A Bout of Gout

‘Tis the season…for holiday eating? No doubt over the past few weeks and perhaps even continuing into the present week, you might have consumed a few Christmas hams here and there. Accompanying these hearty meats and tasty treats, you might have also washed it all down with some delicious red wine. Finally, your great aunt might have decided to bring out an exotic shellfish dish to add to the holiday cuisine this year. As usual, you sink your teeth into the savory delight of yet another holiday feast. The days following these happy holiday dinners, however, aren’t as joyful. In the middle of the night, an intense pain in your big toe suddenly awakens you. You stumble out of bed, hobble into your bathroom, and notice that the joint is red, swollen, and warm to the touch. You wonder what you ever did to deserve this immense amount of pain! You take two aspirin, try your best to stomach the pain, and head to your local podiatrist in the morning.

What you experienced was a gout attack. Gout is a build up of uric acid in a joint. As in the case of the scenario above, the joint most commonly affected is the big toe. Gout is either a result of overproduction of too much uric acid or too little secretion (through urination) of uric acid. This uric acid loves to collect in joints and crystallize when there is a decrease in temperature (ever notice how your feet tend to be cooler than the rest of your body?). Even though the joint in the toe is a popular spot for gout attacks, they can actually happen at any joint in the body. What puts someone at risk for gout? Medical conditions such as high blood pressure or diabetes, obesity, gender (more common in males), family history, or the consumption of beverages and foods high in purines can trigger an attack of gout. This was the case for our scenario above. Once your gout attack has been confirmed, what is the treatment plan? It’s important to first avoid those same foods high in purines that precipitated the initial attack, so make sure to monitor your holiday meals. It’s also essential to get enough water so that you are continually hydrating and monitoring your system. Your doctor will also prescribe some medications to treat the pain and inflammation. Keeping these things in check, you’re sure to have a happy holiday!

Time to Heel?

Over the past month, there has been quite a bit of debate surrounding the parenting skills of Tom Cruise and Katie Holmes regarding their daughter Suri when it comes to her expensive wardrobe and fashion outlook meant for someone twenty years her senior. However, much of the focus of the fashion snafu is based upon what Suri's parents have been putting on her feet; mainly, her multiple pairs of high-heeled shoes. While most little girls like dressing up in their mother's high heels for play, it is quite another matter when their mother decides to place her daughter in these said shoes for daily wear. The health issue of high heels impacting adults is no secret. High heels have been known to contribute to a variety of conditions such as corns, calluses, hammertoes, arthritis, chronic knee pain, and sprained ankles. Walking on high heels can put an abnormal amount of stress on the knee, which will wear down the cartilage at this area much faster than normal causing arthritis to set in. Additionally, one more issues with high heel use in adults is the shortening of the Achilles tendon. When this issue is extended to children, it becomes more problematic, because children are growing quickly, and it's important for everything to be growing at the same rate. When instructing adults on proper high heel wear, moderation is usually what is key, but can the same thing be said for children? At this age, when development is still a vital part of the process, one might argue that keeping children out of heels all together is necessary. The real question is - can Suri's parents let sound advice win over that of a fashion faux pas?

Cutting Corners: Ingrown Toenails

Painful irritation of the nail edge. Possible infection. A minor issue turned complicated for patients who have health issues such as diabetes. All these phrases sum up the nuances of an ingrown toenail. Many times the initial slight pain, discomfort, and irritation that patients experience with ingrown nail growth can eventually lead to signs of infection (redness, swelling, drainage of pus), if not treated. Why do some people experience ingrown nails while others escape the issues of the pesky problem? Some people just have the family history there - perhaps they have a mother or father who always seemed to get ingrown nails. Other causes stem from improperly cutting the nails - either too short or by overzealously cutting into the side of the nail. Additionally, wear the wrong size shoes can contribute to the problem as well.

There are a couple of ways to treat an ingrown nail. A patient may opt to simply have the nail removed by an incision and drainage procedure. In this method, the doctor will numb the toe and then will remove the nail margin. The patient may also opt to have the nail root in the area destroyed so that part of the nail won't grow back. This is done through use of a chemical. Once these nail procedures are done, the doctor may prescribe an antibiotic if the nail was initially infected or may advise soaking the foot in warm water for a few days following. There should be little to no limitations on daily activities and exercise following the nail procedures.

With ingrown nails, prevention and awareness are two key points. As previously stated, it is essential to wear properly fitted shoes and when trimming nails, be sure to cut straight across and not too short. If the onset of an ingrown nail is felt, it is important to schedule an appointment with a local podiatrist. "Self-procedures" when an ingrown nail has already fully developed might only cause further issues and possible infection.

Football and Fasciitis

For all you sports fans out there, you probably heard about New York Giants quarterback Eli Manning being diagnosed with an inflamed tissue in his foot a few weeks back. However, what you might not know are the specifics of this condition known as plantar fasciitis. The condition occurs when the plantar fascia located at the arch is strained over time beyond its normal extension, which causes the soft tissue fibers of the fascia to stretch or tear at points along its length. All of this stretching can lead to swelling, pain, and maybe even the growth of a bone spur. As Mr. Manning leads quite the active athletic lifestyle, this no doubt continued to aggravate the fascia over time leading to chronic irritation and exacerbation of the condition. If you are not the athletic type, however, it's possible to further the progression of plantar fasciitis by use of improper shoes that lack adequate support.

There are several different routes for treatment of this condition. Resting, which team physicians initially attempted with Manning on a day to day basis, only provides temporary relief. Another conservative approach may be to ice and stretch the area to relieve some of the pain in addition to taking over the counter pain medication when necessary. Additionally, if these first conservative methods do not work, a patient might opt to try a steroid injection (if they have accompanying heel pain) or custom orthotics to give them better support. Plantar fasciitis is a very manageable condition of the foot - especially for those who aren't looking to make the winning touchdown any time soon.

You're so Vein

Varicose veins are no longer solely a cosmetic issue - they can also lead to further complications affecting physical appearance, quality of life, time off from work - and treatment options may not even be covered by some insurance companies. Although varicose veins are more common in women, they also affect the male population (prevalence ranges from 25% to 33% in women vs 10% to 20% in men). They also tend to increase in frequency as one ages. Although varicose veins are most commonly found in the legs they can be found elsewhere. The most common presenting symptoms of individuals presenting with varicose veins include heaviness, fatigue, or throbbing pain in the legs. Additionally, pain and swelling may be common. These symptoms usually disappear when patients elevate their legs or get off their feet. So if you suspect varicose veins, what might some of your treatment options be? Some treatment options include external compression devices such as compression stockings (which remain the mainstay of therapy for varicose veins), drug therapy (some diuretics and horse chestnut extract), sclerotherapy (injection of a substance that obliterates the vein), laser and pulsed-light therapy (small veins), and surgery. Treatment considerations would of course depend on the level of necessary therapy needed. Treatment options have come a long way from days in the past where many patients left their physician's office dissatisfied with their treatment due in part to the limited knowledge of varicose veins and the limited treatment options available at the time. With the progression in varicose vein treatment, future developments will more than likely be better streamlined to meet the needs of patients.

Healing for the Future

For some of our veterans, particularly those young ones starting out, loss of limbs and life-threatening injuries are issues that can take a toll on these young individuals for the rest of their lives. One particular area of concern lies in the limited development of good prosthetics for these young veterans who have lost their legs. Modern technology together with basic anatomical principles and the idea of biomechanics (the application of mechanical principles to the human body) has now created robotic prosthetics - prosthetics that integrate human thinking with actual movement. As revealed to the public a few years ago, this idea has really taken off since then. Using robotic prosthetics prevents the user from undergoing fewer stresses and strains elsewhere in the body. In addition, older prosthetics devices tend to be heavier and bulkier which can add weight and heat causing irritation. Recently, this idea has gone even further with the development of the Pentagon's DEKA arm which enables those veterans who have lost their arms in battle to experience the feeling of having an actual arm again. Things that they might have never imagined doing again - from picking up a grape to turning a door knob to opening soda - are options opened to them now. With greater advances in technology in the future and better understanding of the human condition, the possibilities for treatment and healing of individuals of all conditions are endless!

Reduce, reuse, recycle...step it up!

Buying new shoes every few months or so, especially if you are an avid runner, can be an exciting process. But what can you do with that old, run-down pair? Nike has created a solution to both help you clear out your closet and effectively improve the environment. Nike's Reuse-a-Shoe program enables participants to send in their old kicks to help create playground and sports surfaces. Using the materials from your old gym shoes prevents the use of natural materials that are better kept in the environment, essentially saving these resources. This program was initially created back in the 90s and continues to be a work in progress. It's a nice reminder to us, the daily inhabitants of this wonderful planet, of the value of saving the natural resources around us. Additionally, you can take something old and make it into something beautiful. So the next time you are in to see your podiatrist, and you're told to update your athletic shoes, remember the good you can do with just a little bit of recycling insight and an old pair of shoes.

Physical Therapists: Our Friends in the Field

Oftentimes, patients must receive treatment from multiple sources. For instance, a patient might go to their general physician due to a mole they've noticed on their arm. Their general physician might then refer them to a dermatologist to have this mole removed to prevent it from progressing to a more harmful stage. Or another patient might be seen by his podiatrist for treatment of a sore tendon in the ankle when the podiatrist notices this patient has lost some sensation in his feet. The podiatrist would then refer this patient back to a general physician to be sure this patient wasn't borderline diabetic. This cycle of patient referral from physician to physician doesn't push around health care responsibility; instead, it shares the responsibility, ensuring that those who are specialized in certain areas provide the best level of care. This idea extends to the relationship between podiatrists and physical therapists.

Physical therapists provide services that help restore function, improve mobility, and relieve pain. Treatments might include exercises, electrical stimulation, hot packs or cold compresses, ultrasound, and massage. Physical therapists are important to the field of podiatry because they serve as an important adjunct to some of the necessary treatments. For instance, a patient may suffer a fracture in her foot that will keep her in a cast for a few months leaving her somewhat immobilized. This will cause her to perhaps lose some of the strength in this foot over the course of healing time. Physical therapy will enable her to gain the necessary strength back in her foot without the worry of causing re-injury to her foot. As you can see, physical therapists are an integral part of the podiatry field further demonstrating how the medical field is forever interconnected.

Orthotics vs. Shoe Inserts: Which one holds up?

Have you ever been told that you might benefit from a special insert for your shoe? If not, maybe you know someone who suffered from foot pain or arthritis or foot fatigue who is now currently singing the praises of their inserts. More than likely, these inserts are not the ones you can find over the counter at your local drug store. Instead, these inserts, known as orthotics, are custom-made devices which are manufactured based off of the information obtained from your podiatrist. Many individuals don't realize the main difference between those over the counter inserts and specially made orthotics. To put it simply, orthotics are made with your foot and needs in mind. Perhaps you are an athlete who suffers a type of foot pain that might not be experienced by the typical 9-5 business professional. You can get orthotics made to specifically address both your performance level and the extra strain you might put on your feet. Perhaps you are someone who stands in one place all day on a hard floor surface. You can get special orthotics to take some of that pressure off of your feet. Or finally, perhaps you have issues with weight that are now starting to affect the way your knees, ankles, and feet are holding up. Orthotics can provide a solution by better helping you to distribute your weight. So as you can see, no matter your profession, activity level, age, or past medical history, orthotics might be the solution to your foot and ankle pain. In addition, orthotics can work to slow down the effects of some diseases, such as rheumatoid arthritis and bunions, on the feet. If you think orthotics may be an option for your foot pain, make an appointment with your local podiatrist to see if this is the right treatment plan for you.

To Shod or Not to Shod

Shod running - also known as running barefoot - seems to be the hot topic these days with an increasing number of people training for and participating in marathons. Whether one may be a serious athletic runner or just partaking in the trend, shoe gear tends to be question on every runner's mind. What style of athletic shoe offers the best support? Which shoes prevent injuries? Are brands important? Asics or Nike? Running with shoes or running barefoot? Wait...what? Running barefoot? Until recently in the eyes of the public, the latter question may not have crossed the minds of very many. However, it appears that a small collection of runners faithful to "natural" running have started to expand - at least in terms of opening a new idea to the running population. Although many medical experts advise against running barefoot, saying that this may cause more harm than good and that shoes provide a protective barrier against any elements, up and coming research suggests that modern running shoes may not be all that they are cracked up to be. This research states that a lot of these shoes actually don't improve a runner's performance or prevent injury.

The idea of barefoot running has inspired innovative footwear production from some independent companies - specifically the Vibram FiveFingers line which are actually thin rubber "shoes" with individual toe pockets. Shoes such as these mimic barefoot running and hark back to the earlier evolutionary times. Not only has this idea originated in the minds of small and independent companies, but it is also starting to be promoted by big corporations such as Nike with their Nike Free athletic shoe creation. These bigger companies - still maintaining sales with their original supportive shoe gear - hope to have the best of both worlds by allowing customers the option of buying into either idea.

So which option is the right option? Many health professionals say that the idea of running barefoot brings some interesting perspective to the table, but more research is necessary before any concrete decisions can be made. They still see regular shoe gear as the better option to prevent any external injury to the feet. However, with time and more shoe gear studies, barefoot running may be the way of the racing future.

Runway Research

High heels: for many women they are the finishing touch and added accessory to an outfit. But what many women may not realize are the progressive foot problems that can be associated with high heel shoe wear. A recent article on the health issues associated with high heel use explores what wear over time can do to a woman's feet. Many women confess that high heel shoes are utilized for style over comfort. However, many continue to wear these shoes without understanding the impact of this decision - possible injuries of the ankle, constant foot pain, or aching knees. At Temple University of Podiatric Medicine, "runway research" has been started to assess the correlation between the height of the heel and the stress over time on ankle and toe joints. The biggest thing that women need to be wary of in relation to extensive high heel wear is degenerative joint disease, or osteoarthritis. So what should both women and men look for in a shoe? Adequate fit and support are two of the more important factors individuals should investigate when slipping into new shoes. As both men and women will learn, the wrong footwear may contribute to a lifetime of pain.

Pediatric Flat Feet Facts

If you have kids or know people with kids, chances are you might have heard about a condition known as flat feet. While adults can have flat feet, it can seem to be more prevalent in kids due to the concern voiced by parents. Flat feet is a condition in which the foot doesn't have a normal arch. But don't become alarmed if you have a newborn whose feet seem to fit this description. All babies feet look flat because no arch has formed yet. Arches will begin to form by the time a child is two to three years old. Flat feet can be formed by loose connections in the joints and baby fat between the foot bones. This can contribute to the "fallen arches" terminology often referenced in relation to flat feet.

So when might parents need to bring their child in for further evaluation of this condition? Foot or ankle pain are good indicators of the need to bring children in for direct inspection of the arches and possible x-rays. Children with flat feet may have increased pain when walking or running. If pain continues, your local podiatrist may recommend special inserts known as orthotics. Surgery may be considered down the road if inserts don't seem to help, but it usually tends not to be utilized with flat feet issues.

Flat feet is a term that reflects the condition of one's arches. Many people with flat feet can live normally without ever needing medical intervention. However, with evolving pain, scheduling a visit to your child's podiatrist might be a good idea. With proper care, your kids will be off and running again in no time flat!

Don't Sweat it: Dealing with Foot Odor

Have you ever noticed as the summer months get gradually hotter, sometimes the smell of your feet (or the smell of the feet of someone in your family) tends to get worse? Smelly feet is an embarrassing topic many people chose not to discuss, especially if it pertains to them specifically. However, foot odor tends to occur as a result of another issue - mainly, excessive sweating and the trapping of that sweat. The interaction of sweat trapped inside footwear and mingled with bacteria is what can cause this funky odor. Feet have more sweat glands than any other part of the body, so you can imagine how long it might take for this sweat to evaporate! Pairing this anatomical fact with air constricting shoes can contribute to anyone's foot odor problem in no time. And to make matters worse, some conditions such as hyperhidrosis (excessively sweaty feet), stress, and some hormonal changes can increase one's chances of having foot odor.

So what can the foot odor-fearing individual do for prevention? Good hygiene, first of all, is key. Be sure to wash your feet once (if not twice) a day and dry thoroughly, especially between the toes. Change your socks once a day (and try not to wear the same pair of shoes two days in a row if you can). Be aware of your sock material - natural fiber socks such as cotton help to better absorb the moisture. Wear shoes that let your feet breathe (canvas, leather, mesh, etc.). In addition, you might want to give an anti-bacterial foot powder a try. If these preventative measures prove futile, then it might be time to make an appointment with your local podiatrist. With more advanced treatments, your podiatrist can keep your feet smelling like roses!

Worrisome Warts

As we make our way into the month of August, we sadly note the end of summer in sight. At this point in the year, however, children will still be heading off to the local pool for a refreshing swim to escape the summer heat. Unfortunately, environments such as the community pool, can harbor a host of various germs and bugs. One of which can cause warts to form on both children and adults alike. Warts are the most common infection of the skin caused by a virus. This virus, known as human papilloma virus (HPV), can invade the underside of the foot by direct contact creating plantar warts. Two main things may make a person more or less susceptible to plantar warts. This includes (1) being more genetically predisposed to getting them or (2) getting them due to circumstance of the environment (i.e. walking barefoot in public areas or showers). Warts can often hurt as they will feel like a bump under the foot. This and the less than favorable appearance of the wart will often encourage a patient to seek treatment. After over the counter self-treatments, some professional treatment options include burning the wart off with an acid (such as salicylic acid), freezing the warts (cryotherapy - discussed in a previous blog), and even laser treatment.

As for many medical issues, prevention is oftentimes key. The biggest idea behind plantar wart prevention focuses on the avoidance of walking barefoot in public areas, especially those shower rooms at the community pool. In addition, it's important to keep your feet clean and dry, to change your socks daily, and to check children's feet periodically (summer months especially). When keeping these things in check, you can leave your worries at home while enjoying a day at the pool.

Toe Trauma

Summer tends to be a time when more often than not you see runners out and about. Whether training for marathons in the fall or just enjoying the chance to exercise in good weather, runners tend to become commonplace this time of year. Perhaps you might know a runner or perhaps you might be a runner yourself. If so, you might be familiar with a condition called black and blue toenail which can be secondary to running-induced trauma. The usual setting under which a toenail can turn black and blue would be if a heavy object happened to fall onto it which might indicate a possible fracture. However, it's also possible for this condition to surface during times of repetitive trauma, such as running, where the nail tends to hit the front of the shoe repeatedly. If this condition has ever happened to you or a friend, seeing a podiatrist for a complete evaluation would be the first step (you want to be sure it's not a break from some other incident!). If you are an avid runner, prevention is also key. Some of the things you can do to avoid this type of trauma would be making sure you are wearing the appropriate running shoes (size, type, etc.), trimming your nails properly, and again, consider visiting your local podiatrist for further evaluation and advice. With proper prevention and/or treatment, you can go for miles and miles!

Stressing about fractures: when is it time to operate?

Perhaps you have seen the recent news regarding Yao Ming, the stress fracture in his foot, and his decision to undergo extensive surgery to repair it. Ming, after many weeks of consulting with specialists and considering the amount of time off the court he must dedicate to rehabilitation, has decided to undergo two extensive procedures. One will repair the actual fracture in his left foot, and the other will prevent the injury from occurring again. This recent news in sports brings up a important question: when suffering from a stress fracture, is it time to head off to the operating room or not?

Stress fractures, like it or not, can be a fact of life. With the number of people today running in marathons, participating in intramural sports teams, and racing from here to there, people may expect to face an occasional injury from time to time. Sprains and strains can generally be treated with time, rest, and isolated care, but what about those pesky stress fractures?

Stress fractures often develop from overuse during high impact sports such as running, or in Ming's case, basketball. This constant overuse causes the muscles to fatigue, meaning they can no longer absorb repeated shock impacts. During this process, when the muscles get excessively tired, they transfer this stress to the bones which can create the infamous stress fracture. Some bones in the foot are more susceptible to breaks. These include the metatarsals, the heel (calcaneus), and the navicular (the bone which Ming happened to fracture). Once a break occurs, the question at hand revolves around the treatment. For the normal individual, stress fractures may heal with reduced activity and restricted mobility with casts or certain shoe gear. Fractures can take as short a time as two weeks to heal or up to eight weeks. With Ming, the navicular bone usually takes a long time to heal. In his case, being that he is a professional athlete, depends greatly on his feet for his career, and may be susceptible to further injury in this area, surgery was a better option. But in the case of the normal intramural athlete, conservative care, such as casts, may be the best choice. So if you suddenly find yourself in a situation similar to Ming's, understand that surgery is more than likely better left to the pros.

Running into heel pain

Heel pain is one of the most common complaints of runners and non runners alike. It can start as a sudden discomfirt but many times it is a progressive aching that gets worse over time. Pain in the heel can arise from a number of factors. Most often it does not result from a single injury, but usually occurs as a result of excessive or continuous stress or repetitive pounding on the heel.
Plantar fasciitis is the most common of heel pain. This condition develops when the plantar fascia ligament becomes inflamed as a result of strain that pulls the ligament from where it attaches to the heel bone. Heel spurs can also contribute to heel pain. When stress is put on the plantar fascia ligament it can cause a heel spur to form where the plantar fascia attaches to the heel bone.
Usually heelp pain does not require surgery to treat the condition. Treatment may be aa simple as ice and rest, stretching exercises, night splints or custom shoe orthotics. Cryotherapy in the office, has been able to achieve results equal or better than that of other surgical procedures and at a much lower cost to the patient. Cryotherapy is a non invasive procedure where an application of cold to the tissues creates a conduction block. It is done in the office and takes approximately 15 minutes. Postoperative discomfort is minimal and you can resume normal activity within 48 hours.

Can cold winters turn your feet blue?

Did you ever notice that a few hours after shoveling the driveway that your toes are red, swollen and itchy? Did they ever turn blue and tingle? Did you just limp away thinking that you must have frostbite? Well you are not alone. Most people would think that it was frostbite, but there is a chance that it is something more. The condition that I described above is more likely to be Chilblains.
Chilblains are thought to be an abnormal skin reaction resulting from exposure to damp cold. They tend to occur on the extremities, that is the toes, fingers, nose and earlobes. They are small, itchy and painful red swellings on the skin. Chilblains become increasingly painful as they get congested and take on a dark blue appearance. In severe cases blistering, pustules, scabs and ulcerations can occur. Sometimes Chilblains cause the skin to crack and dry out, so that the risk of getting an infection increases. Factors that contribute to a tendency to Chilblains include family tendency, poor circulation and exposure to cold damp weather conditions.
To prevent Chilblains, keep your hands and feet warm especially if your circulation is poor and your mobility is limited. You can use thermal insoles to keep your feet warm and insulated gloves to keep your hands warm. If you think you may already have Chilblains, do not rub or scratch it but seek professional help from a podiatrist.

Does Cryosurgery Make you Cry?

Cryosurgery is a minimally invasive FDA approved procedure for pain relief and nerve problems of the foot. There are few options for successful relief from painful foot conditions. Cryosurgery provides long term pain relief for various podiatric problems. With an application of cold to the tissues to create a conduction block, cryosurgery is similar to the effect of local anesthetics. However, the effect is long lasting. Long term relief from nerve freezing occurs because the formation of an ice crystal disrupts the sensory component of the nerve structure. Cryosurgery is able to achieve results that are equal or better than other surgical procedures and at a much lower cost to you the patient. The advantages of Cryosurgery are numerous: painless, minimally invasive, in office physician performed procedure, ability to walk the day of the procedure, minimal to no down time for work or activity, decreased use of pain medications that can cause complications etc. So Cryosurgery can keep you from crying out in pain.