformities, friction, trauma, pressure, and longstanding diabetes.   

Once an ulcer is noticed, it is important to see a podiatrist right away.  Having medical treatment will reduce the risk of infection and amputation, improve pain and discomfort, and reduce future costs.  The goal of ulcer treatment is to reach healing as fast as possible.  To speed the recovery process, a podiatrist will attempt to prevent infection, take pressure off the area, remove dead skin and tissue, apply bandages, and manage other health problems.  It cannot be stressed how important it is to see a podiatrist like those at Coastal Podiatry Associates as soon as an ulcer is noticed to have the fastest healing. 

By Dr. Joseph Menn 

It is important to get your feet measured on a regular basis as feet naturally widen and lengthen with age.  Have your feet measured while standing with full weight of your body on your feet.  Most people have one larger foot; therefore, it is important to fit your new shoes accordingly.  When trying on your next pair of shoes, there should be one-half inch between your longest toe and the front of the shoe.  It is also a good idea to try on both shoes and walk around the store.  If your feet hurt in the store, don’t buy them, as footwear should not need a break-in period. 

Before purchasing your next pair of shoes, spend a moment to look at how it is made.  To reduce the chance of excessive sweating and blisters choose breathable materials such as leather.  Look inside the shoe for exposed seams, pieces of material, or outcroppings of leather that can rub against you foot and cause blistersor wounds.  It is best to shop for footwear in the afternoon or evening when feet are largest due to natural swelling.  Full-service shoe stores are more likely to carry half sizes and have knowledgeable staff members who can measure your feet and suggest a specific shoe.  Focusing on your foot health as you shoe shop is definitely worth the extra time and effort!

By Dr. Jordanna Baker

Toe Stretches.  This stretch will help keep your toes limber and offset foot pain.  To stretch, point your toes straight ahead for 5 seconds and then curl them under for 5 seconds.  Repeat this stretch 10 times.

Toe Flexing and Contracting.  This is conducted by pressing your toes against a hard surface (such as a wall) to flex and stretch them.  It is important to flex your toes in the opposite direction too.  Each stretch should be held for 10 seconds and be repeated three to four times.

Stretching the Big Toe.  Using your fingers, gently pull your big toe into proper alignment.  Hold this position for 10 sec and repeat three to four times.

Resistance Exercise.  Wrap either a towel or belt around your big toe and use it to pull you big toe toward you while simultaneously pushing forward, against the towel with your big toe.

Towel Curls.  Strengthen your toes by spreading out a small towel on the floor, curling your toes around it, and pulling it toward you.  Repeat five times.

Picking up Marbles.  Place 20 marbles on the floor in front of you and use your foot to pick the marbles up one by one and place them in a bowl.  Gripping objects with your toes like this can help keep your foot flexible.

Walking along the Beach.  Walking on the sand will give a gentle foot massage and help strengthen your toes. 

Being overweight makes you more likely to develop several conditions that can lead to foot pain.  Gout is a condition caused by uric acid crystals accumulating in your joints.  This can cause a sharp, severe pain typically found in the big toe.  Being overweight makes you more likely to develop gout by increasing the body’s production of uric acid.  Also, being overweight is one of the main factors for developing diabetes.  Among other things, diabetes can lead to numbness in your feet.  The reduced blood flow found in diabetics can lead to small injuries turning into major infections.  Increased weight places you at an increased risk for peripheral arterial disease.  This condition is marked by an accumulation of plaque in the walls of arteries in the legs causing a decrease in blood flow.

One concern for people that have weight-related foot conditions is how to get the physical activity required for weight loss without causing foot injuries.  Low-impact aerobic activities such as water aerobics are great ways to lose weight while preventing foot pain.  A podiatrist can make sure your shoes are the right size, type, and offer the proper support.  It is important to start exercising gradually, and avoid activates that cause pain.    

According to the Nation Institutes of Health, smart tips for people with diabetes include:

Do inspect your feet daily.  Stay on the lookout for signs of possible trouble such as red spots, blisters, cuts, and calluses.  If you cannot see the bottom of your foot, lay a mirror on the floor and use it to inspect your soles. 

Do keep your feet warm.  If your feet feel cold or you know they may become cold, put on warm socks.  This will help keep normal blood flow to your feet.

Do wear the right shoes and socks.  Buy shoes that have plenty of support and make sure to wear clean, lightly cushioned socks at all times.  The American Podiatric Medical Association has a list of their favorite shoe brands.

Do control your blood sugar.  This is the best way to prevent foot problems from developing or progressing.  Work closely with your doctors to keep your blood sugar under control.

Don’t walk barefoot.  This means indoors as well as outside.  Always feel the inside of your shoes with your fingers before putting them on.  Make sure to check for sharp objects, rocks, or rough material that can cause irritation.

Don’t smoke.  In addition to harming your heart and lungs, smoking also decreases blood flow.  This inhibits your immune system from fighting sores and infection.

By Dr Jordanna Baker of Coastal Podiatry Associates, Myrtle Beach SC.

Inflammation is a common problem affecting feet that is linked to nutrition.  Plantar fasciitis is a common inflammation problem where the tick band of tissue that runs across the bottom of the foot enlarges and becomes painful.  Many common foods in the American diet encourage inflammation.  These foods include refined grains, sugar, trans fats in baked goods and junk foods; the saturated fat in red meat, and omega-6 fats found in many vegetable oils.  Another source of elevated levels of inflammation is due to chronic food allergies such as wheat.   Inflammation is also increased after consumption of foods that cause a rapid increase in blood sugar.  Sweets, white flour, and pasta are examples of foods that can cause this rapid increase.     

Two simple ways to reduce inflammation include eating more omega-3 fats and a proper general diet. Omega-3 fats are found in fatty fish like salmon and can be added to the diet with fish oil supplements.  This type of fat directly helps to reduce inflammation.  Nutritional studies suggest people should balance their diet of poor omega-6 with the healthier omega-3.  An overall healthier diet can provide anti-inflammatory benefits to the body.  Eating more green vegetables and other fresh plant foods is a great start.  Cutting out refined grain foods and sugary treats can only help too. 

A proper diet will help to prevent the development of diabetes and peripheral artery disease.  Each of these conditions can harm your feet by damaging small arteries that bring them blood.  According to the National Institutes of Health, a diet low in saturated fat, trans fat, and sodium as well as rich in fruits and vegetables can help reduce the risk of peripheral artery disease.  A diet rich in whole grains, beans, vegetables, fruits, lean meats, and a limited amount of fats will help combat diabetes.  Following the National Institutes of Health recommendations will help ensure a balanced, healthy diet. 

By Dr Joseph Menn of Coastal Podiatry Associates, Myrtle Beach SC.

Here is a quick test to see the condition of your feet.

• First, check your skin for calluses, blisters, or areas of irritation.  Next stand next to the shoes you wear most often.  Are your shoes shaped like your feet, or are they tight in areas and causing rubbing?  If you place your hand inside of your shoe are there seams, tacks, or rough places in the shoe?  When your shoe’s shape does not match your foot, it can cause areas of irritation, calluses, or blisters.
• Now look at the color of your toes.  Are they red, pink, purple, or blue?  Press down on the tip of your toes until they turn white.  Once you release your figure from your toe start counting.  The normal color should return in 2-5 seconds.  If it takes longer than 5 seconds, this could mean you have poor blood flow to your toes.    
• How flexible are your toes?  Try to pick up a small rock or dishtowel.  Also, try testing your ankle flexibility by hanging your heel over the edge of a stair while standing on the stair and facing the stairs.  Now let your heel go below the level of the stair.  If this causes pain, stop the test.  If your heel goes below the level of the stair without causing strain then this is excellent.  If there is some strain, this can be improved with flexibility exercises.
• To check the sensation of your feet take a pencil eraser and lightly run it on the top, bottom, and side of both feet.  The sensation should feel equal in all areas.  Now try taking a few steps.  Do you notice any pain or discomfort?  The average foot lacks pain.

By Dr. Scott Werter of Coastal Podiatry Associates, Myrtle Beach,SC

Many bunion problems can be managed without surgery and bunions that are not painful do not need surgical correction.  Podiatrists do not recommend preventive surgery for bunions that do not hut because with proper preventive care they may never grow into a painful problem.  The best way to prevent bunion pain is switching to shoes that fit properly and do not compress the toes.  Podiatrists are excellent guides for choosing the best shoe to prevent bunions as well as other problems.

If nonsurgical treatment fails, surgery may become the only option.  The common goal of these procedures is to realign the joint, relieve pain, and correct the deformity. Podiatrists have many options when choosing which surgery to correct a bunion.  They base their decision from of the degree of malalignment, the length of the toe, health of the patient and physician preference.  Terms used to explain the surgeries might be very confusing.  Here are a few common words associated with bunion surgeries.  An osteotomy is surgical cutting and removal of bone.  An exostectomy is the removal of the bump on the first metatarsal.  This procedure shaves the side of the bone off, is used only for a boney enlargement, and does not realign the bones.  It is typically done in combination with other procedures.  An arthrodesis is the removal of damaged bone around the joint followed by the insertion of screws, wires, or plates to hold the bones together until they heal.  This procedure fuses the joint and is used for patients with severe bunions, arthritis, and when other procedures have failed.   Bunion surgery is a great way to dramatically reduce pain and improve the alignment of the big toe.  These surgeries are very common and a great way to restore normal function of the foot.          

By Dr. Scott Hamilton of Coastal Podiatry Associates, Myrtle Beach, SC

The frequent appearance of symptoms to initiate in the foot may mean a podiatrist is the doctor diagnosing RA.  To determine a patient has RA a podiatrist will ask about the patient’s medical history, occupation, recreational activities, and family history.  Doctors commonly conduct x-ray studies to determine the amount of damage to the bones and joints.  Blood tests are used to determine if the patient is anemic or has an antibody called rheumatoid factor.  While antibodies are normally produced by and protect the body, in RA a few antibodies turn against the body by attacking the lining of joints.  The attacks lead to joint inflammation causing pain and swelling.  Eventually the lining in the joint breaks down and damage to the bones can occur.  The damage may be so severe that joint deformities form. 

Many people with RA can control the pain and disease with medication and exercise.   Medications such as aspirin or ibuprofen are used to control the pain and there are many prescription drugs able to help slow the spread of the disease.  There are also steroid injections available to relieve the joint swelling and inflammation.  In addition to drugs, a podiatrist may prescribe special shoes to help the foot function properly.  Unfortunately, RA is a progressive disease that currently lacks a cure.  Through medication, exercises, and surgery the effects of RA can be reduced and its progress slowed. 

By Dr. Joseph Menn of Coastal Podiatry Associates Myrtle Beach, SC

Diabetic shoe inserts are also considered part of the term diabetic shoe.  These inserts or orthotics are specially designed for each person.  The advantage to using an insert is that it can move from shoe to shoe and people can still buy their choice of shoe (within limits).  A podiatrist can fit a patient for this insert or order a complete shoe.  The shoe prescribed by the doctor will be either custom made or an extra depth model.  The custom-made shoes are created using a unique cast of the patient’s foot.  The shoes come in a variety of sizes, materials, and styles to match the needs of each foot and personal preference.  Extra depth models on the other hand, can receive only moderate modifications.  These shoes provide the needed support and cushioning while having a deeper sole.  This increase in depth allows for customized insoles to replace the standard insole, allowing for a perfect union between shoe and orthotic. 

Again, it is important for people with diabetes to wear seamless socks, stocking, or nylons with shoes.  Proper socks will help wick moisture away from the foot, keeping the skin dry and preventing cracks due to wetness.  Socks also create a barrier between the foot and shoe, preventing blisters and wounds from the shoe rubbing against the skin.  Specially designed diabetic socks will achieve both goals of providing great protection and comfort. 

Ordinary, the tibialis anterior muscle is overused because the foot overpronates.   Pronation occurs when the foot flattens as weight is applied.  This is a normal event in walking but during overpronation the foot becomes so flat that it rolls inward.  The increased movement in the foot increases the demand on the tibailis anterior muscle and its connection to the tibial bone. 

People with shin splints typically complain of tenderness along the bone and may have some swelling in the area.  This pain is most commonly increased when pushing the foot into the ground, like what is done during running.  In addition to taking a detailed medical history and physical, a doctor may order an x-ray or bone scan.  While not all shin splints are the same, basic treatments are.  Applying ice packs or ice massage the area for 20 min three times a day with anti-inflammatory medication will help reduce the pain.  This should be done in addition to making sure shoes are in good condition and the foot does not excessively pronate (a good shoe insert or orthotic should prevent overpronation).  As always, it is important to be evaluated by a doctor if pain is not temporary.    

By Dr Scott Werter of Coastal Podiatry Associates, Myrtle Beach SC.

By Dr. Scott Hamilton of Coastal Podiatry Associates, Myrtle Beach, SC.

Correct barefoot running form will also decrease the risk of injury.  A full discourse of proper form is beyond this blog so I will refer readers to books written on the subject.  One important regard to technique.  Don't overstride.  Get used to a much shorter stride with faster foot turnover and you will reduce the risk of injury.

That's all for this week. My progress?  I'm up to a mile with no pain or injury.  Those calf muscle issues healed within 2 weeks.  My goal now is to gradually increase distance to about 3 miles per run by fall and than start the longer (5+ miles) run when the cooler weather arrives.  Next week I'll let you in on a little secret.

By Dr. Scott Hamilton of Coastal Podiatry Associates, Myrtle Beach, SC.

Because arthritis is commonly felt first in the foot, a podiatrist is often the first physician to encounter some of the complaints.  Diagnosis of arthritis is reached after evaluating lab tests and clinical presentation.  Early diagnosis is important to effective treatment as destruction of cartilage is not reversible.  The goals of treatment are to control inflammation, preserve joint function, and curing the disease if possible.  A vast array of medication have been developed to treat the causes of arthritis but aspirin is still the drug of choice for many forms.

Three of the more frequent forms of arthritis found in the foot include osteoarthritis, rheumatoid arthritis and gouty arthritis.  Osteoarthritis is the most common form of arthritis.  Its onset is generally gradual as aging brings on a breakdown in cartilage and pain slowly increases.  The progression of this condition leads it to be called degenerative joint disease or wear and tear arthritis.  It is also characterized by throbbing nighttime pain and muscle weakness or deterioration.  Rheumatoid arthritis is a complex chronic inflammatory system disease affecting more than a dozen small joints in the foot and hand.  Its symptoms include morning stiffness, fatigue, weight loss, and may affect other parts of the body.  Rheumatoid has a much faster onset than other forms and is distinguished by periods of remission.  Gouty arthritis is caused by a buildup of uric acid (a normal product of the diet) in joints.  It typically affects a big toe.  Men are much more likely to be affected than women especially when they consume a diet with lots of red meat, sauces, shellfish, and brandy. 

By Dr. Jordanna Baker of Coastal Podiatry Associates, Myrtle Beach SC.

Realizing that diabetes is a disease and taking, the steps to control the disease can save your life.  60-70% of people with diabetes have mild to severe forms of diabetic nerve damage.  Severe forms of diabetic nerve damage can lead to foot and leg amputations.  The rate of amputation for people with diabetes is 10 times higher than that for people without the disease.  After an amputation, the chance of another amputation with 3-5 years is almost 50%.    

A podiatrist plays a crucial role in a diabetes management team.  They are uniquely qualified to treat the foot and ankle, which is where diabetic nerve and blood flow problems first occur.  If you have diabetes or are at risk, it is important to have a podiatrist check your feet at least once a year for symptoms, such as loss of sensation, burning, or tingling.  Since diabetes affects your entire body it is important to have other doctors involved in your treatment team.  A primary care physician or internist plays the important role of coordinator.  They can make referrals to other specialists and conduct general care.  Endocrinologist is a specialist used for people having difficulty controlling the disease.  People with diabetes are at an increased risk for gum disease and infections in the mouth due to the elevated blood sugar.  This makes it important to maintain regular dentist appointments.  An ophthalmologist should be a part of the diabetes management team as well.  They are specially trained to detect blood flow problems to the eye along with vision difficulties.  Diabetics should include a trip to the eye doctor for exam once a year as part of their treatment. 

By Dr. Joseph Menn of Coastal Podiatry Associates, Myrtle Beach SC.

*All statistics and numbers are from the American Podiatric Medical Association*   

By Dr. Scott Hamilton of Coastal Podiatry Associates, Myrtle Beach SC.

Plantar Fasciitis      This is an inflammation of the fibrous band of tissue in the bottom of the foot.  This band extends from the heel to the toes, helping to form the arch in the foot by supporting the bones and muscles.  The tissue can become irritated for many reasons; most commonly from placing too much stress on the bottom of the foot.  Plantar fasciitis can be prevented by stretching before and after every run.  Wearing supportive running shoes equipped with shoe inserts can also provide relief.  It is important not to over-train and gradually increase running distance and time.  The recommendation to reduce plantar fasciitis pain is icing, ibuprofin, and rest. 

Achilles Tendonitis     Achilles tendonitis is an inflammation of the Achilles tendon.  This tendon connects the calf muscles to the back of the heel.  Lack of flexibility and too much movement of the foot’s bones often cause this condition.  Regular stretching and shoe inserts prevent Achilles tendonitis.  Ice, ibuprofin, and rest are important methods to reduce pain.

Shin Splints       Also known as tibial stress syndrome, shin splints are experienced as a shooting pain felt near the front or sides of the shin.  Toe raises and shin stretches are excellent prevention exercises.  Replacing worn running footwear is also a key for preventing shin splints.  It can be treated with ice and ibuprofin.  A podiatrist may also recommend a physical therapy program.

Stress Fracture     Stress fractures are caused by repetitive force to a bone.  This starts as a localized pain and swelling that grows worse over time.  Stress fractures are prevented by modifying running equipment or training regimens with emphasis placed on replacing running shoes on a regular basis.  A stress fracture is a break in the bone and requires 8-10 weeks to heal completely.  Treatments consist of rest, icing and if needed immobilization casts.

Morton’s Neuroma    Morton’s neuroma is felt as a burning, stinging pain between the third and fourth toe.  It may also be felt as a pain in the ball of the foot or a feeling of pins and needles or numbness in the toes.  Wearing proper fitting shoes with adequate cushioning is a great way to prevent a neuroma.  Shoes should also have a roomy toe box and not laced too tightly.  Treatment for a neuroma is a cortisone injection and shoe inserts.

By Dr. Scott Werter of Coastal Podiatry Associates, Myrtle Beach SC.

By Dr. Scott Hamilton of Coastal Podiatry Associates, Myrtle Beach SC.

Besides having visible, enlarged veins, varicose veins can also show with mild swelling around the ankles, brown skin color at the ankles, or sometimes an throbbing pain in the legs.  The pain in the legs can be due to the large veins pushing against and irritating the surrounding nerves.  If the swelling becomes sever, skin wounds can develop around the ankle.  These symptoms are made worse by standing or sitting with the legs dangled for long periods.  Varicose veins occur due to defective vain valves from birth, pregnancy, or blood clots.

Varicose Veins are diagnosed based on the appearance of leg veins.  A physician may confirm the diagnosis by ordering an ultrasound exam of the leg.  An ultrasound will allow the physician to see the blood flow in the vein and rule out other disorders of circulation.  Treatment of varicose veins is typically conservative and very simple.  Avoiding extensive standing and sitting with the legs dangled is critical.  It is also advised that patients raise their legs while resting or sleeping and wear an elastic support hose to help the blood return to the heart.  More intense therapy includes laser and radio ablation or the veins.  Surgery to remove varicose veins is typically reserved for patient who are having tremendous pain or have developed skin ulcers.  If you are experiencing varicose veins, see your physician right away as these veins tend to get worse over time but are easily slowed with simple treatments.    

By Dr. Scott Werter of Coastal Podiatry Associates, Myrtle Beach SC.

The posterior tibial tendon is constantly used.  It helps hold up the arch of the foot and during walking it provides support when stepping off the toes.  If this tendon becomes inflamed, over stretched, or torn many things can happen.  First pain and swelling is typically noticed on the inside of the ankle.  Soreness over the arch can occur, especially with activity.  This soreness can increase leading to a loss of the foot’s arch.  General weakness and an inability to stand on the toes can also occur.  Posterior tibial tendon dysfunction occurs most often in women over 50 years of age but can also be brought on by obesity, diabetes, previous surgery or trauma, local steroid injections, or an inflammatory disease. 

A podiatrist will reach the conclusion of PTTD through a history and physical examination.  During the physical exam it is common to have the patient stand on their bare feet facing away from the physician.  This allows the physician to notice how the foot functions.  From behind, it will look as though you have too many toes showing.  A podiatrist may also ask the patient to stand on their toes or do a single heel raise.  During a single heel raise, the heel will normally rotate inward.  The absence of this sign indicates PTTD.  The treatment a podiatrist recommends will depend on how far the condition has progressed.  The ultimate goal is to return the tendon to normal functioning and to prevent permanent flatfoot.  In the early stages, PTTD is treated with ibuprofen, shoe inserts, or immobilization of the foot.  If early treatments do not work surgery may be needed.     

By Dr. Joseph Menn of Coastal Podiatry Associates, Myrtle Beach SC.

Blisters:        Blisters are only painful but can prevent you from doing your favorite activities.  Blisters located on the foot can vary in size and shape.  They are commonly caused by excessive friction due to ill-fitting shoes, stiff shoes, excessive moisture, or wrinkled socks rubbing against the skin.  Blisters can be easily treated at home if simple precautions are followed.  First, it is important to clean around the blister with water and soap.  If the blister is not causing pain, it is best to allow the blister to heal by itself but if this is not possible, the blister can be drained.  A sterilized needle should be used (wipe it with rubbing alcohol and place in boiling water for 30 min) to drain the blister by carefully inserting the needle in a corner of the blister close to the bottom of the foot.  Make sure not to remove the loose skin that covers the blister and coat the area with antibiotic cream before covering with moleskin or band-aid. 

Warts:        Warts are a painful thickening of the skin.   Viruses typically cause warts after they enter the skin through a small cut or abrasion.  The virus normally finds these entrances on the bottom of the foot.  Once the virus grows, it forms a hard, flat, elevated bump.  Warts can be avoided by keeping the feet clean and dry.  It is important to change shoes daily and avoid walking barefoot to prevent coming in contact with viruses.  If a wart forms, do not dig it out yourself.  See your local podiatrist for treatment options and recommendations.  Podiatrists typically offer laser, chemical, or radiofrequency treatment plans.      

By Dr. Jordanna Baker of Coastal Podiatry Associates, Myrtle Beach SC.

Do

1. Schedule your pedicure first thing in the morning when the salon baths are cleanest.
2. Make sure the salon uses proper sterilization techniques to prevent the transfer of bacteria and fungus.
3. Soak your feet in warm water for at least 5 minutes prior to using a pumice stone, foot file, or exfoliating scrub to remove dead skin or calluses.
4. Use a toenail clipper with a straight edge when trimming nails.
5. Use an emery board and file lightly in one direction to smooth nail edges.
6. Gently use a wooden or rubber manicure stick under your nails to keep them free from dirt and build-up.
7. Apply an emollient-enriched moisturizer to keep your skin moist and soles soft.
8. Use a rubber cuticle pusher or manicure stick to gently push back cuticles.
9. Use nail polish to paint toenails if they are healthy, but make sure to remove the polish regularly with non-acetone remover.

Don’t

1. Shave your legs before receiving a pedicure.  Freshly shaven legs or small cuts on your legs and feet may allow bacteria to enter. 
2. While at the salon don’t use the same tools for a pedicure and manicure.  This will help prevent transfer of bacteria and fungus.
3. Allow technicians to use a foot razor to remove dead skin.  A razor can cause permanent damage if used incorrectly and can easily cause infection.
4. Don’t round the edges of your toenails as this increases the chances of developing ingrown toenails.
5. Don’t share nail files with friends and be sure that the salon uses a new one for each customer.
6. Don’t use a sharp tool to clean under the nails.  This makes it easy to puncture the skin, making it suspect to infection.
7. Leaving moisture between toes can promote fungal infection or skin cracking.
8. Cutting cuticles increases the risk of infection and persistently pushing back cuticles can make them thicker.    
9. Use nail polish to cover up a thick or discolored toenail.  This won’t allow the nail bed to get the necessary moisture and can make the fungal problem worse. 

By Dr. Scott Hamilton of Coastal Podiatry Associates, Myrtle Beach SC.

Just like any other bone, sesamoids can break.  A break in a bone is called a fracture and can lead to immediate pain.  But again, sesamoids are not like typical bones.  The tendons surrounding the sesamoids may become irritated or inflamed causing a pain that will slowly rise as the inflammation increases.  This is a form of tendinitis and is common in young people who engage in physical activity like running or dancing. 

During examination, a podiatrist will look for tenderness at the sesamoid bones.  They may manipulate the bone slightly or ask the patient to bend and straighten the big toe.  X-rays are commonly used to determine if the bones are fractured.  Treatment of sesamoiditis is generally nonoperative and involves controlling the pain, icing the sole of the affected foot, and reducing activity.  Additional measures may be used such as changing the type of shoe worn, using a cushioning pad, or an injection of steroid medication to reduce swelling.         

By Dr. Scott Werter of Coastal Podiatry Associates, Myrtle Beach SC.

Yoga, Stretching and Foot Exercises.  The Achilles tendon and calf muscles become tight or shortened with the increased heel height.  This makes it very important to stretch.  Yoga is a great method to stay loose.  The downward-facing dog and virasana-hero pose are specific postures meant to help the feet.  A runners wall stretch will specifically work the Achilles tendon.  Moving the foot up, down, left, right, and in circles will help keep the blood flowing within the foot and help prevent swelling.

Soak Your Feet in a Mineral Foot Bath.  Epsom salt, which is actually a combination of magnesium and sulfate, has long been used to soothe sore body parts.  The magnesium will help build and repair tissues of the foot.  Warm water will dilate blood vessels and open the skin’s pores.

Pamper Your Feet.  Improperly cut toenails or ingrown nails can cause pain, especially after wearing high heels or pointy-toed shoes.  A thick callus can also cause pain.  Visiting a podiatrist can help fix and correct these problems.

Moisturize, a Lot.  It is important to keep skin on your feet supple and moisturized.  Rough areas develop on pressure points and can become painful.  Don’t forget about the top of toes where corns can develop.

Deep Massage.  Massage is thought to provide pain relief from musculoskeletal injury, as well as lower anxiety.  The arch of the foot contains several layers of muscles that work to stabilize the foot.  The change in alignment and step caused by high heels may result in muscular imbalances within the foot causing muscle strains.  Deep tissue massage may also improve blood flow and reduce lymphatic edema.    

Wear Sneakers.  It is extremely important to allow your feet to rest after wearing high heels.  A well-cushioned sneaker will help limit the trauma caused by high heels and allow your foot to recover.  If you cannot wear sneakers, try limiting the amount of time your foot is exposed to a high heel.   

By Dr. Joseph Menn of Coastal Podiatry Associates, Myrtle Beach SC.

The nervous system can be divided into two broad categories.  The central nervous system consists of the brain and spinal cord.  All other nerves in the body can be considered part of the peripheral nervous system.  These nerves include sensory nerves that receive feelings such as heat, pain, or touch, motor nerves that control the muscles, and autonomic nerves that control blood pressure, heart rate and digestion.  Peripheral neuropathy most commonly starts with the longest nerves (the ones that extend to the toes).  It is important to seek medical care right away if any unusual tingling, weakness, or pain is noticed in the hands or feet.  Early diagnosis and treatment offers the best chance for controlling your symptoms and prevent further damage to the nerves. 

Before visiting your podiatrist for peripheral neuropathy or any other issue, it is important to get prepared.  An excellent idea is to write down questions to ask your doctor.  This allows you to ask the most important and pressing questions first.  It is also important to make a list of all medications, vitamins, and supplements.  This allows your doctor to evaluate quickly your current treatments.  The final list to make before visiting concerns any symptoms you are experiencing.  This should include problems that may seem unrelated to the reason why you are seeing the doctor. 

By Dr. Jordanna Baker of Coastal Podiatry Associates, Myrtle Beach SC

Hallux rigidus typically develops in adults between the ages of 30 and 60 years.  Typical symptoms include pain in the joint with activity, swelling around the joint, a bump on the top of the toe, or stiffness in the big toe and inability to bend it up or down.  It is not know why this appears in some people and not in others.  It may be due to injury or a foot structure that increases stress on the joint.  Hallux rigidus is easier to treat when diagnosed early.  If you have difficulty bending your toe up and down, or notice you are walking on the inside of your foot see your podiatrist right away.  Waiting until a bony bump on the top of the toe develops or the toe cannot bend can cause greater treatment difficulties. 

After a foot examination and maybe x-rays, your podiatrist can determine the correct treatment.  Pain relievers and anti-inflammatory medications are commonly used to ease the pain.  Using ice packs and contrast baths (alternating cold and hot water) may also help reduce inflammation and control the pain.  If hallux rigidus is caught early, wearing shoes with a large toe box, rocker bottom design, or orthotics may be all that is needed.  Many times surgery is necessary to correct this condition.  There are three main types of surgery used.   A cheilectomy removes bone spurs and small pieces of bone to allow the more room for the toe to bend.  Arthrodesis is accomplished by fusing the bones together and recommended when sever damage to cartilage exists.  An arthroplasty is typically used for older patients who have few functional demands.  In this surgery, the joint is replaced to reduce pain and preserve motion.  

By Dr. Scott Hamilton of Coastal Podiatry Associates, Myrtle Beach SC.

The exact cause of a neuroma is unclear but foot structure such as high-arched or flat foot can lead to the formation of a neuroma.  This is because nerves run close to the bones of the foot and at times can touch.  When the nerve rubs against the bone, it becomes irritated and inflamed.  This causes the nerve to become painful while continuing to rub and grow.  Trauma can also cause damage to the verve resulting in inflammation or swelling.    

Treatment options vary with the severity of each neuroma.  Wearing shoes with plenty of room for the toes to move, low heels, and laces or buckles that allow for width adjustment are great for preventing and managing a neuroma.  Resting the foot and massaging the affected area can temporarily alleviate pain.  Icing the area can help dull the pain and improve comfort.  For undeveloped neuromas a pair of thick-soled shoes with a wide toe area is adequate treatment, and will allow the condition to diminish on its own.  For more severe conditions, surgery may be needed.  The wide range of neuroma treatment possibilities point to the importance to see a podiatrist at the first sign of pain or discomfort.  Untreated neuromas tend to get worse and it is important to prevent the nerve from enlarging.  The primary goal of podiatric treatment is to relieve pressure on the nerve.  This can be done through padding, medication, or orthotics.  Depending on the extent of damage, a podiatrist is trained to provide adequate therapy to prevent surgery. 

By Dr. Scott Werter of Coastal Podiatry Associates, Myrtle Beach SC.

The fungal infection does not really affect the nail but attacks the surface underneath the nail.  Once the fungi get past the body’s immune system the nail often becomes darker in color and foul smelling.  Waste from the fungus and immune system may collect beneath the nail plate.  This causes the nail to thicken.  The infection can spread to other toenails, the skin (often showing up as dryness on the bottom of the foot), or even the fingernails.  If ignored, the infection will continue to cause thickening of the nails making them difficult to trim and can make walking painful when wearing shoes.  Onychomycosis can also lead to a bacteria or yeast infection.

Toenails are especially vulnerable to picking up fungus around damp areas where people are likely to be walking barefoot.  This includes swimming pools, locker rooms and showers.  An injury to the nail bed may make it susceptible to all types of infection, especially fungal.  Those suffering from diabetes, circulatory problems, or immune-deficiency conditions are at an increased risk for infection.  Many over the counter medications are available to treat onychomycosis.  However, almost all are ineffective at slowing or stopping the fungus.  Your podiatrist can offer the best treatment by prescribing an oral medication or using a nail restoration system (see the March 28^thblog).    

By Dr. Joseph Menn of Coastal Podiatry Associates, Myrtle Beach SC.

Here at Coastal Podiatry Associates we are trained in a new technique that improves the appearance of nails damaged by fungus and other conditions.

This new technique is the KeryFlex Nail Restoration System.

KeryFlex uses polymer resins and special activators to create a durable, yet flexible artificial nail when exposed to a certain frequency of ultraviolet light.

In as little as 15 minutes, we can create create a realistic, natural-looking nail in place of damaged nail.

Here at Coastal Podiatry Associates this done by removing most of the damaged nail. After the old, damaged nail has been removed, we begin the process of restoring the apperance of your nail; we then apply a bonding agent to help the new nail attach to the remnant of your natural nail.

Next, we will apply the gel-like KeryFlex Resin to your nail bed, harden the resin with a special frequency of ultraviolet light for two minutes, and then possibly reshape the nail further, if necessary.

By Dr. Jordanna Baker of Coastal Podiatry Associates, Myrtle Beach SC.

Bone injuries include fractures, stress fractures, and contusions.  Several common fracture patterns occur with ankle sprains.  If pain or swelling persist at a particular area of the foot or ankle, it is essential to see a physician.  They may take x-rays or order an MRI to further evaluate the area and start treatment.    

Cartilage injuries such as scuffs to the joint surface within the ankle may result in increased swelling or pain after activity.  Commonly the pain and swelling improves with rest but then returns once normal activity is resumed. 

Soft tissue injuries come in many forms.  If a frayed ligament associated with the sprain heals in the joint, a catching sensation can cause pain or instability.  Premature return to activity may allow poor healing of ligaments and cause weakness or instability.  Muscles and tendons that stabilize the ankle may be damaged in a sprain.  This results in pain, weakness, and/or unsteadiness. Nerve damage can occur in a sprain leading to weakness, numbness, or pain to the ankle or foot.

Seeking a podiatrist treatment plan is important to improving the long-term outcome of a sprain.  Communication with the physician about the pain and how treatment is progressing is essential, especially if symptoms are not becoming better.  Treatment plans depend on the extent of the sprain and tissues involved and may consist of immobilization, casting, physical therapy, or surgery. 

By Dr. Scott Hamilton of Coastal Podiatry Associates, Myrtle Beach SC.

Ulcers can form due to many factors including a lack of feeling in the foot, poor circulation, foot deformities, irritation, and trauma. Anyone that has diabetes can develop a foot ulcer. People who use insulin are more likely to develop an ulcer, along with people that have diabetes-related kidney, eye, and heart disease. Being overweight, using alcohol and tobacco also increase the risk of developing a foot ulcer. The most common factors to developing a foot ulcer are neuropathy and vascular disease. Neuropathy is a reduced or complete lack of ability to feel pain in the feet due to nerve damage. In those with diabetes, this is most commonly caused by elevated blood glucose levels over time and can occur without pain or one being aware of the problem. Vascular disease can complicate an ulcer by reducing the body's ability to heal and increase the risk of infection. Again, high blood glucose can reduce the body's ability to prevent infection and slow healing.

The primary goal in treating a foot ulcer is to obtain healing as soon as possible to prevent an infection. A podiatric physician is specially trained in ulcer treatment and should be visited immediately after an ulcer is noticed. In treating an ulcer a podiatrist will normally work to prevent infection, remove pressure from the area (called off-loading), remove dead skin and tissue (called debridement), use a medication or dressing to the ulcer, and manage blood glucose or other health problems. Keeping the ulcer from becoming infected is of extreme importance. This can be done by keeping blood glucose levels under tight control, keeping the ulcer clean and bandaged, washing the ulcer daily, and wearing appropriate shoes. Most of the wounds that are not infected can be treated without surgery, however if all treatment fails surgery might be needed.

By Dr. Joseph Menn of Coastal Podiatry Associates, Myrtle Beach SC

Wear Stable Shoes. In first few weeks of managing the pain it is important to wear stability shoes. These shoes help the foot align correctly and prevent the foot structure from changing during each step. This reduces the pull on the tendon located on the bottom of the foot.

Use an Arch Support. An arch support can range from an over the counter shoe insert to a custom made orthotic. Over the counter arch supports range from $20-50 and are great for short term pain relief. An orthotic is custom made from a podiatrist and will properly align the foot during each step.

Stretch. Stretching of the foot and calf muscles has proven to relieve pain and improve flexibility. For a deeper and more consistent stretch, a special stretching device or foot roller can be used.

Ice the bottom of the foot. Applying ice to the painful areas of the foot will help reduce inflammation and pain. Placing the foot on a cold compress or Ziplock bag filled with ice can be helpful but the best way is to freeze a water bottle, place the bottle on the ground, and roll it under the painful foot.

Weight loss. Extra weight can cause the foot to change from its natural function; steps become shorter, the foot arch tends to collapse and flatten, and the feet angle out more while walking. This all places more stress on the foot ligaments causing them to stretch more than normal.

Visit a Podiatrist. A podiatrist can offer their expertise on an individual basis and create the best treatment plan.

By Dr. Jordanna Baker of Coastal Podiatry Associates, Myrtle Beach SC

Skin cancers of the feet have several features in common. Most are painless and often have recurrent cracking, bleeding, or ulceration. Basal cell carcinoma is frequently seen on sun exposed skin surfaces such as the tops of feet. It causes local damage but very rarely spreads beyond the skin. Basal cell cancers appear as pearly white bumps or patches which may ooze or crust. Squamous cell carcinoma is the most common form of skin cancer of the feet. Most types are confined to the skin and will not spread. However, when this type reaches an advanced form, it can become more aggressive and spread throughout the body. Squamous cell carcinoma typically begins as a small scaly bump or plaque with red boarders that may be itchy. Malignant melanoma is one of the most deadliest skin cancers known. It can be found beneath a toenail, soles, and tops of the feet. As a melanoma grows, it extends deeper into the skin, becoming more serious. This skin cancer commonly starts as a small brown-black spot or bump that resembles a common mole.

The ABCDs of skin melanoma are used to determine if a mark on the skin is cancerous. They are to be used as a test at home before seeking a physician's opinion. If one of more of the ABCDs is present, it is important to visit a physician.

Asymmetry- If the skin mark is divided in half, the sides don't match

Borders- They look scalloped, uneven, or ragged.

Color- The skin may have more than one color and be unevenly distributed.Diameter- The skin lesion can appear wider than pencil eraser.

For other types of skin cancer look for impulsive ulcers, non-healing sores, bumps that crack or bleed, nodules with rolled edges, or distinct scaly areas.

By Dr. Joseph Menn of Coastal Podiatry Associates, Myrtle Beach SC.

A hammertoe is formed due to an abnormal balance of the muscles in the toes. The muscles cause increased pressures on the tendons and joints leading to malformation. Factors causing a hammertoe include: heredity, trauma, arthritis, and wearing shoes that are too tight causing the toes to squeeze. You may have a hammertoe if you feel pain at the top of a bent toe from footwear, corns on the top of the joint, redness and swelling at the joint, or pain in the ball of the foot at the base of the bent toe. It is important to see a podiatrist at the first indication of pain and discomfort because hammertoes tend to become rigid, having surgery as the only treatment. Treatment options vary with the type and severity of each hammertoe. Podiatric physicians typical use an x-ray along with their examination to determine the correct treatment plan. Treatment options typically start with a padding and tape to minimize pain. Anti-inflammatory drugs and cortisone injections can also be used for pain management. Orthotic devices are helpful with flexible hammertoes and as mentioned before, surgery is typically needed for rigid hammertoes.

By, Dr. Scott Hamilton of Coastal Podiatry Associates Myrtle Beach, SC

In addition to a physical exam, a podiatric physician normally takes an x-ray. Since the ankle joint is made of three bones (Tibia or shinbone, Fibula the small bone outside of Tibia, and Talus a bone in the foot) there are many different types of ankle fractures. Depending on the severity of the bones involved or how wide the gap between bone surgery may or may not be needed. What is consistent is that it takes at least six weeks for broken bones to heal. This time may be longer if ligaments and tendons also need to heal. Most people will typically return to normal daily activities besides sports within 3 to 4 months. Rehabilitation is a very important part of treatment regardless of how the ankle fracture is treated. When cleared to start moving the ankle by a physician, doing daily exercises is the key to a successful recovery. It goes without saying that following the exercises set forth by a physician and physical therapist will lead to the best results.

By Dr. Scott Hamilton of Coastal Podiatry Associates. Myrtle Beach, SC.

The virus that causes plantar wars is often picked up by walking barefoot on dirty surfaces or littered ground. The virus grows best in a warm, moist environment. This makes a community bathroom or locker room an easy place to become infected. If left untreated, the warts can grow to an inch or more in circumference and can spread into clusters of several warts. These clusters are called mosaic warts. Like other infections, the virus can be spread by touching, scratching, or even by contact with dead skin from another wart.

Self-treatment is generally not the best idea. Over-the-counter treatments contain acids or chemicals that kill healthy skin cells and can cause serious damage if used incorrectly. People with diabetes, cardiovascular, or circulatory disorders should especially avoid self-treatment with these medications. Often times warts spontaneously disappear giving those doing self treatment relief but will return in the same spot a few months later. Visiting your podiatrist is a great idea. They can prescribe and supervise the use of wart treatments. Or, if possible, your podiatrist can remove the war by a simple surgical procedure or laser treatment.

By Dr. Scott Werter of Coastal Podiatry Associates Myrtle Beach, SC.

Your toenails give important clues to many aspects of normal walking. Ingrown toenails can be due to improper trimming or too much pressure on the feet in tight fitting shoes. Ingrown nails are can also come from poor foot structure, heredity, trauma, or foot deformities. These nails result in redness, pain, or swelling around the nail. If you notice ingrown nails, do not use nail polish to cover the discoloration and change in shape. Instead, avoid tight fitting shoes and socks. Be sure to trim nails straight across using a toenail clipper and visit your podiatrist to see what treatment is best. Fungal nails can result from trauma or infection. These nails become thickened, discolored, loose or deformed. It is often caused by athlete's foot but may also be a sign of diabetes or arthritis. Keraloac Gel and Lamasil tablets have proven to be effective in treating this problem and can be prescribed by a podiatrist.

Bone and ligament problems are often due to overuse or ill-fitting footwear. Tendinitis is an overuse injury commonly due to an increase in physical activity or wearing worn out and improperly fitted shoes. Rest and ice is a great starting point to relieve the pain but your podiatrist can also prescribe anti-inflammatory medicine to help. Plantar Fasciitis is pain on the bottom of the hell or arch of the foot. It can be caused by excessive weight, pony overgrowth on the hell, muscle imbalance, extreme arches, improper shoes, or excessive activity. A podiatrist can conduct a detailed examination to see what medications or treatments are needed. Exercise, stretching of the feet, and supportive shoes are also good treatments. Blisters are cause from friction in shoes that do not fit right or are too soft. To prevent blisters keep feet dry and wear socks with properly fitted shoes. If blisters are very painful, try opening a corner of the blister close to the bottom of the foot with a sterilized instrument. Drain the blister and immediately put on an antibiotic cream and bandage.

By Dr. Joseph Menn

Start new workouts gradually. Increase your stamina and length of your workout gradually. This will help prevent overuse injuries such as stress fractures or tendon strains and sprains. Stretching before and after workouts will also help to prevent these types of injuries. It is important to seek treatment to functional pains such as a sprained ankle. Untreated or repeated ankle sprains can lead to lasting ankle instability.

Wear the right shoe and sock. Make sure to wear a proper fitting athletic shoe meant for your exercise or sport. Wearing a shoe that is too small can lead to neuroma, blisters, and discomfort; while a shoe that does not support or cushion your foot can cause heel pain or other deformities. Using a cotton or non-slip sock will help avoid painful blisters.

Use good technique. Improper exercise techniques can lead to injury to your tendons or ligaments in your foot and the rest of your body. Allows follow the directions posted on machines or see an athletic trainer for proper form.

Protect yourself from bacteria. Sweaty shoes, public showers, exercise equipment and the pool deck are breeding grounds for fungus, viruses, and bacteria. Do not go barefoot while in public areas. Water shoes provide an excellent barrier between your feet and wet surfaces. It is also important to cover cuts and cracks in your skin or ingrown toenails. These areas are easier entry points for bacteria, viruses, and fungus. If you have a cut or scrape that becomes red or swollen and is not healing in a timely manner see your physician.

By Dr. Scott Werter

Buying an insert does not require a podiatrist, and many different options are available. A shoe pad is a thin layer of foam or gel meant to replace the sock liner or a shoe with something that gives more cushion. They offer little to no support, and simply make the shoe feel more cushioned. These give a diabetic no real benefit besides comfort. Store-bought arch supports come in a wide variety and price, ranging from flimsy arch pads purchased at a pharmacy to expensive hard plastic inserts sold at arch support chains. All of these are sized based on a shoe size and do not adjust for the shape and function of an individual's own feet. These supports are excellent for people who need limited arch support or extra cushioning and provide a better level of support than shoe pad inserts. However, they still provide little benefit to diabetics as their support will not reduce foot pressure enough to protect against skin wounds and pressure points.

The next two types of inserts can be found at a podiatrist's office. Prescription orthotics will actually alter foot structure. They are made from a hard plastic that conforms to the shape of the foot. They are commonly used in many individuals with and without diabetes to support excessive foot flattening, reduce arch pain, and treat excessive foot tendonitis. Orthotics manage the structural cause of foot wounds and are the preferred way of protecting the foot. Diabetic inserts are used to reduce pressure and shearing damage to diabetic feet. They are commonly used for diabetics with prominent bones, calluses, or a history of foot wounds. Both of these inserts require a podiatrist's evaluation and fitting.

By Dr. Jordanna Baker

There has been a recent surge in barefoot running. It is based on the idea that tribal people have been running barefoot for hundreds, if not thousands, of years and yet do not develop the foot problems that come into my office daily. Now, don't get me wrong, I am all for whatever motivates someone to run and exercise, however I think there has been some lack of common sense in this new trend. First, these primitive civilizations live the way they do out of necessity. They run only to hunt or escape. They are not out running 5ks or doing a fartlek on the weekends and after work. It is not a mile after mile exercise run. From a scientific point, these people have bone structures dissimilar to, and body frames that are smaller than the average Americans'. This means over time they have significantly less stresses placed on their joints and specifically, on their feet. Naturally, primitive people are not running on packed trails or pavement, that is a very important piece of information as surface type is often a key factor in the development of foot problems. Furthermore, it is an understatement to say that they do not suffer from foot problems. I spoke directly with a gentleman, who spent a significant amount of time in Africa with several tribesmen. He saw "the worst callus and fissuring...they would bleed...they would cut an old tire up to make shoes for themselves." This follows in line with the charitable contributions of shoes that come from Americans who donate their shoes in the hopes that they end up on a person in need. If barefoot running was great for feet, why would the demand for shoes be so great? Ultimately, the shoe was created out of necessity and is a valuable addition to the many other luxuries we enjoy in modern civilizations.

By Dr. Jordanna Baker

Gout is caused by higher than normal levels of uric acid in the body. This can develop from the body making too much uric acid or failing to reduce the levels of uric acid. If too much uric acid enters the fluid around joints uric acid crystals can form. It is the crystals that cause the joint to swell up and become inflamed causing the pain. Not everyone with high uric acid levels has gout. The exact reason why crystals from is unknown but certain groups are at a higher risk. Gout may run in families. It is also more common in males, postmenopausal women, people who drink alcohol, and take certain medicines.

Gout is treated in a few ways. Doctors typically suggest taking ibuprofen as soon as symptoms begin and may prescribe a strong painkiller for attacks. If several gout attacks a year, signs of gouty arthritis, or uric acid kidney stone are present, a doctor may prescribe Allopurinol or Probenecid to decrease uric acid levels in the blood. Some diet and lifestyle changes can also help prevent gouty attacks. These changes include avoiding alcohol, oils, organ meat, and limiting how much meat is consumed during each meal. Eating carbohydrates is importing as well as avoiding fatty meals.

Elevate Your Legs.

Help reduce swelling by lying down and lifting your legs above your heart. 5 minutes a few times a day can go a long way.

Massage Your Feet.

This will help release tension, increase circulation and refresh the skin and muscles after a long day on the go. Don't forget the lotion.

Point Your Toes.

Avoid toe cramping by raising, pointing, and curling your toes for five seconds each. Repeat this exercise 10 times for added relief.

Rotate Your Ankles.

Rotating your ankles, cupping your heel, and turning each ankle slowly will relax your feet. Repeating this motion 5 times should loosen your ankle joints.

Wear Smart Shoes.

If you are planning to be on your feet all day, make sure to wear comfortable shoes with arch support and a padded sole. Don't forget to wear appropriate socks. This also means leaving your high heels behind.

A flexible flatfoot that has normal muscle function and good joint mobility is thought to be a minor variation of a normal foot. As the child grows and continues to walk, the foot's soft tissues tighten causing gradual shaping of the arch. It is common for flexible flatfoot to continue until the child is at least 5 years old and can last later into childhood. If flexible flatfoot continues into adolescence or if the child experiences pain along the bottom of the foot, a podiatrist should be consulted.

To conclude the child has flexible flatfoot, a doctor will examine the child to rule out other types of flat feet that may require treatment. Other conditions include flexible flatfoot with a tight Achilles tendon or rigid flatfoot. To determine which type of flatfoot is present, the doctor will look for patterns of wear on the child's shoes, verify if the child has any neurological or muscle disease, and ask if the condition is present in other family members. The doctor may conduct a few tests by having the child sit, stand, stand on tiptoe, examine the Achilles tendon, and check the bottom of the foot for calluses. Treatment for flexible flatfoot is required only if the child is complaining of pain or if the condition lasts into adolescence. The major treatment is a shoe insert. Inserts provide pain relief by bringing the ground up to the foot, allowing the foot to function properly. Sometimes a doctor may prescribe physical therapy or casting if the child also has tight heel cords.

Ingrown nails develop for many reasons. If you trim your toenails too short, especially at the sides of your big toes, you may be helping to start an ingrown toenail. Cutting the corners of a nail to allow the nail to curve with the shape of the toe may encourage the nail to grow into the toe's skin. An ingrown toenail may also occur if shoes are too tight or short. Other times congenital factors such as the nail being too large for the toe can cause onychocryptosis. Stubbing a toe or having a toe stepped on are examples of trauma that can also cause an ingrown nail. To prevent ingrown nails it is important to protect your feet from trauma and to wear shoes and socks that fit properly. Nails should be cut straight across with a clean, sharp nail trimmer without rounding the corners.

Ingrown toenails should be treated as soon as they are recognized. The following home care steps may be enough to avoid infection and prevent the need for further treatment.

1. Soak the foot in warm water 3-4 times a day.

2. Keep the foot dry during the rest of the day.

3. Wear comfortable shoes that fit properly.

4. Take ibuprofen or acetaminophen for short-term pain relief.

If the area surrounding your nail remains inflamed, swollen, painful, and pus is present it is important to see your podiatrist. These are signs of infection or a more serious ingrown nail. Your doctor may prescribe oral antibiotics for an infection. They may also need to remove some of the nail. Removing the troubling nail edge provides quick relief from pain caused by the inward growing nail. If the problem is recurrent, your doctor may advise a permanent removal of the nail border.

In my practice I rely on simple skin biopsy to determine the degree and progression of neuropathy. Treatment can range from medication to surgical intervention. Proper education and patient understanding of the disease process is also very important in prevention of complications that can arise from neuropathy. If you are an active patient in our practice please ask us about new treatments for diabetic neuropathy. If you are not an active patient please call and schedule an appointment to discuss the risks of diabetes as well as treatment options.

Another condition is nail fungus, or onychomycosis. Fungal nails are often discolored, thickened and difficult to cut. However, not all nails that fit this description are fungal nails. There are a several other things that can alter the appearance of a nail. One of those is nail trauma. This can be a one-time incident (i.e. you accidentally dropped a soup can on your toe or jammed it on furniture) or from repetitive microtrauma that you didn't even know occurred. Other causes of nail changes can include nutritional deficiencies, psoriasis and genetic disease. A nail biopsy is one way your podiatrist can diagnose the nail condition and recommend a proper treatment. There are several treatments for fungal nails so be sure to ask what's the best one for you.

Did you ever have a nail turn black or purple and then lift from or fall off the nail bed? A condition called subungual hematoma can occur to one or more toenails at a time. This can be a painful or painless condition and it can occur over a short time. It forms when a blood vessel under the nail is broken, usually from acute trauma or constant pressure. In turn, the bleeding fills the nail bed and discolors the nail. It may cause pain because of pressure under the nail. This is a very treatable condition that your podiatrist is more than happy to take care of.

Many eager consumers may be ready to lace up the first pair they find. The American Podiatric Medical Association (APMA) stress that people be mindful of the footwear products they purchase and to wear them safely. Dr. Kathleen Stone, APMA President said, "It's important for people to realize that so-called 'toning' or 'fitness' footwear is not a cure-all that will tone the entire body. Toning shoes should be utilized similar to any other piece of athletic training equipment. This type of footwear should be viewed as an addition to an exercise program, to strengthen and tone certain targeted muscle groups."

The APMA recommends that users read about each specific shoe and what the manufacturer has recommended to prevent injury. Additionally, keep in mind the following tips when using the shoes.

Look for the APMA Seal. Several toning footwear products have been evaluated by the APMA and found to be foot friendly.

Find the right design for you. There are many types and brands of toning footwear available for purchase. Consider your use for the shoe writher it be running or walking. There are differences in how each toning shoe is constructed, so finding a shoe that fits comfortably and does not cause too much instability is important.

Ease into wear. Toning footwear has a break- in period in order to be worn safely and effectively. All types of toning shoes should be worn for short period of time until the body adjusts to the new requirements for walking.

Remember to stretch. As with any form of exercise, spend several minutes stretching before and after participation.

The underlying cause of corns is shoes that do not fit properly and cause rubbing. If shoes are too tight they will squeeze the foot increasing pressure. If they are too lose, the foot may slide and rub against the shoe. High heeled shoes are especially troublesome as they increase the pressure on the forefoot. The construction of the shoe can lead to corns if the foot rubs against a seam or stitch inside the shoe. Consistently wearing socks that do not fit properly can cause enough friction to cause corns. Toe deformities such as hammer toe or claw toe can also lead to corns.

Corns can usually be noticed easily, with a typical tender spot in the middle surrounded by yellowish dead skin. Your podiatrist may trim the corn by shaving the dead layers of the skin to restore the normal shape of the skin and relieve pain. Home treatments can help with pain and reduce the size of the corn. Soaking the feet and using a pumice stone or callus file can soften and reduce the size of corn. While wearing shoes, placing a donut-shaped foam pad around the corn (with the corn in the hole of the pad) can help to relieve the pressure on the corn causing less pain. Be sure to use non-medicated corn pads as medicated pads may increase irritation and result in infection. Placing lamb's wool between the toes will help cushion soft corns. Since corns are due to irritation caused by shoes, wearing a shoe that fits properly and has a roomy toe area will help reduce rubbing.

Achilles tendinitis is an inflammation of the tendon. People who develop this tendinitis usually feel a burning pain or tenderness an area just above the heel. This condition has many causes but the most common are training errors, calf muscle inflexibility, and foot function abnormalities. Training errors include increasing workout intensity or amount too suddenly or changing running terrain without proper transition time. Inflexibility of the calf muscle can result from improper stretching or due to wearing high-heeled shoes causing shortening of the tendon.

The long time to heal Achilles tendinitis is due for the poor blood supply to the tendon. This is why early treatment is needed to prevent long-term injury. Treatment is possible at home with reduction or stopping the sport activity and icing the tendon three times a day for 15 minutes. Heal cups can be used to help take the stress off the tendon, but be sure to place them in both shoes to prevent other injuries. If pain continues for more than two weeks, it is necessary to talk to your podiatrist for a more thorough evaluation and treatment.

Except in cases of bone shortage, a stress fracture is an overuse injury. When muscles are overtired, they lose their ability to lessen the shock of repeated impacts. As muscles lose their ability to absorb the shock of the foot hitting the ground, they transfer the stress to bones. Over a period of time, this can create small cracks or fractures in the bone. Those suffering from stress fractures generally feel pain that starts slowly, increases with weight-bearing activity, and diminishes with rest. This pain may become more severe and occur during normal, daily activities. Swelling and bruising may occur on the top of the foot or outside of the ankle. Pain may also occur when the fracture is touched.

To treat a stress fracture rest is the key. It typically takes six to eight weeks for a stress fracture to heal. In addition to rest, normal treatment includes ice and elevation of the foot along with anti-inflammatory medicines. To reduce the stress of foot and ankle, a podiatrist may recommend wearing protective footwear or if severe enough a cast or surgery may be needed. After a stress fracture has healed it is important to resume activity at a slow pace until full muscle strength has returned.

High ankle sprains commonly occur when the body and lower leg excessively rotates around a rigid foot that is flat on the ground. This action causes a force that pulls apart the two bones that make up the lower leg (tibia and fibula). When these bones attempt to separate a sprain results to the ligaments that hold them together. In contrast, a normal ankle sprain involves rolling the foot inward and damaging ligaments on the outside portion of the ankle. This injury is much quicker to heal than a high ankle sprain because the ligaments involved do not have as much of a role in the stability of the ankle. The connection of the tibia and fibula creates a joint that must withstand forces much greater than a person's body weight and in a high ankle sprain, this joint loses its effectiveness and stability.

High ankle sprains are given a grade from I-III depending on the severity and the amount of instability. Grade I means pain but no instability. Grade II occurs with some instability and pain. Grade III indicates considerable instability with pain. Time and competition missed depends on the severity. A high ankle sprain that does not require surgery is anywhere from 1-7 weeks compared to 12-14 weeks if surgery is needed.

Paying attention to your feet is vital to pain free walking. Changes such as swelling, red spots, numbness, and tingling or pain in the foot and ankle are not normal and can indicate a serious problem. Becoming familiar with your feet and ankles and routinely checking them can prevent a small problem from growing. As always, be sure to visit your podiatrist for questions or when noticing changes to your feet. For those suffering from diabetes this is especially important. Many people with diabetes experience a loss of sensation in the feet, making it difficult to detect injury. Routine self-examinations are the best method to prevent permanent damage or amputation.

It is important to exercise smart. Establishing a walking route can take time and through appropriate and realistic goals, longer distances and faster times can be achieved. Using a soft ground path will prevent wear and tear to your body. This is especially important for and elderly population. With age the natural shock absorbers in the feet deteriorate along with bone density. Walking on a softer ground produces less shock to your body. Warming up and cooling down helps improve circulation and decreases build-up of lactic acid. This practice also helps alleviate any muscle stiffness and prevents future muscle strain. A few simple stretches of the hamstrings, calves, Achilles tendons and shins can allow you to walk further, longer, and injury free.

If the muscles, ligaments and tendons that support the arch do not function properly, the arch itself cannot work correctly. The tendons and ligaments can become excessively stretched and strained from years of misuse and start to lose their ability to support the arch. This causes the arches to fall and results in painful movements. If the foot is flat throughout the stride and walking motion, the relocking of the bones cannot occur. Because of this, the foot is unable to provide a solid push-off and the muscles of the leg have to work harder. This is why someone with fallen arches commonly complains of aching, fatigued muscles at the end of the day. Along with leg pain, a fallen arch may also cause pain in the heel. If the ligaments on the bottom of the foot are over stretched, the place where the ligaments attach on the heel can become inflamed and sore. Pain can be felt elsewhere when the arches collapse. It is very common that when one joint of the body is not working correctly, other joints of the body are affected negatively. Problems with the arch often lead to problems with the ankle join, knee, hip and joints of the lower back. These joints need to make up for the fallen arch and this compensation puts the joints at risk for osteoarthritis.

It is very important to treat fallen arches to relieve foot pain as well as decrease the risk for developing knee, hip, and low back pain. Fallen arches have a solution that is hassle-free, cost-effective, and does not generally need drugs or surgery. An arch support made to support the foot will relieve the foot pain and prevent the foot from cause other complications. The arch support will permit the bones of the arch to function properly during unlocking and locking movements. Unfortunately, many people with fallen arches suffer because they do not know the solution is easy and reasonably priced.

When choosing shoes it is important to keep many factors in mind, as not all shoes are created equal. It is important to bring your child with you when buying their shoes. Every shoe fits differently and letting them have a say in what shoe they wear promotes healthy foot habits. Depending on their age and growth rate, sock and shoe sizes can change every few months. Again, having them with you will allow for the correct size to be purchased. A shoe that does not fit properly can aggravate the feet. This can cause irritation and lead to problems such as bunions and ulcers. It is an excellent idea to measure your child's feet before buying and watch for signs of pain when trying on different styles. Buying shoes that do not need a "break-in" period is important. Shoes are now constructed to be comfortable immediately. Children rarely have the exact same size foot so make sure to buy for the larger foot. Handing down footwear from one child to another is not a good practice. Just because a shoe size fits one child doesn't mean it with fit another. Sharing shoes can spread fungi like athlete's foot and nail fungus.

Once you and your child have selected a shoe, apply this quick three step test. This test is designed to make sure the shoe will bend with the foot in the correct way. First, look for a stiff heel. Press on both sides of the heel counter and make sure it doesn't collapse. Next, check the toe flexibility. The shoe should bend with your child's toes not being overly flexible or stiff. Lastly select a shoe with a rigid middle. Using two hands grasp the toe and heal area attempting to twist the shoe, twisting is a bad sign. If the shoe fails one of these steps, try a different model.

Dr. Jordanna L. Baker:

"Foot and ankle problems affect the entire body because they limit activity and eventually the quality of life. Whether it is a structural irregularity, inherent abnormality or acquired injury, I can provide advanced diagnostics that allow me develop a specific, tailored treatment plan for each individual. This translates into better care for each and every walk of life with foot and ankle pain."

Dr. Jordanna L. Baker is a graduate of Coastal Carolina University where she was on full academic scholarship. After gaining her undergraduate degree she attended Barry University School of Podiatric Medicine in Miami Shores, Florida and went on to complete her 3-year Surgical Residency at James A. Haley VA Hospital in Tampa, Florida.

She joined Coastal Podiatry Associates in July 2010 and is currently accepting new patients!

"It cannot be broken because I can move it."
False. The truth is that often certain types of fractures of the foot can still be moved. Small chip fractures of the foot or ankle, breaks in the fibula, or bones in the toes can often appear to function properly but medical attention is still needed.

"A broken toe needs immediate treatment."
False. While it never hurts to error on the side of precaution, a toe does not always need immediate care. When an x-ray shows a simple break, a podiatrist can usually provide quick and full relief. Other times an x-ray may display a displaced or folded break. In these situations, rapid realignment of the fracture actually prevents s complete healing.

"Appling an elastic bandage for a sprained ankle is the only treatment needed."
False. The term "ankle sprain" is very general. Many times an "ankle sprain" includes torn or stretched ligaments. A podiatrist should be seen to receive appropriate treatment.

"When you hurt your foot or ankle, immediately put it in hot water."
False. Hot water is the opposite of what should be done. Heat promotes blood circulation leading to a faster inflammation response. This will cause more swelling and pain. A bad of ice wrapped in a towel is the correct treatment, this prevents swelling and reduces pain.

"RICE will reduce swelling"
True. RICE is an acronym used to treat swelling. While a podiatrist should be seen in the case of trauma or recurrent swelling, RICE is a great way to handle small amounts of infrequent swelling. Rest is the first step. This means limiting activities and making it a point to reduce use of inflamed area. Ice is used to cool the area. A bag for of ice should be placed in a towel and then wrapped to the injured area for 20 min intervals. Compression wrapping is used when ice is not applied to the injured area. Elevation is the last part. Elevating the injured area above the heart will help drain the excess fluid and blood from the injury.

1. Flats and Slides
Problem: Arch and heel pain is common due to inadequate cushioning and foot support.
Secret Solution: If prolonged wearing cannot be avoided, try cushioned inserts for shock absorption. APMA accepted Foot Petals' Amazing Arches are an ideal product. Also, when buying this type of sandal avoid a sole that twists excessively.

2. Gladiator and Strappy Sandals
Problem: Lack of support and shock absorption is frequent. Due to the sandal design, irritation between the toes along with callus and dead skin build-up around the heels are commonly noticed.
Secret Solution: When buying select materials such as leather and ensure proper fit without toes or heels hanging off the edge.

3. Platform and High Heels
Problem: Pain in the ball of the foot and ankle injuries are frequent.
Secret Solution: Purchase and wear a lower more sable heel (less than 2 inches in height).

4. Wedge and Espadrille Sandals
Problem: Instability and difficulty walking cause ankle twists or sprains.
Secret Solution: Pick a sandal with a wider, flatter wedge that also contains a rubber sole with good traction.

5. Peep-toe Sandals
Problem: Bunions and hammertoes can develop from loads of pressure on the toes.
Secret Solution: Wear these sandals for only short periods. A Giovanna Toe Cusion by Heaven4Toes or another APMA accepted insert is also recommended. .

6. Ankle Wrap Sandals
Problem: The straps can cause blisters as well as provide inadequate ankle support.
Secret Solution: Purchase a sandal with ankle wraps made of a soft, breathable material such as leather, cotton or satin. When wearing don't wrap the ankle strap to tight.

Rigid orthotics are designed to control the function of the foot while in a walking or dress shoe. They are made of a firm material like plastic and made from a plaster of mold of the individual foot. Rigid orthotics are long enough to go from the sole of the heel to the ball or toes of the foot. These orthotics are used to control motion in two major foot joints located below the ankle joint. They are long lasting, do not change shape, and are difficult to break.

Soft orthotics are meant to help absorb shock, increase balance, and to take pressure off uncomfortable spots of the foot. Constructed of soft, spongy materials, this orthotic is molded by the action of a walking foot or created from a mold of the foot. The advantage of soft orthotics is that they may be easily adjusted to changing weight-bearing forces. Their disadvantage is a shorter lifespan and they must be periodically replaced. Due to their spongy nature, they are particularly effective for arthritic and deformed feet where there is a loss of protective fatty tissue and diabetic feet.

The last type of orthotics, called semirigid orthotics offer dynamic balance of the foot while walking or playing sports. Each orthotic is made specifically for each individual athlete and sport they participate in. The orthotic helps guide the foot through proper functions, helping the muscles and tendons perform more efficiently. The typical semirigid orthotic is made of layers of soft material, reinforced with more rigid materials.

If you are using orthotics, below is a list of a few tips.
- Wear shoes that work well with your orthotics, your podiatrist can tell you which shoes are best.
- Before buying a new pair of shoes, try them on using your orthotics. Also remember to wear socks similar to those you plan on using the shoes with.
- Make sure to schedule and go to your follow-up appointment with your podiatrist. It is very important to make sure your feet and orthotics are functioning properly together.

There are two bones in the lower leg and one in the foot that make up the ankle joint. The two bones in the foot run together from the knee to the ankle. The inner and larger bone is called the tibia. This bone supports ½ of the body's weight above it. The smaller and outside bone is called the fibula. This long skinny bone serves as an attachment point for muscles and tendons. The tibia and fibula are joined just above the ankle joint by the distal tabiofibular ligament. The bone in the foot is called the talus. This bone fits into the space between the tibia and fibula. The talus pivots in this space allowing movement between the foot and leg. On the inside of the ankle joint the talus and tibia are connected by a group of ligaments called the deltoid ligament. On the outside, the talus and fibula are connected by three ligaments: anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament. The last thing to talk about is the two broad ligaments that wrap around the entire joint. These are called the flexor retinaculum and extensor retinaculum and help stabilize and keep all of the parts of the ankle joint together.

Now that some of the anatomy is clear it's time to read about the different types of ankle sprain, how they are caused, and graded. The term "sprain" is used when a ligament is damaged or ruptured. The three basic types of ankle sprains are inversion, eversion, and syndesmosis or high-ankle sprains. The most common is an inversion sprain. This occurs when the foot is pointed toward the floor and the foot rolls inward placing the body weight over the outside of the foot and ankle. An inversion sprain usually happens by stepping or landing on uneven ground or making a cutting motion. These sprains damage the ligaments on the outside of the ankle with the anterior talofibular ligament most commonly damaged. Eversion ankle sprains require a large amount of force to occur. The most common way they occur is when an athlete has a foot planted and there is a blow from the side of the planted leg. The syndesmosis or high-ankle sprain is a stretch of the distal talofibular ligament. This occurs when the talus bone twists between the tibia and fibula, forcing the two leg bones unnaturally apart. This injury is most common when the foot is planted and the body twists over the planted foot.

During the diagnosis of a joint sprain, doctors may use the following scale. This helps them categorize the degree of damage to the joint and develop a treatment plan.

Grade 1: The joint has mild pain with little to no swelling. Minor tears and stretching of the ligament have occurred. There is only minimal loss of function and stiffness of the joint. Expected recovery is a few days.

Grade 2: The joint has moderate to severe pain with swelling. A partial tear of ligaments and moderate loss of function has occurred to the joint. Joint is also experiencing stiffness. Full recovery is within 2-3 months.

Grade 3: Initially there is severe joint pain but afterwards little or no pain. The joint becomes very stiff with large amounts of swelling. Ligaments are completely ruptured and joint has complete loss of function. Full recovery can take up to 4 months.

These symptoms are a result of nerve loss. Nerves come in two forms, those relaying feeling information like pain, temperature, or touch and those relaying information to muscles to cause movement. Diabetic peripheral neuropathy usually starts with a loss of feeling with damage to the sensory fibers beginning at the place farthest from the brain: toes, feet, and legs. The numbness will not allow feeling of pain or temperature on the numb areas. As a result, infections develop more easily do to cuts, scrapes, or ulcers that go unnoticed.

There is no perfect treatment for diabetic peripheral neuropathy, which is why maintaining a healthy blood glucose level is important. For most people managing blood glucose levels will slow down or even prevent further nerve damage. This is not the case in everyone, as diabetic peripheral neuropathy is not always caused by poor glucose levels. Management of pain can be a large treatment concern. To combat the pain many doctors focus on prescription drugs that block or slow down pain receptors preventing or lessening the patient's pain. Newer treatments include Alpha Lipoic Acid (ALA) and Evening Primrose Oil (EPO). These newer treatments help reduce pain and inflammation as well as reduce nerve damage and may be worth talking to your doctor about. Since none of the treatment methods can reverse the damage due to nerves, it is important to practice excellent preventative care. This includes keeping your blood glucose in a healthy range and keeping your feet healthy with daily care and checking numb areas for sores.

The symptoms of athlete's foot are found alone or in any combination that include dry skin, itching, scaling, inflammation, and blisters. The blisters often lead to cracking of the skin and breaking leading to small raw areas of deeper layers of skin. This can cause pain and swelling, not to mention and a higher risk of infection. As the infection spreads, itching and burning become worse. Athlete's foot can also spread to the soles of the feet and toenails. It can also spread to other parts of the body when people scratch the infection and then touch themselves elsewhere.

Prevention of athlete's foot is not always as easy as it sounds. The fungus is picked up in dressing rooms, showers, and pool locker rooms, places where bare feet are very common. When using these places a few extra steps can go a long way in reducing the risk of coming in contact with the fungus. Using shower shoes and avoid walking barefoot in these areas is a great prevention. Daily washing of the feet with soap and water followed by carefully drying (especially between the toes) and quality foot powder are also excellent methods. Outside of the previously mentioned areas, athletes should wear light and airy shoes, socks that keep their feet dry, and changing socks frequently if heavy perspiration occurs.

Treatments with chemicals commonly advertised often fail to contact the fungi key layers of skin. For this reason, topical or oral antifungal drugs are being prescribed with growing frequency. If a person is still experiencing similar symptoms to those listed before after two weeks of proper foot hygiene and self care then it is time to consult a podiatrist. The doctor will determine if a fungus is the cause of the problem and determine a specific treatment plan often including the prescription of antifungal medication.

Do's
- Do shop for a flip-flop made of high quality, soft leather. Leather is the best prevention of blisters and other types of irritation.
- Do gently bend the flip-flop from end to end before buying. Only purchase those that bend at the ball of the foot, shoes of any kind should never fold in half.
- Do ensure that your foot does not hang off the edge of the flip-flop.
- Do look for flip-flops that hold APMA's Seal of Acceptance. Evaluated by a team of APMA podiatrists, these products are shown to allow for the most normal foot function and health. For a complete list of all flip-flops with APMA Seal of Acceptance see http://www.apma.org/MainMenu/RecommendedProducts/SealofAcceptance/Seal-Flip-Flops.aspx
- Do wear a sturdy pair of flip-flops when walking around a pool, beach, locker room areas, and hotel rooms. Walking barefoot can expose the foot to plantar wars and athlete's foot.

Don'ts
- Don't re-wear flip-flops year after year. Inspect older pairs for wear and discard them if they show signs of severe wear.
- Don't ignore irritation between toes where the toe thong fits. Irritation can lead to blisters and possible infections.
- Don't wear flip-flops while walking long distances. Even the sturdiest flip-flops offer little in terms of shock absorption and arch support.
- Don't play sports in flip-flops. It becomes much easier to twist the foot or angle causing sprains and breaks.
- Don't do yard work while wearing flip-flops. Always wear a shoe that fully protects feet when doing outside activities especially when mowing the lawn or using a weed-eater.

Short-term pain relief is easy to do at home. Examples of ways to ease the pain include over the counter bunion pad placed around the bony prominence, wearing shoes with a wide and deep toe area, avoiding high-heeled shoes, and using ice to reduce the swelling. The best treatment for bunion pain is to see your podiatrist. Depending on the size and pain of the bunion, nonsurgical or surgical treatments are both options. Early management tries to relieve pressure on the bunion and stop increased joint deformity. These methods include taping, anti-inflammatory injections, physical therapy, and orthotics. If surgery is required, the surgeon will remove the bony enlargement and restore the natural joint form.

While some foot types have an increased risk of forming bunion, the following list provides tips on preventing bunions. As always, see your podiatrist if you have questions or pain due to a bunion.

- Wear comfortable shoes that mold to your feet
- Always fit the larger foot if you have different sized feet when buying shoes
- Avoid high-heeled shoes over two inches tall
- Wear shoes with plenty of room in the toe area

Wash feet daily.
Use mild soap and lukewarm water to wash your feet in the mornings or before bed. Make sure to dry carefully with a towel especially between toes and apply talcum powder to wick away any remaining moisture.

Inspect feet and toes daily.
Every day check your feet for cuts, bruises, sores, or changes to the toenails.

Wear thick soft socks.
Socks made with acrylic blend are great but avoid mended socks or those with seams that can cause skin injuries such as blisters.

Be properly measured and fitted every time you buy shoes.
Poorly fitted shoes are involved in the majority of problems that lead to amputations. Your foot size and shape may change over time leading to skin injuries if changes are not accounted for.

Stop smoking.
Tobacco can contribute to circulatory problems, which can increase in diabetics.

Never try to remove calluses, corns, or warts by yourself.
At-home treatments can burn the skin and cause lasting damage to your feet, while cutting can lead to more serious ulcers and lacerations.

Don't wear anything too tight around the legs.
Panty hose, panty girdles, thigh-highs, knee-highs, or men's dress socks can constrict circulation to legs and feet.

See your podiatric physician.
Regular visits to your podiatric physician are the best way to make sure your feet remain healthy.

Check out our May Newsletter!

To start the season off right, smart choices about grooming and extra care are important. The following at-home treatments recommended by the foot experts at the APMA are designed to get your feet ready for their showing in your favorite summer shoes.

1. Fill a bucket large enough for both feet with warm water and place it at the base of a comfortable chair.
2. Remove nail polish with non-acetone polish remover.
3. While sitting, grasp your foot and begin slowly moving your thumbs from the top of your toes to the bottom of your heal and back. Repeat this stroking as many times as needed to warm your feet and increase circulation.
4. Use a nail clipper to cut toenails straight across. Then use an emery board to smooth nail edges by filing in one direction without drastically rounding edges.
5. Soak feet in warm bucket of water for at least 5 minutes.
6. Raise feet out of bucket and place a foot file or pumice stone into the water. Use the file or stone to gently smooth the skin around the heal, balls, and sides of your feet.
7. Use a fresh towel to dry feet being sure to dry between each toe. As you are drying, cup your heel with one had at the ankle and grab the top of your foot with the other hand. Next, rotate the foot slowly at the ankle a few times in each direction. This will loosen your foot joints.
8. Apply and massage emollient-enriched skin lotion all over your feet. This will hydrate the skin and increase circulation.
9. After allowing the lotion to soak in, wash your feet with soap and water.
10. Before bed, lightly wrap cellophane around your entire foot. This will hold in the moisture allowing your feet to feel soothingly soft in the morning.

As we move forward with our blog, we hope to promote podiatric awareness as a vital part of your healthy, active lifestyle. Here you will find a variety of articles and topics including the latest developments in podiatry, podiatric treatments and helpful foot care advice from Drs. Hamilton, Menn, Werter, Baker and their staff.

We hope you find our blog to be helpful, engaging and informational to ensure the long-term health of your feet.

As always, feel free to contact us with any questions or concerns.

Corns and calluses are thick, hard sections of skin found on the foot.  These conditions aren’t serious, but they can result in severe pain.  Corns and calluses are really an area of increased thickness of the skin formed by too much pressure or friction.  They generally form at bony prominences of the foot where friction is greatest.  Usually poor fitting shoes cause these areas of friction, but they can also form because of how the foot moves during walking.

Calluses are typically found on the bottom of the foot.  Corns are actually calluses that occur on the toes when hammertoes have formed.  (Hammertoes are toes that are always bent, forming an upside down V when looked at from the side.)  These thick layers of dead skin cells are generally white or yellow patches of thick, tough skin.  They may also look flaky, or seem like dry skin.  Corns are generally small and round, with a very sore spot in the middle and yellowish skin surrounding.  Calluses are commonly larger and may have a peak in the middle. 

Anyone can develop a callus or corn from poor fitting shoes or the way their foot moves during walking.  The podiatrists at Coastal Podiatry Associates can easily treat these painful areas.  The fastest and easiest way to treat calluses and corns is to remove the areas of increased skin.  Another method is to reduce the friction or irritation that caused the callus or corn.  This can be accomplished by adding padding to the shoe to offload the pressure area or adding an orthotic.  Orthotics are custom shoe inserts that help the foot move in its most natural path.  Another important preventative step is to wear comfortable shoes to help protect the foot from corns and calluses.

Dr. Scott Hamilton

Excessive sweating from the soles of the feet, known as palmoplantar hyperhidrosis, can affect both children and adults.  This condition occurs when the eccrine (sweat) glands of the soles secrete inappropriately large amounts of sweat.  It typically occurs due to unknown reasons, begins in childhood, and commonly runs in families. 

Eccrine glands are found on almost all parts of the body but are most dense in the palms and soles.  The glands have developed and work normal in patients with palmoplantar hyperhidrosis, they just work more than needed.  These glands produce sweat in response to emotion and stress.  This is the reason people do not notice sweaty feet as they sleep. 

Diagnosis is obvious because the sweating is easily noticed.  Various treatment options are available but each has limitations.  Creams and sprays are a great way to limit the severity of sweat but do not cure the condition.  These are time-consuming therapies because the cream must be applied nightly.  Iontophoresis is the passage of an electrical current onto to the skin, and has long been used to treat hyperhidrosis.  Iontophoresis consists of 30 min sessions for ten consecutive days followed by one or two maintenance sessions per week.  Oral pills will achieve desired results but must be taken for long periods of time and have numerous side effects.  Surgical treatment is an option to treat hyperhidrosis.  Sympathectomy involves the surgical destruction of nerves in the soles.  Although the procedure is effective, it is permanent and should be considered only after all other therapeutic options have been explored.  It is important to visit a podiatrist for treatment of palmoplantar hyperhidrosis, as there are many treatment methods.  Coastal Podiatry Associates can help determine which treatment method is best to restore normal function of the sweat glands.   

By Dr. Scott Werter

People with flat foot experience different symptoms depending on the cause.  Pain and swelling may be felt on the inside of the foot and ankle.  This pain points to involvement of the posterior tibial tendon.  The pain may increase with activity and high intensity activities such as running can be very difficult.  As the condition worsens, the arch can collapse causing the heel bone to move placing pressure on the outside of the ankle.  This can cause outside ankle pain and arthritis of the ankle joint. 

The posterior tibial tendon is one of the most important tendons of the leg.  It starts at a muscle in the calf and travels down the inside of the ankle and attaches to bones on the inside of the foot.  The main function of this tendon is to support the arch.  If the tendon becomes inflamed or torn, the arch will slowly collapse.  Inflammatory arthritis can attach the ligaments, as well as, the cartilage in joints.  Arthritis can cause pain and changes to the shape of the foot.  Injury to the ligaments can cause joints to fall out of alignment and cause flat foot.  The last major cause of adult-acquired flat foot is diabetes.  People with diabetes or with nerve loss can have arch collapse.

 Adult-acquired flat foot is a very common problem affecting the foot and ankle.  The good news is orthotics and braces can help most people.  Those who have tried orthotics and braces without any relief, surgery can be an effective way to reduce pain and deformity.  Your podiatrist is specially trained in treating flat foot and will create a custom treatment plan.   

By Dr. Jordanna Baker   

Ankle sprains are so common that many people never seek medical care.  One simple misstep can cause the ankle to twist at just the wrong angle leading to pain for days.  Two important questions to ask after spraining an ankle include; when is it appropriate to see a podiatrist and what can be expected during the visit?

During the most common ankle sprains, the outer ligaments of the ankle are injured due to an excessive stretching force.  This can happen by awkwardly planting the foot while walking, stepping, or running.  In these situations, the foot rolls in and forces the ankle to move away from the body.  Ankle sprains can cause pain, swelling, bruising, and weakness.  This pain intensifies with movement or touching of the ankle joint. 

For mild sprains, the RICE principle should offer enough treatment.  RICE stands for rest, ice, compression, and elevation.  RICE combined with a reduction in activity and over the counter anti-inflammatory medications such as ibuprofen may offer full relief.  If pain, swelling, and weakness last longer than a week, it is important to seek medical attention.  The podiatrists at Coastal Podiatry Associates are trained to evaluate ankle injuries.  They will examine the ankle to make sure that a serious injury, such as an ankle fracture has not occurred.  In the office, they will evaluate the ankle’s range of motion, strength, and locate the area of maximum tenderness.  They may use x-ray or MRI to ensure their diagnosis and check for bone or ligament damage.  Depending on the severity of the sprain, a doctor might recommend a brace, splint, or crutches to keep pressure off the ankle joint.  Physical therapy may be needed to help regain full range of motion and strength.   

By Dr. Joseph Menn

While running can be great for a person’s overall health, it is harder on the feet than any other physical activity.  Foot pain is common in both recreational and competitive runners.  This is because the average person hits the ground with two to three times their normal body weight when they run.  This pounding places considerable stress on the foot and ankle.  According to the American Podiatric Medical Association, a 150-pound jogger will expose their feet to a total impact of 150 tons over the course of a three-mile run.   To put this into perspective, a small compact car weighs about 1 ton. 

To help the feet cope with this impact, proper footwear is crucial for preventing pain.  Foot pain due to running can range from minor aches to serious injuries.  Heel pain is due to a condition called plantar fasciitis.  The plantar fascia is a band of tissue that connects the bottom of the heel to the base of the toes.  This tissue becomes swollen and painful do to overstretching.  Tendinitis is an irritation and swelling of tendons and can often affect the arch of the foot.  It can be caused by excessive running or running too far too fast.  Toe pain is common when running shoes are too small as the toes slam against the front of the shoe.  Small shoes can cause toenails to turn black or fall off.  Improper fitting shoes can also result in blisters, which form from friction between the skin and shoes. 

Wearing running shoes specifically designed for the sport can help prevent many foot problems.  Running shoes have extra padding to cushion the impact and are constructed to provide support and stability for the foot’s arch.  Other methods to prevent pain include stretching, proper training increases, running on dirt terrain, and stopping once pain is noticed.   

By Dr. Scott Hamilton   

Feet are just like anything else, as they are used and time passes, change is inevitable.  The average person takes approximately 10,000 steps per day, which can add up to more than 3 million steps a year.  Each of these steps can place a force on your feet equal to two or three times your body weight.  It is easy to see that with time, this extensive repetitive use can lead to several changes related to growing older.

Normal aging is associated with gradual stretching of the ligaments that support your foot’s anatomical shape.  It is normal to notice your feet becoming wider and longer.  This is generally combined with a mild settling of the foot’s arch more often noticed as a flattening of the foot.  Another normal change is thinning of the skin on the bottom of the heel.  This is from a reduction of a fat pad as the body loses its ability to retain water.  Again, normal aging is the corporate.  An increase in the stiffness of joints and a loss of joint range of motion may occur.  Think back to the facts of taking 10,000 steps where 2-3 times your body weight is placed on your feet, this workload on your joints will cause a natural amount of arthritis that can lead to stiffness.

Some common foot changes are abnormal or pathological.  These conditions tend to occur in association with prolonged use of ill-fitting  shoes and extreme stress placed on the foot.  They are most commonly noticed when people are in their 30s, 40s, and 50s.  These problems do not occur naturally and can be slowed or prevented with the use of proper shoes and inserts.  A bunion is the most common problem and is a large bump on the inside of the big toe.  Another condition is a hammer digit, which occurs when the toe becomes curled or constantly bent.  Bunionette is a term used to describe a large bump found on the outside of the smallest toe in addition to the toe pointing toward the rest of the foot.  Calluses or corns can occur on the toes or foot in areas of high pressure points.  If you notice these changes, it is important to get your feet checked by a doctor.  Podiatrists are specially trained to treat these conditions and reduce the associated discomfort or pain.     

Dr. Scott Werter

PRP is blood that has been concentrated with platelets, growth factors, and other blood products.  It is used to stimulate the healing of bone and soft tissue.  The interesting fact about PRP, is that every part of the process involves a patient’s own blood.   Blood is first withdrawn from the patient.  It is then spun in a centrifuge to separate the blood into a platelet- rich component, platelet-poor plasma, and red blood cells.  The concentrated platelet- rich component is then removed from the rest and injected back into a patient’s problematic areas.  This process is nonsurgical and since it involves the patient’s own body, the chance for infection, rejection, or allergic reaction is greatly reduced. 

The platelets found in the PRP injection contain proteins and other particles involved in the body’s self-healing process.  A teaspoon or two of this injection contains 3 to 10 times the concentration of platelets from that of normal blood.  Many times the injection is placed in locations where blood rarely reaches.  This allows PRP to deliver the healing instincts of platelets without triggering the clotting response that platelets typically cause. 

Since PRP is relatively new and only early studies have been completed, insurance coverage is not universal.  If you are interested in this technique to treat plantar fasciitis or other foot pain, it is important to consult a trusted podiatrist.  They can help determine the correct treatment path and help you return to pain free activity.

By Dr. Jordanna Baker

Septic arthritis is an extremely painful infection of a joint where germs infiltrate a joint and cause damage that leads to severe pain, warmth, and swelling.  Bacteria and other microorganisms are the cause of septic arthritis and commonly target the knee, hip, or ankle.  In the United States, 20,000 cases are reported each year in mostly young children and older adults.  Septic arthritis is considered a medical emergency, as the microorganisms can destroy the joint in a few short days or can spread to other areas of the body. 

There are four main causes of septic arthritis.  The first is called contiguous spread.  This occurs when a preexisting bone infection travels down the bone and reaches a joint.  Direct implantation of bacteria can occur when a puncture or stab wound occurs in the joint.  Heamtogenous source of septic arthritis develops when an infection enters the bloodstream from another area of the body and reaches a joint.  The last cause takes place after joint surgery and is due to contamination. 

Septic arthritis typically causes extreme discomfort and difficulty using the affected joint.  Signs and symptoms can include fever, severe pain especially when moving the joint, swelling, joint warmness, and redness.  Medications for other types of arthritis may mask the pain and fever.  It is important to seek a doctor if these signs develop.  It is especially important if signs and symptoms of infection such as fever and chills occur, as this may indicate a severe infection.  To diagnosis septic arthritis, a doctor will consider the clinical presentation, vital signs, x-rays, and blood labs.  Generally, septic arthritis is treated with joint aspiration, removal of infected tissue, and antibiotics. 

By Dr. Joseph Menn

  A bunion, otherwise known as hallux abducto valgus, involves misalignment of the bones at the big toe joint and sometimes the joint within the big toe.  This abnormal anatomy causes the boney prominence on the inside of the big toe.  Conservative treatments vary, but surgery is the best treatment and extremely common.  Some people avoid the surgery because they have heard stories and misconceptions.  The surgery does typically require realignment of the bones through bone cuts and screws.  The podiatrists at Coastal Podiatry Associates are well trained, having executed hundreds of bunion surgeries.  The following statements are myths, especially when using Coastal Podiatry Associates.

Myth 1: Bunion Surgery is Extremely Painful

Bunion surgery is not different from other surgeries.  In general, foot surgery can lead to increased pain due to swelling as the foot is below the level of the heart and blood can easily rush to the area.  In addition, the foot has less soft tissue surrounding the bones, so moderate swelling can aggravate the nerves leading to pain.  Swelling can be reduced through elevation and icing the affected foot.

Myth 2: Bunion Surgery Means a Cast and Crutches

Modern surgical techniques allow patients to mobilize quicker.  Most bunion surgeries involve walking in a surgical shoe for six weeks.  Mild surgeries can lead to an early return to shoes, while more complex surgeries may require casting and crutches. 

Myth 3: You Have to be Off Work

As a general statement, this is not true.  The amount of time away from work depends on the demands of the job and type of surgery.  A patient can return to a sedentary desk job within two weeks of the surgery.  However, jobs requiring excessive walking, standing, and physical activity may require a medical leave of absence.

Myth 4:  Healing after Bunion Surgery Results in Unsightly Scars

Surgical healing is part of the process with any surgery.  Newer techniques allow for smaller incisions and alternative surgical approaches may be used to hide surgical scars.  Bunion incisions are either on the top of the foot or along the side, based on the surgeon’s technique.  A surgeon may use a plastic surgery-type closure to minimize scaring. 

Myth 5:  Bunions Come Back After Surgery

Recurrence can happen after any surgery.  The return of a bunion is no different, and it may be something that can happen over time.  Patients that have excessive motion in the foot or do not reduce their risk for developing a bunion may experience a recurrence.     

By Dr. Scott Hamilton

Every mile you walk places a tremendous amount of stress on your feet.  The good news is your feet can handle a heavy load, but, too much stress may push them past their limit.  The shoes you wear or surfaces you walk on can increase the stress level.  Heel pain is one of the first signs that too much stress is being placed on your feet.  A sore heel will usually get better on its own with adequate rest.  The problem is that many people try to ignore the early signs of heel pain and continue the activities that caused it. 

 It is important to see the podiatrists at Coastal Podiatry Associates right away to determine why there is foot pain and determine the proper treatment.  The doctors will begin by asking where exactly the pain is located and when it began.  Next, they will examine your foot, looking and feeling for signs of tenderness, swelling, and bruising.  The doctors may ask you to walk, stand on one foot, or other physical tests that help determine the pain’s cause.  Conditions that cause heel pain generally fall into two main categories: pain beneath the heel and pain behind the heel.

If the pain is greatest under you heel, you may have a condition causing inflammation in that area.  A stone bruise occurs after stepping on a hard object such as a rock or stone.  The object can bruise the fat pad on the underside of the heel and pain gradually reduces with rest.  Plantar fasciitis typically occurs after too much running, jumping, or stretching of the tissue band that connects the heel bone and the base of the toes.  The pain is centered under the heel and is most intense with taking your first steps after resting.  A heel spur is another cause of pain and can form from long standing plantar fasciitis.  An x-ray may be used to visualize the boney projection from the heel. 

Pain behind the heel is generally due to the Achilles tendon.  This condition is called retrocalcaneal bursitis and is an inflammation of the insertion of the Achilles tendon into the heel bone.  People often develop this by running too much or wearing shoes that rub or cut into the back of the heel.  This irritation can cause a slow increase in skin thickness, redness, or swelling.  A bump that is tender and warm to touch may also develop.  Pain is most severe with first activity after resting.  It is not uncommon for the pain to be so severe that normal shoes cannot be worn.  After taking x-rays, a podiatrist will prescribe stretching exercises, anti-inflammatory medications, and icing.  

By Dr. Scott Werter

By Dr. Jordanna Baker                                                                                                                                           

 Have you ever dropped a heavy box on the top of your foot?  Have you ever stepped into a small hole, falling, and twisting your foot?  These two common accidents can result in midfoot or Lisfranc fracture-dislocation.  Lisfranc injuries (named from the French doctor that first described the injury) occur at the midfoot.  This area is a cluster of bones and joints that form an arch on the top of the foot between the ankles and toes.  In total, five long bones extend to the base of the toes meet four bones projecting towards the rear of the foot.  These bones are held into position by ligaments that stretch across and down the foot.  The bone extending to the second toe is extremely important as it acts as a stabilizing force in the area but lacks ligaments to secure it to the first long bone.  These two long bones may shift, break, or dislocate in a twisting fall.

Lisfranc fracture-dislocations are often mistaken for sprains.  The top of the foot may be swollen and painful with some bruising.  If the injury is severe, you may not be able to place any weight on the foot.  Lisfranc injuries are often difficult to see on X-ray and can have serious complications if left untreated.  It is important to see a podiatrist if rest, ice, and elevation do not reduce the pain and swelling within a day or two.  At the doctor’s office, a podiatrist will evaluate the foot through a detailed physical exam and image study.  If initial x-rays do not show an injury, a CTor MRI may be needed.

Treatment for a Lisfranc injury depends on the severity of the injury.  If the bones have are still in alignment, a cast is typically used in addition to not placing any weight on the foot for six weeks.  Unfortunately, surgery is often needed to stabilize the bones and hold them in place after they have become dislocated.  Pins, wires, or screws may be used to restore normal position.  After surgery, a cast and non weight bearing to the foot for six to eight weeks is typical.  In both situations, arch support and a rigid soled shoe are commonly used until all symptoms have disappeared. 

It is important to seek appropriate medical advice when rest, ice, and elevation do not resolve pain.  It is equally important to follow doctor’s orders and refrain from activities until instructed.  The podiatrists at Coastal Podiatry Associates are trained in Lisfranc fractures and will help their patients return to normal activity as quickly as possible.    

By Dr. Joseph Menn

The first thing a doctor will evaluate is the history of your chronic ankle pain.  This will help them determine the cause, as there are so many potential reasons for chronic ankle pain.  Your doctor will also feel for tender areas and look for signs of swelling.  They may have you move your foot and ankle to assess range of motion and flexibility.  To test the sensation of the nerves, your doctor may administer a shot of local anesthesia.  Your doctor may order x-rays of the ankle joint and foot to help view the bony alignment. 

The podiatrists at Coastal Podiatry Associates will tailor your treatment plan to your needs.  Conservative treatments include anti-inflammatory medications, physical therapy, braces, local steroid injections, and casts.  If conservative treatment doesn’t bring relief, surgery may be needed.  Most procedures are done on an outpatient setting with six to ten weeks of post-op rehabilitation.  Surgical options include removing loose tendon fragments, cleaning the joint or joint surface, and ligament repair or reconstruction. 

By Dr. Scott Hamilton

Coming soon.

“Color me happy,” “Cajun Shrimp,” “Italian Love Affair” all of these are nail polish colors. Fantastic names!  Oh, so alluring and adorable.  However, what if they were named “Fungus Among Us” or “Love that Bacteria” or “Shades of Virus?”  Nail salons are toted in some literature to give an infection to seventy percent of people that visit them. That means that more than most leave with pretty toes and a bacterial, fungal or viral infection.  There are several places that an infection can be transferred, so you can minimize your risk and enjoy your pedicure.  First, make sure the place itself looks clean. Is the floor clean? Are the stations well-maintained? Make sure the foot bath stations are cleaned after each person and if there is dirt or debris in the bath, insist it be cleaned.  Take your own instruments and nail polish as this will prevent you from getting or spreading an infection…it’s important that we all take measures to prevent infection.   Keep in mind that it is illegal to use sharps or debride (remove) skin in these places, so speak up if a razor blade, scalpel or scraping instruments are being used to remove callus or rough skin.  Unfortunately, the proper way to trim toenails is different than the way to trim fingernails and consequently the nail can become ingrown.   This begins the cycle of getting an ingrown and getting another pedicure to treat it.  Usually, once the nail has started to become ingrown, eventually it will result in pain and/or pain and infection.  This should be treated immediately by your podiatrist and not by the nail salon personnel.  If you see changes in your toenail including discoloration, thickening or lifting you should at minimum remove all nail polish and stop getting pedicures for a month or so. Then, perhaps a different place should be sought. Some discoloration may be from chronic nail polish or nail polish that contains formaldehyde.  Allow your nails some time to return to normal and then seek your podiatrist’s help in determining if you have an infection of the nail or have had trauma to the nail that will affect its appearance.  You can now get nail polish without formaldehyde and with antifungal in it at our clinic. An arrangement of gorgeous, cleverly named colors are available for purchase without an appointment.  So stop by on your way to your next pedicure!

By Dr. Jordanna Baker