It's That Time of Year Again

I admit I am a bit late talking about this, but being from the North I am not quite used to putting up Christmas decorations in 75 degree weather.  As the holiday season approaches, may of us are undoubtedly busy and on our feet.  Some of us do a lot more walking with all our holiday shopping than we are used to.  Our feet and ankles don't like this sudden increase in activity and this is when we set ourselves up for "overuse injuries."  These injuries include: stress fractures, tendonitis, plantar fasciitis, as well as pain from any arthritis that might be present.

Of course we want to avoid foot and ankle pain, so the best advice I can give is to wear a supportive shoe.  If you do experience foot pain after a long day shopping, icing is a safe way to bring down pain and inflammation.  If the icing still does not help, do not put off seeing a podiatrist as often these conditions can just worsen and be more difficult to deal with and also take longer to treat.

Going Home to NE Ohio

I was fortunate this past week to spend a long weekend up in NE Ohio at the 25th Annual NEOAPM Seminar.  It gave me a chance to see my former classmates and professors and learn about some new ideas.  We had excellent faculty at the conference including some doctors from the nearby Cleveland Clinic.  I look forward to having a chance to put this new information to use down here in Florida.

This is NOT recommended

Just when I thought I had seen it all, I read this story online from "Runner's World": Keith Levasseur ran Saturday's Baltimore Marathon in 2:46:58 while wearing flip flops.  Apparently, he performed the stunt for the Guinness Book of World Records.  Looking closely at the picture, they are some of the more supportive flip flops, but still I find this to be insane.  To top it all off, he finished 39th out of over 3000 runners.

Flip flops are a popular shoe all over the country, and here in Florida they can be worn essentially all year.  However, these shoes are not created to walk in for long distances or even wear long-term.  Historically, they are to protect feet to get to the beach from your car over hot pavement or to prevent you from picking up a wart or athlete's foot in a public shower or pool.

These shoes can lead to all sorts of problems such as heel pain and also provide no protection for the top of the foot or the end of the toes.  I have seen several painful toenail injuries from the wearing of these shoes.

I know I will not make many people give up their flip flops but I recommend them only for limited periods of time and certainly prefer my patients wear ones with an arch in the sole.  Our shoe store and all of our offices have available sandals and flip flops that are better for you feet than the "traditional" flip flop.

Derek Jeter's Fractured Ankle

It can happen to anyone, especially athletes.  I woke up this morning to news that one of the best players in baseball had fractured his ankle last night.  Currently the news stories do not have the extent of the injury to Derek Jeter, but they do relate that he is done for the post-season and then a 3 month recovery.  I am also sure that a CT scan and MRI are pending if not already done to determine the damage and treatment.

Many people are not aware that podiatrists are foot and ANKLE specialists.  Everyday, I treat ankle sprains and we do also see ankle fractures.  It is important to treat ankle fractures promptly because if the joint is disrupted from the fracture it can lead to traumatic arthritis.  This can be a lifelong problem that will need treatment with bracing and even sometimes a surgical ankle fusion to manage the pain.

UPDATE (on 10-16-12): It looks like Derek Jeter will have surgery to repair his fractured ankle.  I have not seen x-rays to know but usually this means the ankle joint is out of alignment and surgical repair is an attempt to allow the ankle to heal in proper alignment and reduce the chance for further problems.

High Heel Horror

I just found an interesting article on yahoo regarding "dangerous" high heels.  The article can be found here: http://shine.yahoo.com/the-thread-how-to/scariest-shoes-time-173900092.html

Needless to say, these shoes are not podiatrist approved!  It doesn't take a professional opinion to conclude these shoes are an accident waiting to happen.

Kobe Bryant's "Mild Foot Discomfort"

I admit that I am not a huge basketball fan, but I do keep an eye on the sports headlines.  Being a podiatrist, a recent headline caught my attention.  It turns out that yesterday Kobe Bryant missed both LA Laker practices with "mild foot discomfort."  I am sure one of the greatest basketball players of all time will be closely evaluated but anyone can take note of this headline.  Foot pain is not normal!  If Kobe Bryant would have tried to "work through it" he could have made the condition much worse.  I can not tell you how many times I see a patient who waited several months or even a year with significant foot pain.  This patient is much harder to treat as the condition has often worsened.  As with most things the sooner you deal with an issue, the easier it is to resolve.  Moral of the story: foot pain is not normal and we should take it seriously.

Barefoot running

There is a lot of discussion in the media right now involving barefoot running.  Many people claim it is a wonderful way to run.  However, as a podiatrist, I will have to say I can not agree that it is safe.  Many different things have to be considered.  Does the runner have a high arch foot?  If this is the case, I do not believe that the foot can adapt to the ground well.  This sets the runner up for stress fractures and degenerative arthritis.  If the runner has a low arch or "flatfoot,"  I believe that this will make it hard for the runner to go through the propulsive phase of running setting him or her up for tendinitis and various deformities such as hammertoes and bunions.  The running surface also needs to be considered.  A sandy beach is probably better than concrete.  When a patient tells me going barefoot is natural, I often tell them that even if that is true, the ground we often walk on is not.  I tend to believe shoes are important, especially when we are active.  I have seen a lot of injuries from barefoot activity.

"Shape-up" shoes

I am sure everyone is aware of these shoes.  They claim to help "tone" your lower body.  I do have patients that say they like these shoes.  However, there are several lawsuits over these shoes not doing what they said they were going to do.  One woman in Ohio is also suing for causing a stress fracture in her foot.  I tell my patients that I believe shape-up type shoes take away the effects of a tight achilles tendon.  This is also known as "ankle equinus."  When wearing them with the rocker bottom, the foot does not have to compensate as much.  This is fine if you are going to wear these shoes all the time, but most people still want to wear other shoes or sandals and end up with foot pain.  I have even had a patient train for a marathon in them and she developed significant tendonitis because of this.  Thankfully, we were able to get her running again with treatment.

"Toe-besity" surgery

There has been some talk in the news and online regarding foot surgery being done for cosmetic reasons.  More specifically, surgery for people who think their toes are "too fat."  As a foot and ankle surgeon, I find this discussion interesting.  With some exceptions for limb-threatening infection, most surgery that we perform on the foot and ankle is considered "elective."  This means that though there may be significant pain and the problem could drastically effect the quality of life, the surgery is still not considered emergent.

So, when I hear about people having surgery for purely cosmetic reasons I get a bit concerned.  Don't get me wrong, often times, foot surgery to correct a painful deformity also can cosmetically improve a patient's foot, but there are complications to be aware of.  People have asked me, well there is cosmetic surgery for example my nose, why can't it be done on my feet?  My reply is to state the obvious that we do not walk on our noses but we do walk on our feet.  That is the difference and the concern.  The foot is a functional body part that can be disrupted through surgical intervention.  If there is pain, surgery can be wonderful, but if there is no pain and surgery is performed for cosmetic reasons alone, one needs to be very careful.

The Podiatric Physician's Oath

This week is a personal milestone for me, as 10 years ago on May 24, 2002 I took this oath as I became a physician.  In many ways it does not seem that long ago.

The Podiatric Physician’s Oath
I do solemnly swear to my God, on my honor, to those who have taught me, and by all things that I hold sacred, that as a practitioner of Podiatric Medicine, I shall abide by the following precepts:

I shall, above all, hold paramount the welfare of my patient, regardless of fee or favor, and I shall neither prescribe nor give any treatment or drug which will be detrimental to his well being.

I shall endeavor to uphold the dignity of the professional way of life, the aims of which are to render public service.

I shall cherish those who have taught me, holding high their principles and precepts and I pledge that I shall do everything that I am able to do to promote and to protect the profession of Podiatric Medicine and to aid my fellow practitioners.

In swearing to this oath, I hereby dedicate myself in service to the health of humanity, and I hold as my goal the relief of pain and suffering. If I keep this Oath, may I receive God‟s guidance in the practice of my art, and may I enjoy my life in the respect of all men.

Steven Tyler's Foot Deformity

I admit it, I am still a fan of American Idol.  I wasn't sure last season if I would miss Simon Cowell too much to continue watching, but I found that I actually liked Steven Tyler better.  Speaking of Steven Tyler, there is much talk recently about, of all things, his feet.  He stated that he has foot pain due to a "morton's neuroma" and has had surgery.  I did not examine Steven Tyler to know for sure but, on his right foot he has a severe hammertoe looking at the picture.  Perhaps his left foot had a neuroma which is essentially an inflammed nerve between the metatarsals (or bones below the toe joints).  A neuroma is usually between the 3rd and 4th toes but can also be between the second and third toes.  Conservative treatment includes padding and injections but sometimes surgery is necessary to remove the nerve.

With regards to the hammertoe, short of padding to prevent rubbing, conservative options to actually correct the deformity itself are limited.  For a toe as deformed as Steven Tyler's, surgical correction is actually complex and usually requires a wire to hold the toe in place as it heals.

I have years of experience treating both of these conditions.  If Steven Tyler is ever in Central Florida, I would be happy to see him and I will continue to enjoy watching him on TV in the meantime.

What shoes should you wear?

Being a Disney lover, I still have to "pinch myself" that I can go to the parks on a very regular basis.  Recently on the "Disney Parks Blog," the following video of "feet at EPCOT" was posted.  Most non-podiatrists do not notice people's shoes but I find this interesting.  Most of the feet are covered in sneakers but I also saw several flip flops.  Everyone is different, but typically I find you can never go wrong with a supportive sneaker while active.  If you are going to wear a sandal, I recommended one with an arch.  These can be more difficult to find, but are available.  In fact, we have several in our office.  Foot pain is never normal and I pride myself at keeping my patients on their feet so they can do whatever activity they like including walking around all the great theme parks we have here in Central Florida.

Paula Deen

This past week, Paula Deen admitted that she had diabetes.  This likely made the news because she has been known for her cooking of what many people believe are unhealthy foods that could lead to diabetes.  Diabetes, in the most simple of terms, can be described as a disease of high blood sugar.  As a podiatrist, I see the manifestation of the disease in the feet everyday.  This includes nerve damage that can be painful and / or not allow a patient to feel his or her feet.  Also poor circulation in the lower extremities can occur.  Finally, the patient's ability to fight infection can be compromised.  We worry about all of these issues as combined they can lead to serious problems.  For example, a diabetic can step on a tack or get a rock in the shoe and because of nerve damage may not feel it.  This can cause a sore that can get infected and the diabetic patient's ability to heal the area is poor and antibiotics can not get to the area due to poor circulation.  The infection can worsen and to prevent severe life-threatening sickness, amputation of a toe, foot, or even leg can be necessary.  So prevention is key.  Diabetics are encouraged to establish a relationship with a podiatrist for regular evaluation and if, after daily inspection of the feet any problems are observed, a visit to the podiatrist is imperative.