Kelly Ripa's Broken Foot

Yesterday Kelly Ripa came out to host her morning show with a walking boot on her left foot.  It turns out that the day before she "stepped wrong" on a weight left on the floor during her dance class.  She later found out that she broke multiple bones in her foot after hearing a "bubble wrap" sound.  She is told that she does not need surgery but will require 6 weeks of immobilization in the boot.  I am not sure whether or not she was joking but she says for her it will be "more like 3."

As a podiatrist who treats foot fractures, I find this interesting.  Fractures anywhere in the body take at least 6 weeks to heal.  So she is not going to cut down her time to 3 weeks unless she wants to have a non-healing fracture or even further damage that may require surgery.

I also found interesting her choice of a shoe for the other foot.  (Apparently she was advised to wear an appropriate shoe on the other foot and refused according to her discussion on her show). One does want to balance a walking boot with a shoe of equal height on the other foot, but she is not weight bearing yet.  She is wearing a fairly high heel on her right foot and I certainly worry about a foot or ankle injury on the right limb as well.

The National

Since Orlando is only a couple hours away, I was excited to see that the National Scientific Seminar of the American Podiatric Medical Association was to be held in Orlando this year.  I decided that I would attend my first national conference and just returned home to Spring Hill.  Podiatrists from all over the country came to Orlando this past weekend.  I must say I was very impressed with the conference.  I have, of course, attended many conferences more regional in the past, but this one was so much bigger.

In addition to well respected speakers, the exhibit hall was great.  I have again found products and services to make the practice and care I provide to my patients even better.  I am eager to get to the office Monday morning and get to work!

A Personal Milestone

I am the type of person who does my best to avoid bragging.  I really do not have an ego and consider myself a fairly humble guy.  However, I am also a person who has been blessed with many experiences throughout my life and enjoy reflecting on my life.  July 2015, specifically July 10, 2015, marks the completion of 10 years in private practice.

I hope readers of this blog will bear with me as I have a little fun and look back on these 10 years:

Indianapolis:
July 11, 2005 - August 2008

As a doctor fresh out of residency, this was a time to grow in my career.  Medical school and residency does not do a lot to prepare someone for private practice and I learned a great deal during my 3 years here.  Indianapolis is a wonderful city and my wife and I will certainly treasure our time here.

Pittsburgh:
September 2008 - October 2011

I specifically lived and worked a little south of the city in the West Mifflin area.  (About 6 miles south of downtown).  Growing up in NE Ohio (and a Cleveland sports fan), I was not raised to love Pittsburgh, but it is a unique and beautiful city.  With me being from Akron, and my wife being from Dubois, PA, this put us exactly in between and 100 miles away from each of our hometowns.  In Pittsburgh, I learned a lot about caring for patients in the hospital setting and wound care.  These are certainly valuable skills.  The surgeries I performed here completed my requirements for board certification which I achieved during the end of my time here.

Winter Haven (Polk County), Florida:
November 2011 - April 2013

You can see from the Pittsburgh picture that snow was always part of my winters.  I was thrilled to move to "Winter Haven" and haven't seen snow since.  I would say that my experience here was concentrated on "practice management."  Having learned the medicine part pretty well, this allowed me to focus on learning how to run a practice.  More than just billing and coding, but also providing valuable services that give patients great outcomes.

Spring Hill, Florida (Absolute Healthcare, LLC):

April 2013 - April 2015

Coming to Spring Hill and working with a multi-specialty group was invaluable.  I have a great deal of respect for Dr. Gaurav Malhotra.  Working with an MD helped me figure out where I fit in with the medical team to care for patients.  Having only worked with podiatrists in the past I missed different viewpoints.  Medicine is changing, the primary physician is going to direct care in the future to cut down costs and focus on prevention.  Though no one really knows exactly where we are headed with all of this, my time here allowed me to better determine my role in patient care within the medical team.

Spring Hill, Florida (Donald J. Adamov, DPM, PA):

May 2015 - Present

Never would have I imagined, as a young doctor going into work for the 1st time on July 11, 2005 in Indianapolis, that 10 years later I would be practicing in my own practice 1000 miles south in Florida.  I moved around a lot in those 10 years, but the experience I gained has been so important in the forming of the philosophy of the care I provide my patients.  I appreciate the trust that my patients have placed in me.  I never take the responsibility of caring for my patients lightly.



Kyrie Irving's Sprained Foot

I am not typically a basketball fan.  In fact, it is probably on the bottom of my list of major professional sports.  However, after my first week at my new office, I am taking some time just to relax.  After all, this is the 1st weekend in a while on which I did not have to go work at the office preparing it to see patients.

As many of you know, I spent the 1st 29 years of my life in Northeastern Ohio.  I was born in Akron and my undergraduate degree is from The University of Akron.  I went to podiatry school in Cleveland and did my residency in the greater Cleveland area.

So, even though I am not a huge basketball fan, I pay attention when a team in Cleveland is doing well.  I do not think it is fair to call me fair-weather as I have been to plenty of Browns, Indians, Cavs, and minor league hockey games in downtown Cleveland and even in Richfield at the old Coliseum when these teams were not doing well.  I also really appreciate LeBron James returning to our hometown to try to bring the people of Northeastern Ohio a championship.

Therefore, I admit I have been following the Cavs.  Unfortunately, with Kevin Love's season being over, I am concerned with Kyrie Irving.  Reports say he has a foot sprain and he is playing with a limp.  As a podiatrist, I wonder if there is more than a sprain.  I start to think about a stress fracture.  After all, a painful foot and limping is not normal.  Often, when someone keeps walking on a sore foot or ankle, it can make the condition worse and harder to treat.

I just hope that Kyrie's injury does not worsen as he and Lebron compliment each other well and would not want any long term problems.

As I type this at the end of the 3rd quarter of game 4 vs. the Bulls, things certainly do not look good for the Cavs.  However, in sports anything can happen.

A Very Exciting Annoucement

Many of you may be aware that in December of 2014 I began transitioning from being an employed podiatrist at Absolute Healthcare to becoming a solo practitioner.  Late last year, Donald J. Adamov, DPM, PA was formed.  I decided that after close to 10 years in private practice, it was time to "give it a try" on my own.  I figured that I would be able to care for patients the best way I know how and could make my own decisions when it comes to the services I offer my patients.

This is why, I am so excited to announce, that effective Monday, May 4th, I will begin practicing at my new location:

1250 Mariner Blvd.
Spring Hill, Florida 34609
352-606-3950

The new office is just over 2 miles south of the old location at 3376 Mariner Blvd.  It is just south of the YMCA on the same side of the road.  Our office is in the plaza directly behind Susie's Grill.  We have purchased brand new comfortable treatment chairs as well as a state-of-the-art digital x-ray machine.  This machine will allow us to diagnose fractures and other bone problems during your visit.  We are also looking into offering more items to help treat our patients such as arch supports and other medical equipment.

The new office is in addition to adding an additional morning to see patients at the Spring Hill wound care center.  Now in addition to Thursday afternoon, I will be seeing patients Wednesday morning as well.  If you have a wound you can always see us at the Mariner office, and if appropriate, I can then follow-up with you at the wound center.

I look forward to seeing you at the new location!

 

The SAM Conference

I spent an extended weekend at the Florida Podiatric Medical Association's Scientific and Management Conference at the Orlando Hilton.  It was a very valuable weekend to me and I believe that I learned some things that will improve the care I provide to my patients.  Some of you may know that my podiatry practice is transitioning to being a solo private practice.  For my patients, you will see some differences such as in the next few months you might have to fill out some new paperwork and any bills will come from a different place.  However, I will continue to provide the best care that I can provide.  Hopefully, you will notice some increases in convenience.  I am exploring some resources to provide more services at the practice.  For example, instead of simply telling a patient to go and buy a shoe insert at Wal-Mart or the sporting goods store; I am looking to provide the best products I can find for the best value right at the office.  I am also looking to update my website on which I look to add some additional helpful information.

I have blogged before about my 10 years in private practice.  These years of experience have taken me through Indianapolis, Pittsburgh, Polk County (Florida), and finally here in Hernando County.  Each one of these practices afforded me valuable experience.  I saw a lot, and learned a lot.  This helped me formulate the absolute best way to care for my patients.  My philosophy is to treat every patient the way I would want myself, my wife, my mother, my father, or my children treated.  I am excited about the future and the care I will provide my patients.

Pascal Dupuis

Most of the people that read my blog know I love to watch ice hockey, and also know that I especially like the Pittsburgh Penguins.  Today, the Penguins announced that winger Pascal Dupuis has a a "blot clot in his lung."  This is more specifically a pulmonary embolism.   A few months ago, I blogged about how American Idol contestant, Michael Johns, lost his life due to a pulmonary embolism.

The Penguins say that Pascal had chest pain and was evaluated and the embolism was found.  He apparently had a blood clot in his leg (DVT = deep vein thrombosis) that traveled to his lungs.  A DVT in the leg is, in and of itself, not the problem.  However, it can cause very painful leg swelling and inflammation.  The problem is if that blood clot breaks away and travels to the lungs it can be deadly.  Most people would go to the ER if they had trouble breathing, but people need to take sudden painful swelling in the leg just as seriously.  Immobilization after injury, as well as being seated for long periods of time (eg, a long airplane trip), can be a couple of the common causes.

Pascal will be unable to play hockey for at least 6 months as he will need to be on anti-coagulants, or blood thinners, for at least that time to prevent further clots.  As most of you know, hockey is a contact sport and blunt trauma and blood thinners are not a good combination.

The Penguins say that Pascal should be able to return to hockey.  Unfortunately, however, this is his second blood clot.  One has to wonder if he would want to risk coming off anti-coagulation as he is obviously prone to developing thrombi in this body.  I guess time will tell, but either way, he will have to closely watch for developing symptoms for the rest of his life.

Let's Play Hockey!

For a hockey fan like myself it is the greatest time of the year.  (OK, so maybe second greatest if your team makes the playoffs).  The season officially begins tonight and tomorrow my favorite team, the Penguins, and the local team, the Lightning, begin the season.  Because of this occasion, I feel it is appropriate to post my previous hockey blogs.

http://donaldjadamovdpm.blogspot.com/2013/06/alex-ovechkins-broken-foot.html

http://donaldjadamovdpm.blogspot.com/2013/03/kris-letangs-broken-toe.html

http://donaldjadamovdpm.blogspot.com/2013/02/erik-karlssons-achilles-laceration.html

http://donaldjadamovdpm.blogspot.com/2013/01/ice-hockey-is-back.html

http://donaldjadamovdpm.blogspot.com/2011/11/ice-hockey-and-foot-injuries.html

The Passing of Michael Johns

I was saddened to read that a few days ago, former American Idol contestant, Michael Johns, had passed away due to a blood clot after twisting his ankle.  I do not watch American Idol much anymore, but back in 2008 I rarely missed an episode.  I do remember Michael Johns competing.

At 35 years old this is a tragic loss.  Fortunately, blood clots after twisting an ankle leading to death are very rare.  However, blood clots in the legs are not uncommon.  The clot in the leg is not what is fatal but instead it is the blood clot "breaking off" and traveling to the lungs that can lead to death.  This is called a pulmonary embolism.

How do blood clots form in the legs?  Well, there are large veins in the legs and when a person does not move his or her legs for a long period of time there is no muscular activity to help the blood return to the heart.  This blood can then pool in a vein in the leg causing a deep vein thrombus (DVT).

I am not sure of the facts but it seems that Michael Johns twisted his ankle and it was causing him severe pain.  It was too painful to move and he probably stayed off of it.  A blood clot formed and likely traveled to the singer's lungs.

This could have been possibly prevented if the singer sought medical advice.  A possible sign of a DVT is severe calf pain and swelling.  If this happens seek medical attention right away.  An ultrasound can be done to determine if a DVT is present or a blood test called a D-dimer can be done to see if a clotting process is present.

RIP Michael Johns.  Hopefully, some good can come out of this tragedy by educating people on the dangers of this condition.

New Office Renovation

People are hard at work completing the final touches on the new podiatry building on the campus of Absolute Healthcare.  I am very pleased with the new spacious office.  I find it very welcoming and am excited to start caring for my patients in this beautiful building.

Way to go, Scouts!

I was quite interested in the recent story that Ann Curry was hiking in New York and was "rescued" by a group of boy scouts.  There are two reasons for this interest.  First, as is the topic of this blog, I am a podiatrist treating conditions of the foot and ankle.  The second reason is something not everyone may know about me; I was a boy scout.  In fact, I am an Eagle Scout.

I remember learning how to splint ankles and my first aid training but never had to put it into action like these young men.  I found it even more of a feel good story that most of these guys didn't even know that they were helping a celebrity.  Kudos to these young men!

Osteomyelitis

Since it has been awhile since I have posted on this blog, I wanted to post on a topic that I have seen a lot of patients develop recently.  I decided to talk a little bit about osteomyelitis, or bacterial infection of bone.

Working at the wound care center, I have found that a great deal of patients with chronic ulcerations can develop infection in the bone under the ulcer.  I have also found that a doctor needs to suspect this whenever there is a chronic wound that is not healing.  To say it in simple terms, infected bone can "die" and needs to leave the body and this can often be why a wound will not heal.  If infected bone can not find a way to "exit" the body, this infection can lead to a localized infection or abscess.

Sometimes a simple x-ray is enough to suspect osteomyelitis but often more advanced studies such as a bone scan or MRI are necessary to form a diagnosis.  The only definitive test, however, is a biopsy of the bone.  In my experience, though, MRI / bone scan is pretty reliable and a bone biopsy is often deferred due to its invasive nature.

Treatment for osteomyelitis includes more than 6 weeks of IV antibiotics and / or resection of the infected bone (amputation).  Obviously, amputation is always a last resort.  Medicine has made great advances to treat osteomyelitis.  Hyperbaric oxygen therapy is one such treatment.  The clinician must also assess other issues such as a patient's circulation to heal the infected bone and the patient's nutrition.

If you have a chronic wound that will not heal, do not delay treatment.  See you podiatrist if it is a foot or ankle wound or wound care specialist for any chronic wounds.

Charcot Neuroarthropathy

A recent article just came out that shows there is an increase in the occurrence of "charcot foot."  This condition usually affects diabetic patients who have decreased sensation or "neuropathy."  The process is not completely understood, but essentially the foot starts breaking in the midfoot.  What are supposed to be hard bones can become like mush.  The condition is self limiting and eventually the bone destruction stops.  The bones then will heal.  The problem is not the process causing damage it is when the patient walks on this foot that is breaking.  It can deform the foot and the bones can heal leaving a "rocker bottom" foot that is difficult to walk on.  This can cause sores, or "ulcers."  These ulcers can become infected and patients can have to have an eventual amputation from the problems this condition can cause.

The key to treating "charcot foot" is prevention.  A diabetic patient that usually doesn't have foot pain should be seen as soon as possible as this could be the early start of the condition.  The condition is often misdiagnosed as an infection or gout as the foot can become red and swollen mimicking these conditions.

If caught early, strict immobilization is imperative.  If caught after the deformity has already lead to disfigurement of the foot, wounds often develop and special braces and offloading shoes are needed.  This often becomes a wound care center issue.

I am not writing this to scare people but instead educate them.  This condition is rare but is becoming more common as I am seeing in my practice.  The take home message is to go see your podiatrist as soon as possible if you have any foot pain, especially if you are a diabetic.

5 common things medical professionals can overlook with treating the foot and ankle

To continue my "5 things" thoughts from earlier in the year, I want to focus on some of the things I see that medical professionals can commonly overlook when treating foot and ankle issues.  This list includes some things that I, myself, might not always have noticed at first glance as a podiatrist.

1) Poor circulation:  There is a common misconception, especially with general medical practitioners, that if one can feel a pulse and the foot is warm then the circulation is OK.  I have seen many patients that I have diagnosed with peripheral vascular disease in the lower extremity that has been overlooked by some pretty well-trained and respected clinicians.  Often times, these patients are told it is just their neuropathy or arthritis.  I always become suspicious when a patient admits cramping at night, when they have been or are a smoker, and when they have a history of cardiac bypass and stenting.  A simple doppler test that is abnormal can give an indication to me that can be followed up by other studies.

2) Stress fractures:  A stress fracture in the foot (usually a metatarsal) is often overlooked.  These can be "hairline" fractures caused from injury or non-traumatic simply from a change in activity.  Problem is, normal everyday x-rays usually do not show an early stress fracture.  These are read as negative by radiologists who do not have an opportunity to examine the patient.  (These studies are, in fact, negative most of the time).  I have treated true painful stress fractures for several weeks diagnosed clearly by MRI that not once showed up on regular x-rays.  If a patient comes in with a swollen foot more painful after activity, I tell my patients, "if it looks like a duck, and quacks like a duck, it's probably a duck."  In other words, if I think it is a stress fracture due to what I see, I can do little wrong by treating it as such with immobilization.  Usually, if a stress fracture is caught earlier it resolves more quickly.

3) Not giving an injection when appropriate:  With a lot of conditions we treat, injections are very helpful.  I often see, and was guilty of this earlier in my career, doctors with-hold injections in favor of conservative treatment.  This is fine, if after discussion with the patient, that is what is desired.  However, I have seen people who do not mind injections come in with severe heel or acute arthritis inflammation that have went to other doctors and were given very little treatment.  If appropriate, an injection of a corticosteroid can quickly and safely give a patient great relief.  There is nothing wrong with giving an injection on an initial visit if indicated.

4) Giving an injection when inappropriate:  On the other hand, I have seen injections given when they likely maybe should not have.  Fortunately, it is rare to cause significant harm from giving an injection, but doing so may delay resolution of the condition or frustrate a patient because other treatment is often not given and only temporary relief is gained.  A stress fracture is a perfect example.  A quality practitioner will often get a negative x-ray and inject a painful foot.  If a stress fracture is present, the corticosteriod can delay healing if injected in the area of the fracture.  Also, I have seen injections in areas that are debatable for injecting.  A good example is a tendon.  Corticosteroids can increase the risk of tendon damage and rupture.  Thankfully it is not common, but, in my opinion, conservative immobilization can often heal these patients without taking this risk.

5) Not advising a patient on footwear:  Especially here in Florida, flip-flops and flimsy shoes are common all year.  I have seen patients treated by more than one other doctor when no one talked to the patient about his or her shoes at all.  Many foot and ankle problems will not resolve if people do not at least change their shoes or shoe wearing habits a little.  Sometimes a change in shoes to something more supportive will be all it takes to alleviate foot pain.

So there is my list of "5 common things medical professionals can overlook with treating the foot and ankle."  Please keep in mind that good practitioners disagree on how to appropriately treat many conditions.  I do not make this list to criticize, but instead just highlight some things I have learned throughout my over 10 years of experience as a podiatrist.

My Weekend in San Antonio

This past weekend, I traveled to San Antonio, Texas for a wound care course.  Though I have visited Texas while in middle school, I have never been to San Antonio.  I enjoyed seeing the city including staying on the Riverwalk and visiting the Alamo.  However, my primary purpose for the trip was a 12 hour wound care course.

As a podiatrist, part of what we do is caring for diabetic foot ulcerations.  So, I have been doing wound care for over 10 years.  The 3 years I spent in Pittsburgh was heavy on surgical limb salvage of diabetic feet.  During my time in Winter Haven, I also was on staff at the wound center in Lake Wales, Florida.

I really think I could make a difference in this community of Hernando County in regards to wound care.  Therefore, I have been working closely with the Spring Hill Wound Care Center and the experts at this facility recommended this course.

Though I am experienced, I still learned quite a bit at the course and am eager to begin using these new ideas to help people here in this area.

Two Years in Florida!

Those that know me, know that I like milestones.  I have been blessed to have the chance to experience many wonderful things in my life.  So, today is meaningful to me as I started practicing in Florida 2 years ago today.  Though it has taken some unexpected turns, I have enjoyed my time here and look forward to many more years as a northerner living in the sunshine state.

I think it is a good time to blog about my life and education.  This can be "my bio" as I have not really posted it on my blog yet.

The majority of my life was spend in Northeastern Ohio.  I was born in Akron and spent my entire childhood in Uniontown, Ohio.  A small town between Akron and Canton.  Growing up I always wanted to be a "surgeon."  I enjoyed activities at church, with scouting (I am an Eagle Scout), and playing the saxophone in band.

I graduated from Lake High School in Uniontown and my undergraduate degree is from the University of Akron.  My podiatry degree is from the Ohio College of Podiatric Medicine which is now the Kent State University College of Podiatric Medicine.  (This is interesting for an Akron grad).

I completed 3 years of training in podiatric medicine and surgery in the greater Cleveland area.  My training was affiliated with satellite hospitals of University Hospitals and The Cleveland Clinic as well as the podiatry school.  It was a well rounded program with lots of "hands on training."  On a personal level I married my wife, Heidi, during my second year of residency.

Upon graduation of residency, Heidi and I moved to Indianapolis where I started my career in private practice.  We enjoyed living there.  It had a smaller town feel with a lot to do.  I think some of the best restaurants are in Indy.  Living there over 3 years, we enjoyed all the city had to offer with the sports and auto racing to the culture.

In the fall of 2008 I decided to advance my career and Heidi and I also wanted to move closer to our hometowns and families.  Therefore, we moved to Pittsburgh.  This was 100 miles from my hometown and 100 miles from Heidi's hometown of DuBois, PA.  This was weird for a Browns fan from Ohio to live 6 miles south of downtown, but I fell in love with the Penguins as many know and also enjoyed following the Pirates.  However, sorry Steeler fans, never quite got into them.

The most significant event of our 3 years in Pittsburgh was the birth of our son.  Soon after that a job opportunity came up in Winter Haven and our family moved south.  We enjoyed our time in Winter Haven but transitioned to Spring Hill last April.

As one can see, I have lived in several places.  Great experiences for sure.  However, I certainly wouldn't mind settling here in Spring Hill, Florida and I am very excited as we continue to grow both professionally and as a family as we are expecting a baby girl next month!

MRSA from an Ingrown Toenail

A local football player is battling MRSA for the 2nd time.  The Tampa Bay Buccaneers have confirmed that their guard, Carl Nicks is again being treated for MRSA.  Media sources indicate that the initial cause was an ingrown toenail.

MRSA is an infection of Staph aureus that is found to be resistant to the antibiotic Methicillin.  The media makes the population fearful of MRSA but we do have antibiotics that can fight it.

Additionally, ingrown toenails can become bacterially infected and MRSA can be the cause.  It is important to point out, however, that most ingrown toenails can be treated in the office through excision and oral antibiotics.

As is true with most foot problems, any pain or problems are easier to address earlier rather than later.  I do not know what happened with Carl Nicks but I suspect his ingrown toenail became so infected that the bone in the toe got infected necessitating IV antibiotics.

The moral of the story: If you think you have an ingrown nail, see a podiatrist as soon as you are able for treatment.

Tom Hanks Makes an Announcement

Earlier this week, on late night TV, Tom Hanks announced that he has been diagnosed with diabetes.  He talked about lifestyle changes he needed to make and also a little about how the disease effects the body.  I have had a few patients over the years that presented with foot problems that lead me to suspect that he or she could be a diabetic.  The patient usually knew something wasn't quite right but was completely unaware that this disease was present.

One of the earliest signs of diabetes in terms of the foot would be numbness or tingling.  Diabetes is a disease of high blood sugar and this high blood sugar can cause several problems with the body.  Diabetic neuropathy is caused when nerve fibers are damaged by the high blood sugar.  This can be uncomfortable as a bothersome numbness in the feet but also can lead to pain.  Besides the discomfort, this loss of feeling can but a patient at risk for injury.  For example, a stone in the shoe can cause a sore.  A person without diabetic neuropathy would remove his or her shoe and remove the stone, but a diabetic patient may not even know that there is a stone in his or her shoe.  Left in the shoe the stone can lead to a sore or ulceration.

If you think you have diabetes you should see a physician for testing.  Symptoms are not just tingling in the feet but also weight loss, increased thirst, and increased urination.

5 things people do wrong for their feet

I was recently talking to a close colleague who is an internal medicine physician.  As people who read my blog know, I like to blog about sports injuries and celebrity foot problems.  However, this doctor was interested to know what I believe are the most common things people do wrong with regards to caring (or often times, not caring) for their feet.  I thought about it, and in my 10+ years of experience I had an answer, I thanked my colleague for the question and immediately answered it.  I think this information is worth sharing.

5 THINGS PEOPLE DO WRONG FOR THEIR FEET:

1) Ignore foot pain:  Many patients think that pain in their feet will just go away.  It could, but odds are it will get worse if not treated.  For example, heel pain can affect how you walk as a patient can often compensate by walking differently due to the pain.  Walking differently can lead to tendon pain in the other ankle or in a different part of the painful foot.  Additionally, pain in the foot or ankle is often inflammatory in nature.  Inflammation that is allowed to worsen can often be much more difficult to resolve than when treated earlier.

2) Going barefoot:  Especially down south, many people do not like to wear shoes.  However, this can have significant consequences.  Of course, there is always a chance of injury without the protection of footwear.  Cuts and scrapes can be especially harmful to a patient with poor circulation or feeling in his or her feet.  Additionally, when one goes barefoot there is no support.  This can lead to tendonitis as tendons work to support a foot that a shoe should be supporting.  I often hear, "going barefoot is natural."  I counter this argument by replying "what is natural about concrete?"  You do best in a man-made supportive shoe when walking on this man-made surface.

3) Wearing flip-flops:  In Florida, these shoes are a year round favorite.  In other parts of the country, they come out when the snow thaws.  However, these shoes, especially the really flat flimsy ones, are just as bad as going barefoot.  They offer little support or protection for the foot.  It is hard, as people love these shoes, but at least try to get one with a rigid sole and even an arch.  A small heeled wedge sandal is much better than a flimsy flip-flop.  However, a trip to Disney World is probably best enjoyed in a sneaker.

4) Using medicated pads or callus remover:  I am fine with padding that can be bought in the drug store, as this can be a good conservative treatment for some foot problems.  However, any padding that says "medicated" can be very harmful.  Medicated pads usually contain salicylic acid.  Yes, real acid that damages skin.  The acid can not select the "good" tissue from the "bad" callused tissue and I have seen infections from using these products.  Unfortunately, in a few diabetic patients, I have seen the use of these pads lead to bone infection and toe amputation.  A callus is more than just something that can be removed easily as there is often an underlying deformity leading to this hardened uncomfortable skin.

5) Doing "bathroom surgery":  We likely have all done this.  A toe can be a little sore and we "dig out" a toenail in our bathroom using a dirty pair of toenail clippers or whatever object available.  This can lead to a bacterial infection needing antibiotics.  Again, as with medicated padding, I have seen bathroom surgery lead to amputation.

This is my list of 5 things people do wrong for their feet.  Podiatrists are trained to treat almost all foot or ankle problems.  I welcome new patients who are experiencing any foot or ankle pain.

Kobe Bryant's Scar

There has been a lot of talk recently regarding Kobe Bryant's quick recovery from his achilles tendon surgical repair.  Not to down-play this recovery, but being a physician who has performed several achilles tendon repairs, I noticed something about this scar.  When looking at it, I notice that it is obviously healed well, but I also notice that the scar stops further up on the ankle.  To me, this means that he likely didn't require a more complex repair that often involves some detachment of the tendon from the heel bone.  In this case, the repair, though still very successful, has a much longer recovery time.  This is because hardware is often used to reattach the achilles tendon to the heel.  In this case, the patient must partake in a much more gradual return to activity, especially to perform at the high level needed to play in the NBA.

If you have any achilles tendon problems, keep in mind that it is important to address them and not wait.  Patients who wait have a much higher chance of needing surgical correction.