Nashville Podiatrists: The Nashville Foot and Ankle Group

Foot-Friendly Tips to Prevent Common Running Injuries

2010-11-23T12:30:00.000-08:00

Keep Moving with Products Bearing the APMA's Seal of Acceptance
Bethesda, MD – Making running part of a workout routine leads to better physical stamina and a more positive state of mind—but a detrimental foot injury can quickly stop runners in their tracks. Keeping feet healthy and pain-free can go a long way toward ensuring that every run is enjoyable, for both experienced runners and those just starting out. Following a few simple steps provided by the American Podiatric Medical Association (APMA), before hitting the trail or treadmill, can keep foot and ankle injuries at bay.

"Some of the most common running-related foot injuries that today’s podiatrists treat are arch pain, tendonitis, and blisters," said APMA president Kathleen Stone, DPM. “However, if runners can take just a few minutes to stretch properly pre-workout, select appropriate footwear, and see a podiatrist immediately when foot pain occurs, many of these ailments can be avoided entirely.”
In order to get the most out of each run without falling victim to injury, APMA recommends the following:

Select a good running shoe: According to Karen Langone, DPM, president of the American Academy of Podiatric Sports Medicine (AAPSM), the most important running tip is proper shoe selection. “A running shoe purchase is dependent upon the type of foot and function of the foot for the individual. Runners should research shoe construction and keep in mind that footwear can vary in size from one manufacturer to the other,” she said.

APMA has recently given several running shoes its Seal of Acceptance for allowing proper foot function, including models made by Puma, Mizuno, Asics, Reebok, Avia, and Ryka. A sports medicine podiatrist can help aid in the footwear selection process if needed.

Select good socks: Runners should always fit shoes with the socks that they plan on wearing during a run. Socks should be made of a poly-cotton blend that pulls moisture from the skin, fit well, and be comfortable when worn with a running shoe.

Stretch out and build momentum: Before a run, begin by warming up and gently stretching for 5-10 minutes, focusing on lower leg muscles. Amateur runners should start with short distances, increasing distance over time to help prevent injury. All runners should begin every workout slowly, as this allows the body to warm up further and decreases the chance of muscle strain. Runners should also focus on keeping both the feet and entire body relaxed, avoid tensing or cramping toes, and run with a gait that feels the most natural. Cease running immediately if any pain is experienced.

Cool down and rest: After reaching the end of a running workout, cool down and stretch for about 10 minutes. Submerging the lower extremities in an ice bath after longer runs can reduce muscle soreness, as can the use of a self-massager designed for post-athletic activities (Health Enterprises Therapeutic Hot & Cold Foot Massager has the APMA’s Seal of Acceptance).

Muscle pain is common after exercise, and minor injuries may be treated with the RICE regimen (rest, ice, compression, elevation). However, if pain does not resolve itself after several days—or returns immediately upon resuming exercise—runners should seek out care from an APMA member podiatrist immediately.

Frequent runners should see a podiatrist on a regular basis to maximize any running program and prevent serious injury. For more on running and foot health, visit APMA’s new Runner’s Resource page at www.apma.org/runners.

For more information:
Mike Kulick
(301) 581-9220
mskulick@apma.org

"Like" APMA on Facebook: www.facebook.com/theAPMA
Follow us on Twitter: @APMAtweets

Founded in 1912, the American Podiatric Medical Association (APMA) is the nation's leading and recognized professional organization for doctors of podiatric medicine (DPMs). DPMs are podiatric physicians and surgeons, also known as podiatrists, qualified by their education, training and experience to diagnose and treat conditions affecting the foot, ankle and structures of the leg. The medical education and training of a DPM includes four years of undergraduate education, four years of graduate education at an accredited podiatric medical college and two or three years of hospital residency training. APMA has 53 state component locations across the United States and its territories, with a membership of close to 12,000 podiatrists. All practicing APMA members are licensed by the state in which they practice podiatric medicine. For more information, visit www.apma.org.

Footprints Newsletter: Fall 2010 Edition

2010-10-14T08:38:00.000-07:00

Footprints: An informational newsletter for patients of APMA member podiatrists like Nashville Foot and Ankle, the Nashville Podiatrist Group.

Let's Move! With the First Lady

“The physical and emotional health of an entire generation and the economic health and security of our nation is at stake.” First Lady Michelle Obama made this moving statement when she launched the “Let’s Move” initiative earlier this year. She has been hard at work telling kids and parents about the new program, and we’re taking the ride with her. Because healthy feet are such an important part of many aspects of the Let’s Move plan, your podiatrist wants to work with you and your family to help ensure that you can participate and be healthy.

Did you know that over the past three decades, childhood obesity rates in America have tripled? That’s probably due to a number of factors. Thirty years ago, kids mostly walked to school, played outside after school, and then sat down to portion-controlled dinners at home with their families. Today, our kids ride to school, have little or no activity at school or at home after school, and eat fewer home-cooked meals. In addition, kids today tend to snack nearly three times more than kids did in the past.

All this adds up to a problem for our kids and our nation. So what can we all do to help? Mrs. Obama’s Let’s Move program outlines five steps to success:

• Provide healthy snacks to kids both in their lunches and at home. Since fruits and veggies are a great source of vitamins and minerals and tend to be lower in calories and fat, they are a great replacement for cookies, chips, and ice cream.

• Make physical activity a part of your family’s routine. Kids need about 60 minutes of physical activity each day, so make it a point to do activities with your kids. Take a walk to the playground, walk the dog, or do active chores together. Park farther away from your destination so that a short walk is required. The main point is to get away from the couch, the TV, and the computer. A visit to the podiatrist this fall will help you get started on a plan for the entire family.

• Plan a healthy menu. Making sure that the whole family eats nutritious meals in reasonable portions can be an experience shared by the family. Get kids involved in planning meals and even in shopping for groceries. Cut back on sugar and highcalorie drinks, and try to eat together as a family. All of these tactics create an atmosphere for better health.

• Reduce screen time and get active. Experts indicate that more than an hour or two each day of TV or computer time is too much. Parents need to set rules that limit the amount of time kids watch TV and play video games and encourage more activity. Setting a good example is a great way to begin. Parents also need to provide alternatives to kids, and encourage them to play outside, find new hobbies, or learn a new sport.

• Organize a school health team. Many schools have developed wellness policies that address school food service and physical activity. You can get involved in your community’s program by contacting your school principal or PTA for more information.

Your podiatrist can be integrally involved in helping your family get started on the “right foot” by making sure that everyone has healthy feet. A regular visit either before school starts or just after will give you an opportunity to discuss the best sports, shoes, and lifestyle changes for you and your kids. Let’s Move today.

For more information about
Mrs. Obama’s Let’s Move program,
visit: www.letsmove.gov
Let’s Move! With the First Lady

Healthy Shoe Shopping

As parents and children begin the annual hunt for deals on back-to-school items, shopping for healthy shoes should top the “must-buy” list for more important reasons than just a fashionable new look. According to the American Podiatric Medical Association (APMA), well-fitting shoes not only reduce the incidence of foot and ankle injuries in kids, but also encourage physical activity, helping to decrease the likelihood of childhood obesity.

Your podiatrist will tell you that if your child’s feet hurt, he or she will be far less likely to participate in outdoor sports and other activities that keep him or her moving and physically fit. With childhood obesity considered an epidemic today, it is vital that parents take just a few moments during this busy back-toschool shopping season to select a shoe that provides adequate support and fits properly. It is one of the easiest ways to keep your child pain-free and healthy.

Shopping for healthy shoes, however, can be a daunting task without knowing what to look for—but the following APMA tips can make your back-to-school shoe purchases easy, smart, and safe:

• Before buying a shoe, perform the “1,2,3 Test.” First, squeeze the back of a shoe’s heel and ensure that it does not collapse. Second, grab the front (toe box) of the shoe and make sure that the shoe bends where the child’s toes would naturally bend in the shoe. Third, grab the shoe at both ends and try to gently twist. Shoes should never twist in the middle and should be rigid. If a shoe fails any of these three steps, don’t buy it.

• Look for the APMA’s Seal of Acceptance. Many products, including select children’s footwear models made by Pediped, Reebok, and Tsukihoski, have been awarded the APMA’s Seal of Acceptance for demonstrating proper foot health. Look for the APMA Seal on product packaging or a manufacturer’s website.

• Never hand down footwear. Sharing shoes can spread and encourage the growth of fungus and bacteria such as athlete’s foot, and regardless of shoe size, shoes can fit every child differently.

• Have a child’s foot professionally measured regularly. Most shoe stores will be happy to professionally measure a child’s foot, or your podiatrist can measure your child’s foot during a foot health check-up to ensure proper fit. Also, measure for proper length from toes to the tip of shoes to prevent irritation and injury.

• No “break-in” period required. Your child’s shoes should be comfortable to wear immediately and should not require a break-in period for comfort.

For more shoe-shopping tips,
visit: www.apma.org/kids-shoes

For more information on children’s
footwear with the APMA Seal,
visit: www.apma.org/pediatricfootproducts

ER or DPM? Making a Decision with Trauma

Foot and ankle trauma is all too common in the fall when kids go back to school and participate in fall sports. In addition, many of us ramp up our exercise regimens as temperatures become more moderate. When faced with what to do and where to go for foot and ankle injuries such as a twisted ankle, broken toe, or open laceration, here are some tips:

• Today’s podiatrists have been educated and trained to diagnose and treat injuries of the foot and ankle.

• Most foot and ankle injuries can be evaluated and treated by the podiatrist in his or her office, saving a trip to the emergency room.

• Most podiatrists have X-ray equipment in their offices, so they can determine if your foot or ankle is fractured or just sprained.

• If you decide to go to an emergency room, ask to see a podiatrist.

Wait times and insurance co-payments are often less in your podiatrist’s office than in an emergency room. If in doubt, call your podiatrist to determine where you should go if you injure your foot or ankle.

Doctors of podiatric medicine are podiatric physicians and surgeons, also known as podiatrists, qualified by their education, training, and experience to diagnose and treat conditions affecting the foot, ankle, and related structures of the leg.

This patient information newsletter is supported
by an educational grant from Spenco, Inc.

Nashville Foot and Ankle Group is a member of the
AMERICAN PODIATRIC MEDICAL ASSOCIATION
9312 Old Georgetown Road, Bethesda, MD 20814 -1621
• www.apma.org •

2010-06-20T18:16:00.001-07:00

Dr. Therese Tlapek

2010-06-20T16:34:00.006-07:00

99 White Bridge Rd.
Suite 203
Nashville, TN 37205
615.353.0626

Dr. Therese Tlapek
Complete Foot Care

Hospital Outpatient-based Surgery
Endoscopic Surgery
Shock Wave Therapy for Heel Pain
Orthotics and Arch Support
Sports Medicine

Therese A. Tlapek, D.P.M.
Dr. Therese TIapek will be celebrating her 24th year in practice in 2010 and she has enjoyed the same location for all 24 years.
She graduated in 1986 from the Dr. William M. Scholl college of Podiatric Medicine in Chicago, IL and performed a surgical residency at the Baptist Memorial Specialty Hospital in Memphis, TN. Undergraduate studies were at Southeast Missouri State University in Cape Girardeau, MO, and Houston Baptist University in Houston, TX.
Dr. TIapek is Board Certified by the American Board of Podiatric Surgery since 1995 and continues to perform all recertification requirements to maintain Board Certification in surgery.
She performs surgery and is on staff at St. Thomas Hospital, St. Thomas Surgicare outpatient, Baptist Hospital, and Baptist Ambulatory Surgery Center.
Dr. Tlapek's friendly and efficient office staff makes an office visit a pleasant experience. Most all insurances are welcome and quick filing procedures ensure rapid reimbursements.
Her office is a complete Podiatric practice caring for all ages and foot types.
Dr. Tlapek is a member of American Podiatric Medical Association, Tennessee Podiatric Medicine, and Middle Tennessee Podiatric Association.

99 White Bridge Rd.
Suite 203
Nashville, TN 37205

Dr. Gary W. Cockrell

2010-06-20T16:34:00.005-07:00

Dr. Gary W. Cockrell
Medical & Surgical Treatment

Bunions
Hammertoes
Ingrown Nails
Warts
Heel & Arch Pain
Orthotic Supports
Sports Medicine
Bone Spurs
Corns/Calluses
Fractures/Injuries

Non-Invasive Extra Shock Wave Therapy
for Chronic Heel Pain
Outpatient/In-Office
Gary W. Cockrell, D.P.M.
Education:

High School: Salem Stephen's Episcopal Prep School 1971 to 1975
Undergraduate: Virginia Polytechnic Institute and State University – Blacksburg, Virginia 1975 to 1979
- Degree: B.S. Animal Science (Pre-Vet) 1979 – Minor: Biology (Pre-Med)
Graduate: California College of Podiatric Medicine – San Francisco, California 1984 to 1988
- Degree: D.P.M. 1988
Post Graduate Residency: Baptist Memorial Hospital – Memphis-Georgetown, Tennessee
- Podiatric Surgical residency program 1988 to 1989

Professional Organizations:

American Board of Podiatric Surgery – Board Certified 1996
American Board of Podiatric Orthopedics and Primary Podiatric Medicine – Board Certified 1984
American College of Foot and Ankle Surgeons – Fellow 1989 to Present
American Podiatric Medical Associative – Member 1989 to Present
Middle Tennessee Podiatric Medical Association – Treasurer, Vice President
Tennessee Podiatric Medical Association – Member 1989 to Present
- Served continuously on the Executive Board since 1995.
- Held all TPMA Board positions (Scientific Chair, Treasurer, Secretary, Vice President, President-Elect)
President (Elected for two terms 2001-2003)
Middle Tennessee, TPMA Honorary Board Positions (2005 to Present)
Current TPMA Delegate for the APMA House of Delegates
TPMA Representative, Cigna/Medicare Carrier Advisory Committee (1995 to Present)

785 Old Hickory
Brentwood, TN 37027

1994 Gallatin Pike
Madison, TN 37115

Dr. Steven Head

2010-06-20T16:34:00.003-07:00

Dr. Steven Head is a native Nashvillian, graduating from Mt. Juliet High School (1976), David Lipscomb College (1980) and the Ohio College of Podiatric Medicine (1984). He will celebrate 25 years in practice at the same location in Southeast Nashville in February 2011. He was Board Certified by the American Board of Podiatric Surgery in 1993 and has maintained that status for 17 years. Our office accepts most insurance plans and enjoys working together to make each patient visit relaxed and comfortable.

Dr. Head performs surgery at Physicians Pavilion Surgery Center and Southern Hills Medical Center. Some minor surgery is performed in the office on occasion. We see patients in all age ranges and treat a wide variety of foot conditions daily. Most of these problems are treated conservatively initially, as a non-surgical approach is usually successful. When surgery is necessary, Dr. Head’s staff helps by assisting with insurance issues and by helping to create a friendly, caring atmosphere.

As a member of both the American and Tennessee Podiatric Medical Association for over 24 years, Dr. Head served on the Executive Board of the State Association for over 10 years and served as the State President for 2 years. He has also been a member of the Middle Tennessee Association and is a past president.

We look forward to seeing you and easing your foot pain!

Make an appointment today:
615.333.2555

315-B Harding Pl.
Nashville, TN 37211

Dr. Berkeley Nicholls

2010-06-20T16:34:00.001-07:00

Dr. Berkeley Nicholls
Surgery & Medicine of the Foot
Smyrna – Hermitage – Nashville
Berkeley H. Nicholls, D.P.M.

Undergraduate B-S, Magnum cum laude, London, England.
Doctor of Podiatric Medicine. New York college of Podiatric Medicine.
In podiatric practice since 1989 in the Nashville area.
Practices Podiatric Medicine and Surgery to persons from all age groups.
Hospital and surgical privileges at Centennial Medical Center, Stonecrest Medical Center.
Surgical privileges also at Physicians Pavilion Surgery Center, Smyrna, Tennessee.
Services offices in Hermitage, Downtown Nashville and Smyrna with the assistance of a friendly, courteous and compassionate staff.
Preferred provider on most insurance plans.
Board Certified in Foot Surgery and Podiatric Orthopedics by the American Board of podiatric surgery and the American Board respectively.
Member of the American Podiatric Medical Association.
Current member, Tennessee Board of Podiatry.

1915 Charlotte Ave.
Nashville, TN 37203

4779 Andrew Jackson Pkwy
Nashville, TN 37201

300 Stonecrest Blvd Suite 340
Smyrna, TN 37167

Phone: 459-5078

Custom Orthotic Supports

2010-06-20T16:06:00.008-07:00

What are Orthotics?

Orthotics are shoe inserts that are intended to correct an abnormal, or irregular, walking pattern. Orthotics are not truly or solely “arch supports,” although some people use those words to describe them, and they perhaps can best be understood with those words in mind. They perform functions that make standing, walking, and running more comfortable and efficient by altering slightly the angles at which the foot strikes a walking or running surface.

Doctors of podiatric medicine prescribe orthotics as a conservative approach to many foot problems or as a method of control after certain types of foot surgery; their use is a highly successful, practical treatment form.

Orthotics take various forms and are constructed of various materials. All are concerned with improving foot function and minimizing stress forces that could ultimately cause foot deformity and pain.

Foot orthotics fall into three broad categories: those that primarily attempt to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.

Rigid Orthotics

The so-called rigid orthotic device, designed to control function, may be made of a firm material such as plastic or carbon fiber and is used primarily for walking or dress shoes. It is generally fabricated from a plaster of paris mold of the individual foot. The finished device normally extends along the sole of the heel to the ball or toes of the foot. It is worn mostly in closed shoes with a heel height under two inches. Because of the nature of the materials involved, very little alteration in shoe size is necessary.

Rigid orthotics are chiefly designed to control motion in two major foot joints, which lie directly below the ankle joint. These devices are long lasting, do not change shape, and are usually difficult to break. Strains, aches, and pains in the legs, thighs, and lower back may be due to abnormal function of the foot, or a slight difference in the length of the legs. In such cases, orthotics may improve or eliminate these symptoms, which may seem only remotely connected to foot function.

Soft Orthotics

The second, or soft, orthotic device helps to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. It is usually constructed of soft, compressible materials, and may be molded by the action of the foot in walking or fashioned over a plaster impression of the foot. Also worn against the sole of the foot, it usually extends from the heel past the ball of the foot to include the toes.

The advantage of any soft orthotic device is that it may be easily adjusted to changing weight-bearing forces. The disadvantage is that it must be periodically replaced or refurbished. It is particularly effective for arthritic and grossly deformed feet where there is a loss of protective fatty tissue on the side of the foot. It is also widely used in the care of the diabetic foot. Because it is compressible, the soft orthotic is usually bulkier and may well require extra room in shoes or prescription footwear.

Semirigid Orthotics

The third type of orthotic device (semirigid) provides for dynamic balance of the foot while walking or participating in sports. This orthotic is not a crutch, but an aid to the athlete. Each sport has its own demands and each sport orthotic needs to be constructed appropriately with the sport and the athlete taken into consideration. This functional dynamic orthotic helps guide the foot through proper functions, allowing the muscles and tendons to perform more efficiently. The classic, semirigid orthotic is constructed of layers of soft material, reinforced with more rigid materials.

Orthotics for Children

Orthotic devices are effective in the treatment of children with foot deformities. Most podiatric physicians recommend that children with such deformities be placed in orthotics soon after they start walking, to stabilize the foot. The devices can be placed directly into a standard shoe or an athletic shoe.

Usually, the orthotics need to be replaced when the child’s foot has grown two sizes. Different types of orthotics may be needed as the child’s foot develops and changes shape.

The length of time a child needs orthotics varies considerably, depending on the seriousness of the deformity and how soon correction is addressed.

Other Types of Orthotics

Various other orthotics may be used for multidirectional sports or edge-control sports by casting the foot within the ski boot, ice skate boot, or inline skate boot. Combinations of semiflexible material and soft material to accommodate painful areas are utilized for specific problems.

Research has shown that back problems frequently can be traced to a foot imbalance. It’s important for your podiatric physician to evaluate the lower extremity as a whole to provide for appropriate orthotic control for foot problems.

Orthotic Tips

Wear shoes that work well with your orthotics.
Bring your orthotics with you whenever you purchase a new pair of shoes.
Wear socks or stockings similar to those that you plan on wearing when you shop for new shoes.
Return as directed for follow-up evaluation of the functioning of your orthotics. This is important for making certain that your feet and orthotics are functioning properly together.

Your podiatric physician/surgeon has been trained specifically and extensively in the diagnosis and treatment of all manner of foot conditions. This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.

Make an appointment

With our seven locations across Middle Tennessee, Nashville Foot and Ankle Group has an office near you! Call your nearest Nashville podiatrist today and a member of our courteous and smiling staff will be happy to assist you!

Corns & Calluses

2010-06-20T16:06:00.007-07:00

Corns and calluses are protective layers of compacted, dead skin cells. They are caused by repeated friction and pressure from skin rubbing against bony areas or against an irregularity in a shoe. Corns ordinarily form on the toes and calluses on the soles of the feet. The friction and pressure can burn or otherwise be painful and may be relieved by moleskin or padding on the affected areas. Never cut corns or calluses with any instrument, and never apply home remedies, except under a podiatrist’s instructions.

Make an appointment

Flat Feet / Fallen Arches

2010-06-20T16:06:00.006-07:00

Flat feet- or fallen arches- refers to a condition of the foot in which the arch of the foot collapses while standing (or in some extreme cases, even when no weight is applied to the feet), causing the sole of the foot to become flat.

Make an appointment

Diabetic Foot Care

2010-06-20T16:06:00.005-07:00

Diabetes: Startling Statistics

Diabetes mellitus is a chronic disease that affects the lives of nearly 24 million people in the United States, nearly 6 million of whom are unaware that they even have the disease. In 2007 alone, 1.6 million new cases of diabetes were diagnosed in people aged 20 years or older. The disease is marked by the inability to manufacture or properly use insulin and impairs the body’s ability to convert sugars, starches and other foods into energy. The long-term effects of elevated blood sugar (hyperglycemia) are damage to the eyes, heart, feet, kidneys, nerves and blood vessels.

Symptoms of hyperglycemia may include frequent urination, excessive thirst, extreme hunger, unexplained weight loss, tingling or numbness of the feet or hands, blurred vision, fatigue, slow-to-heal wounds and susceptibility to certain infections. People who have any of these symptoms and have not been tested for diabetes are putting themselves at considerable risk and should see a physician without delay.

Part of keeping your diabetes in control is testing your blood sugar often. Ask your doctor how often you should test and what your blood sugar levels should be. Testing your blood and then treating high blood sugar early will help you to prevent complications.

The socioeconomic costs of diabetes are enormous. In 2007, the total annual economic cost of diabetes was estimated at $174 billion -- about $116 billion of which are direct costs from the disease with $58 billion indirectly related. Diabetes is the sixth leading cause of death by disease in the United States, and individuals with diabetes are two to four times as likely to experience heart disease and stroke.

The growth of the disease worldwide is especially alarming. The World Health Organization (WHO) expects the number of new diabetes cases to double in the next 25 years from 135 million to nearly 300 million. Much of this growth will occur in developing countries where aging, unhealthy diets, obesity, and sedentary lifestyles will contribute to the onset of the disease.

According to a recent survey, about 86,000 lower limbs are amputated annually due to complications from diabetes. Diabetes is the leading cause of end-stage kidney disease, accounting for about 44 percent of new cases. Diabetes is also the leading cause of new cases of blindness among adults aged 20 to 74.

While there is no cure for diabetes, there is hope. With a proper diet, exercise, medical care and careful management at home, a person with diabetes can keep the most serious of the consequences at bay and enjoy a long, full life.

How Do You Get Diabetes?

No one knows why people develop diabetes, but once diagnosed, the disease is present for life. It is a hereditary disorder, and certain genetic indicators are known to increase the risk of developing diabetes. Type 1, previously known as insulin-dependent diabetes mellitus or juvenile-onset diabetes, afflicts five to ten percent of diagnosed cases of diabetes. This type occurs most frequently in children and adolescents, and is caused by the inability of the pancreas to produce the insulin needed for survival. Type 2, previously called noninsulin-dependent diabetes mellitus or adult-onset diabetes, affects the other 90-95 percent of all diagnosed cases of diabetes, many of whom use oral medication or injectable insulin to control the disease. The vast majority of those people (80 percent or more) are overweight; many of them obese, as obesity itself can cause insulin resistance.

Certain characteristics put people at a higher risk for developing Type 2 diabetes. These include:

A family history of the disease
Obesity
Prior history of developing diabetes while pregnant
Being over the age of 40
Being a member of one of the following ethnic groups: African American, Native American, Latino American, Asian American, Pacific Islander

African Americans are 1.7 times more likely to have diabetes than the general population, with 25 percent of African Americans between the ages of 65 and 74 diagnosed with the disease. Hispanic Americans are almost twice as likely to develop type 2 diabetes, which affects 10.6 percent of that population group. Native Americans are at a significantly increased risk for developing diabetes, and 12.2 percent of the population suffers from the disease. In some tribes, as many as 50 percent of its members have diabetes.

Of all the risk factors, weight is the most important, with more than 80 percent of diabetes sufferers classified as overweight.

The Role of Your Podiatric Physician

Because diabetes is a systemic disease affecting many different parts of the body, ideal case management requires a team approach. The podiatric physician, as an integral part of the treatment team, has documented success in the prevention of amputations. The key to amputation prevention in diabetic patients is early recognition and regular foot screenings, at least annually, from a podiatric physician.

In addition to these check ups, there are warning signs that you should be aware of so that they may be identified and called to the attention of the family physician or podiatrist. They include:

Skin color changes
Elevation in skin temperature
Swelling of the foot or ankle
Pain in the legs
Open sores on the feet that are slow to heal
Ingrown and fungal toenails
Bleeding corns and calluses
Dry cracks in the skin, especially around the heel

Wound Healing

Ulceration is a common occurrence with the diabetic foot and should be carefully treated and monitored by a podiatrist to avoid amputations. Poorly fitted shoes, or something as trivial as a stocking seam, can create a wound that may not be felt by someone whose skin sensation is diminished. Left unattended, such ulcers can quickly become infected and lead to more serious consequences. Your podiatric physician knows how to treat and prevent these wounds and can be an important factor in keeping your feet healthy and strong. New to the science of wound healing are remarkable products that have the appearance and handling characteristics of human skin. These living, skin-like products are applied to wounds that are properly prepared by the podiatric physician. Clinical trials have shown impressive success rates.

If You Have Diabetes Already . . . Do:

Wash feet daily.
Using mild soap and lukewarm water, wash your feet in the mornings or before bed each evening. Dry carefully with a soft towel, especially between the toes, and dust your feet with talcum powder to wick away moisture. If the skin is dry, use a good moisturizing cream daily but avoid getting it between the toes.

Inspect feet and toes daily.
Check your feet every day for cuts, bruises, sores or changes to the toenails, such as thickening or discoloration. If age or other factors hamper self-inspection, ask someone to help you, or use a mirror.

Lose weight.
People with diabetes are commonly overweight, which nearly doubles the risk of complications.

Wear thick, soft socks.
Socks made of an acrylic blend are well suited but avoid mended socks or those with seams, which could rub to cause blisters or other skin injuries.

Stop smoking.
Tobacco can contribute to circulatory problems, which can be especially troublesome in patients with diabetes.

Cut toenails straight across.
Never cut into the corners, or taper, which could trigger an ingrown toenail. Use an emery board to gently file away sharp corners or snags. If your nails are hard to trim, ask your podiatric physician for assistance.

Exercise.
As a means to keep weight down and improve circulation, walking is one of the best all-around exercises for the diabetic patient. Walking is also an excellent conditioner for your feet. Be sure to wear appropriate athletic shoes when exercising. Ask your podiatric physician what’s best for you.

See your podiatric physician.
Regular checkups by your podiatric physician—at least annually—are the best way to ensure that your feet remain healthy.

Be properly measured and fitted every time you buy new shoes.
Shoes are of supreme importance to diabetes sufferers because poorly fitted shoes are involved in as many as half of the problems that lead to amputations. Because foot size and shape may change over time, everyone should have their feet measured by an experienced shoe fitter whenever they buy a new pair of shoes.

New shoes should be comfortable at the time they’re purchased and should not require a "break-in" period, though it’s a good idea to wear them for short periods of time at first. Shoes should have leather or canvas uppers, fit both the length and width of the foot, leave room for toes to wiggle freely, and be cushioned and sturdy.

Don’t go barefoot.
Not even in your own home. Barefoot walking outside is particularly dangerous because of the possibility of cuts, falls, and infection. When at home, wear slippers. Never go barefoot.

Don’t wear high heels, sandals, and shoes with pointed toes.
These types of footwear can put undue pressure on parts of the foot and contribute to bone and joint disorders, as well as diabetic ulcers. In addition, open-toed shoes and sandals with straps between the first two toes should also be avoided.

Don’t drink in excess.
Alcohol can contribute to neuropathy (nerve damage) which is one of the consequences of diabetes. Drinking can speed up the damage associated with the disease, deaden more nerves, and increase the possibility of overlooking a seemingly minor cut or injury.

Don’t wear anything that is too tight around the legs.
Pantyhose, panty girdles, thigh-highs or knee-highs can constrict circulation to your legs and feet, as can men’s dress socks if the elastic is too tight.

Never try to remove calluses, corns, or warts by yourself.
Commercial, over-the-counter preparations that remove warts or corns should be avoided because they can burn the skin and cause irreplaceable damage to the foot of a diabetic sufferer. Never try to cut calluses with a razor blade or any other instrument because the risk of cutting yourself is too high, and such wounds can often lead to more serious ulcers and lacerations. See your podiatric physician for assistance in these cases.

What is a Diabetic Foot Ulcer?

A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes, and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication.

Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States, and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer have an amputation. Research, however, has shown that the development of a foot ulcer is preventable.

Who Can Get a Diabetic Foot Ulcer?

Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics and older men are more likely to develop ulcers. People who use insulin are at a higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.

How do Diabetic Foot Ulcers Form?

Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain and one may not even be aware of the problem. Your podiatric physician can test feet for neuropathy with a simple and painless tool called a monofilament.

Vascular disease can complicate a foot ulcer, reducing the body’s ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body’s ability to fight off a potential infection and also retard healing.

What is the Value of Treating a Diabetic Foot Ulcer?

Once an ulcer is noticed, seek podiatric medical care immediately. Foot ulcers in patients with diabetes should be treated for several reasons such as, reducing the risk of infection and amputation, improving function and quality of life, and reducing health care costs.

How Should a Diabetic Foot Ulcer be Treated?

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:

Prevention of infection.
Taking the pressure off the area, called “off-loading.”
Removing dead skin and tissue, called “debridement.”
Applying medication or dressings to the ulcer.
Managing blood glucose and other health problems.

Not all ulcers are infected; however if your podiatric physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

There are several important factors to keep an ulcer from becoming infected:

Keep blood glucose levels under tight control.
Keep the ulcer clean and bandaged.
Cleanse the wound daily, using a wound dressing or bandage.
Do not walk barefoot.

For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” Patients may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.

The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.

Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.

For a wound to heal there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels with noninvasive tests.

Controlling Blood Glucose

Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Working closely with a medical doctor or endocrinologist to accomplish this will enhance healing and reduce the risk of complications.

Surgical Options

A majority of noninfected foot ulcers are treated without surgery; however, when this fails, surgical management may be appropriate. Examples of surgical care to remove pressure on the affected area include shaving or excision of bone(s) and the correction of various deformities, such as hammertoes, bunions, or bony “bumps.”

Healing Factors

Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound. Healing may occur within weeks or require several months.

How Can a Foot Ulcer be Prevented?

The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrist on a regular basis. He or she can determine if you are at high risk for developing a foot ulcer and implement strategies for prevention.

You are at high risk if you:

have neuropathy,
have poor circulation,
have a foot deformity (i.e. bunion, hammer toe),
wear inappropriate shoes,
have uncontrolled blood sugar.

Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose are important in the prevention and treatment of a diabetic foot ulcer. Wearing the appropriate shoes and socks will go a long way in reducing risks. Your podiatric physician can provide guidance in selecting the proper shoes.

Learning how to check your feet is crucial in noticing a potential problem as early as possible. Inspect your feet every day—especially between the toes and the sole—for cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality. Each time you visit a health care provider, remove your shoes and socks so your feet can be examined. Any problems that are discovered should be reported to your podiatrist as soon as possible, no matter how “simple” it may seem to you.

The key to successful wound healing is regular podiatric medical care to ensure the following “gold standard” of care:

lowering blood sugar
appropriate debridement of wounds
treating any infection
reducing friction and pressure
restoring adequate blood flow

The old saying, “an ounce of prevention is worth a pound of cure” was never as true as it is when preventing a diabetic foot ulcer.

Make an appointment

Foot & Ankle Injuries

2010-06-20T16:06:00.004-07:00

Immediate Treatment

Foot and ankle emergencies happen every day. Broken bones, dislocations, sprains, contusions, infections, and other serious injuries can occur at any time. Early attention is vitally important. Whenever you sustain a foot or ankle injury, you should seek immediate treatment from a podiatric physician.

This advice is universal, even though there are lots of myths about foot and ankle injuries. Some of them follow:

Myths

"It can't be broken, because I can move it." False; this widespread idea has kept many fractures from receiving proper treatment. The truth is that often you can walk with certain kinds of fractures. Some common examples: Breaks in the smaller, outer bone of the lower leg, small chip fractures of either the foot or ankle bones, and the often neglected fracture of the toe.
"If you break a toe, immediate care isn't necessary." False; a toe fracture needs prompt attention. If X-rays reveal it to be a simple, displaced fracture, care by your podiatric physician usually can produce rapid relief. However, X-rays might identify a displaced or angulated break. In such cases, prompt realignment of the fracture by your podiatric physician will help prevent improper or incomplete healing. Often, fractures do not show up in the initial X-ray. It may be necessary to X-ray the foot a second time, seven to ten days later. Many patients develop post-fracture deformity of a toe, which in turn results in a deformed toe with a painful corn. A good general rule is: Seek prompt treatment for injury to foot bones.
"If you have a foot or ankle injury, soak it in hot water immediately." False; don’t use heat or hot water on an area suspect for fracture, sprain, or dislocation. Heat promotes blood flow, causing greater swelling. More swelling means greater pressure on the nerves, which causes more pain. An ice bag wrapped in a towel has a contracting effect on blood vessels, produces a numbing sensation, and prevents swelling and pain. Your podiatric physician may make additional recommendations upon examination.
"Applying an elastic bandage to a severely sprained ankle is adequate treatment." False; ankle sprains often mean torn or severely overstretched ligaments, and they should receive immediate care. X-ray examination, immobilization by casting or splinting, and physiotherapy to ensure a normal recovery all may be indicated. Surgery may even be necessary.
"The terms 'fracture,' 'break,' and 'crack' are all different." False; all of those words are proper in describing a broken bone.

Before Seeing the Podiatrist

If an injury or accident does occur, the steps you can take to help yourself until you can reach your podiatric physician are easy to remember if you can recall the word “rice.”

Rest. Restrict your activity and get off your foot/ankle.
Ice. Gently place a plastic bag of ice wrapped in a towel on the injured area in a 20-minute-on, 40-minute-off cycle.
Compression. Lightly wrap an Ace bandage around the area, taking care not to pull it too tight.
Elevation. To reduce swelling and pain, sit in a position that allows you to elevate the foot/ankle higher than your waist.
For bleeding cuts, cleanse well, apply pressure with gauze or a towel, and cover with a clean dressing. See your podiatrist as soon as possible. It’s best not to use any medication on the cut before you see the doctor.
Leave blisters unopened if they are not painful or in a weight-bearing area of the foot. A compression bandage placed over a blister can provide relief.
Foreign materials in the skin—such as slivers, splinters, and sand—can be removed carefully, but a deep foreign object, such as broken glass or a needle, must be removed professionally.
Treatment for an abrasion is similar to that of a burn, since raw skin is exposed to the air and can easily become infected. It is important to remove all foreign particles with thorough cleaning. Sterile bandages should be applied, along with an antibiotic cream or ointment.

Prevention

Wear the correct shoes for your particular activity.
Wear hiking shoes or boots in rough terrain.
Don't continue to wear any sports shoe if it is worn unevenly.
The toe box in “steel-toe” shoes should be deep enough to accommodate your toes comfortably.
Always wear hard-top shoes when operating a lawn mower or other grass-cutting equipment.
Don’t walk barefoot on paved streets or sidewalks.
Watch out for slippery floors at home and at work. Clean up obviously dangerous spills immediately.
If you get up during the night, turn on a light. Many fractured toes and other foot injuries occur while attempting to find one’s way in the dark.

Make an appointment

With our seven locations across Middle Tennessee, Nashville Foot and Ankle Group has an office near you! Call your nearest Nashville podiatrist today and a member of our courteous and smiling staff will be happy to assist you!

Reconstructive Foot Surgery

2010-06-20T16:06:00.003-07:00

When is Foot Surgery Necessary?

Many foot problems do not respond to “conservative” management. Your podiatric physician can determine when surgical intervention may be helpful. Often when pain or deformity persists, surgery may be appropriate to alleviate discomfort or to restore the function of your foot.

Bunions
A common deformity of the foot, a bunion is an enlargement of the bone and tissue around the joint of the big toe. Heredity frequently plays a role in the occurrence of bunions, as it does in other foot conditions. When symptomatic, the area may become red, swollen, and inflamed, making shoe gear and walking uncomfortable and difficult. If conservative care fails to reduce these symptoms, surgical intervention may be warranted. Your podiatric physician will determine the type of surgical procedure best suited for your deformity, based on a variety of information which may include X-rays and gait examination.

Hammertoes

A hammertoe deformity is a contracture of the toe(s), frequently caused by an imbalance in the tendon or joints of the toes. Due to the “buckling” effect of the toe(s), hammertoes may become painful secondary to footwear irritation and pressure. Corn and callus formation may occur as a hammertoe becomes more rigid over time, making it difficult to wear shoes. Your podiatric physician may suggest correction of this deformity through a surgical procedure to realign the toe(s).

Neuroma

An irritation of a nerve may produce a neuroma, which is a benign enlargement of a nerve segment, commonly found between the third and fourth toes. Several factors may contribute to the formation of a neuroma.

Trauma, arthritis, high-heeled shoes, or an abnormal bone structure are just some of the conditions that may cause a neuroma. Symptoms such as burning or tingling in the ball of the foot or in the adjacent toes and even numbness are commonly seen with this condition. Other symptoms include swelling between the toes and pain in the ball of the foot when weight is placed on it.

Those suffering from the condition often find relief by stopping their walk, taking off their shoe, and rubbing the affected area. At times, the patient will describe the pain as similar to having a stone in his or her shoe.

Your podiatric physician will suggest a treatment plan. If conservative treatment does not relieve the symptoms, then your podiatric physician will decide, on the basis of your symptoms, whether surgical treatment is appropriate.

Bunionette (Tailor’s Bunion)

A protuberance of bone at the outside of the foot behind the fifth (small) toe, the bunionette or “small bunion” is caused by a variety of conditions including heredity, faulty biomechanics (the way one walks) or trauma, to name a few. Pain is often associated with this deformity, making shoes very uncomfortable and at times even walking becomes difficult. If severe and conservative treatments fail to improve the symptoms of this condition, surgical repair may be suggested. Your podiatric physician will develop a surgical plan specific to the condition present.

Bone spurs

A bone spur is an overgrowth of bone as a result of pressure, trauma, or reactive stress of a ligament or tendon. This growth can cause pain and even restrict motion of a joint, depending on its location and size. Spurs may also be located under the toenail plate, causing nail deformity and pain. Surgical treatment and procedure is based on the size, location, and symptoms of the bone spur. Your podiatric physician will determine the surgical method best suited for your condition.

Preoperative Testing and Care

As with anyone facing any surgical procedure, those undergoing foot and ankle surgery require specific tests or examinations before surgery to improve a successful surgical outcome. Prior to surgery, the podiatric physician will review your medical history and medical conditions. Specific diseases, illnesses, allergies, and current medications need to be evaluated. Other tests that help evaluate your health status may be ordered by the podiatric physician, such as blood studies, urinalysis, EKG, X-rays, a blood flow study (to better evaluate the circulatory status of the foot/legs), and a biomechanical examination. A consultation with another medical specialist may be advised by a podiatric physician, depending on your test results or a specific medical condition.

Postoperative Care

The type of foot surgery performed determines the length and kind of aftercare required to assure that your recovery from surgery is rapid and uneventful. The basics of all postoperative care involve to some degree each of the following: rest, ice, compression, and elevation. Bandages, splints, surgical shoes, casts, crutches, or canes may be necessary to improve and ensure a safe recovery after foot surgery. A satisfactory recovery can be hastened by carefully following instructions from your podiatric physician.

Your Feet Aren’t Supposed to Hurt

Remember that foot pain is not normal. Healthy, pain-free feet are a key to your independence. At the first sign of pain, or any noticeable changes in your feet, seek professional podiatric medical care. Your feet must last a lifetime, and most Americans log an amazing 75,000 miles on their feet by the time they reach age 50. Regular foot care can make sure your feet are up to the task. With proper detection, intervention, and care, most foot and ankle problems can be lessened or prevented. Remember that the advice provided in this pamphlet should not be used as a substitute for a consultation or evaluation by a podiatric physician.

Make an appointment

Sprains & Fractures

2010-06-20T16:06:00.002-07:00

Immediate Treatment

This advice is universal, even though there are lots of myths about foot and ankle injuries. Some of them follow:

Myths

"It can't be broken, because I can move it." False; this widespread idea has kept many fractures from receiving proper treatment. The truth is that often you can walk with certain kinds of fractures. Some common examples: Breaks in the smaller, outer bone of the lower leg, small chip fractures of either the foot or ankle bones, and the often neglected fracture of the toe.
"If you break a toe, immediate care isn't necessary." False; a toe fracture needs prompt attention. If X-rays reveal it to be a simple, displaced fracture, care by your podiatric physician usually can produce rapid relief. However, X-rays might identify a displaced or angulated break. In such cases, prompt realignment of the fracture by your podiatric physician will help prevent improper or incomplete healing. Often, fractures do not show up in the initial X-ray. It may be necessary to X-ray the foot a second time, seven to ten days later. Many patients develop post-fracture deformity of a toe, which in turn results in a deformed toe with a painful corn. A good general rule is: Seek prompt treatment for injury to foot bones.
"If you have a foot or ankle injury, soak it in hot water immediately." False; don’t use heat or hot water on an area suspect for fracture, sprain, or dislocation. Heat promotes blood flow, causing greater swelling. More swelling means greater pressure on the nerves, which causes more pain. An ice bag wrapped in a towel has a contracting effect on blood vessels, produces a numbing sensation, and prevents swelling and pain. Your podiatric physician may make additional recommendations upon examination.
"Applying an elastic bandage to a severely sprained ankle is adequate treatment." False; ankle sprains often mean torn or severely overstretched ligaments, and they should receive immediate care. X-ray examination, immobilization by casting or splinting, and physiotherapy to ensure a normal recovery all may be indicated. Surgery may even be necessary.
"The terms 'fracture,' 'break,' and 'crack' are all different." False; all of those words are proper in describing a broken bone.

Before Seeing the Podiatrist

If an injury or accident does occur, the steps you can take to help yourself until you can reach your podiatric physician are easy to remember if you can recall the word “rice.”

Rest. Restrict your activity and get off your foot/ankle.
Ice. Gently place a plastic bag of ice wrapped in a towel on the injured area in a 20-minute-on, 40-minute-off cycle.
Compression. Lightly wrap an Ace bandage around the area, taking care not to pull it too tight.
Elevation. To reduce swelling and pain, sit in a position that allows you to elevate the foot/ankle higher than your waist.
For bleeding cuts, cleanse well, apply pressure with gauze or a towel, and cover with a clean dressing. See your podiatrist as soon as possible. It’s best not to use any medication on the cut before you see the doctor.
Leave blisters unopened if they are not painful or in a weight-bearing area of the foot. A compression bandage placed over a blister can provide relief.
Foreign materials in the skin—such as slivers, splinters, and sand—can be removed carefully, but a deep foreign object, such as broken glass or a needle, must be removed professionally.
Treatment for an abrasion is similar to that of a burn, since raw skin is exposed to the air and can easily become infected. It is important to remove all foreign particles with thorough cleaning. Sterile bandages should be applied, along with an antibiotic cream or ointment.

Prevention

Wear the correct shoes for your particular activity.
Wear hiking shoes or boots in rough terrain.
Don't continue to wear any sports shoe if it is worn unevenly.
The toe box in “steel-toe” shoes should be deep enough to accommodate your toes comfortably.
Always wear hard-top shoes when operating a lawn mower or other grass-cutting equipment.
Don’t walk barefoot on paved streets or sidewalks.
Watch out for slippery floors at home and at work. Clean up obviously dangerous spills immediately.
If you get up during the night, turn on a light. Many fractured toes and other foot injuries occur while attempting to find one’s way in the dark.

Warts / Skin Problems

2010-06-20T16:06:00.001-07:00

What are Plantar Warts?

Warts are one of several soft tissue conditions of the foot that can be quite painful. They are caused by a virus, which generally invades the skin through small or invisible cuts and abrasions. They can appear anywhere on the skin, but technically only those on the sole are properly called plantar warts.

Children, especially teenagers, tend to be more susceptible to warts than adults; some people seem to be immune.

Identification Problems

Most warts are harmless, even though they may be painful. They are often mistaken for corns or calluses—which are layers of dead skin that build up to protect an area which is being continuously irritated. The wart, however, is a viral infection.

It is also possible for a variety of more serious lesions to appear on the foot, including malignant lesions such as carcinomas and melanomas. Although rare, these conditions can sometimes be misidentified as a wart. It is wise to consult a podiatric physician when any suspicious growth or eruption is detected on the skin of the foot in order to ensure a correct diagnosis.

Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. Plantar warts are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black. It is important to note that warts can be very resistant to treatment and have a tendency to reoccur.

Source of the Virus

The plantar wart is often contracted by walking barefoot on dirty surfaces or littered ground where the virus is lurking. The causative virus thrives in warm, moist environments, making infection a common occurrence in communal bathing facilities.

If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of several warts; these are often called mosaic warts. Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, another route for spreading.

Occasionally, warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.

When plantar warts develop on the weight-bearing areas of the foot—the ball of the foot, or the heel, for example—they can be the source of sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.

Tips for Prevention

Avoid walking barefoot, except on sandy beaches.
Change shoes and socks daily.
Keep feet clean and dry.
Check children's feet periodically.
Avoid direct contact with warts—from other persons or from other parts of the body.
Do not ignore growths on, or changes in, your skin.
Visit your podiatric physician as part of your annual health checkup.

Self Treatment

Self treatment is generally not advisable. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self treatment with such medications especially should be avoided by people with diabetes and those with cardiovascular or circulatory disorders. Never use them in the presence of an active infection.

Professional Treatment

It is possible that your podiatric physician will prescribe and supervise your use of a wart-removal preparation. More likely, however, removal of warts by a simple surgical procedure, performed under local anesthetic, may be indicated.

Lasers have become a common and effective treatment. A procedure known as CO2 laser cautery is performed under local anesthesia either in your podiatrist’s office surgical setting or an outpatient surgery facility. The laser reduces post-treatment scarring and is a safe form for eliminating wart lesions.

Tips for Individuals with Warts

Avoid self treatment with over-the-counter preparations.
Seek professional podiatric evaluation and assistance with the treament of your warts.
Diabetics and other patients with circulatory, immunological, or neurological problems should be especially careful with the treament of their warts.
Warts may spread and are catching. Make sure you have your warts evaluated to protect yourself and those close to you.

Heel Pain / Spurs, Bunions & Hammertoes

2010-06-20T16:06:00.000-07:00

Heel Pain Has Many Causes

In our pursuit of healthy bodies, pain can be an enemy. In some instances, however, it is of biological benefit. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we've suffered.

When we sprain an ankle, for example, the pain warns us that the ligament and soft tissues may be frayed and bruised, and that further activity may cause additional injury.

Pain, such as may occur in our heels, also alerts us to seek medical attention. This alert is of utmost importance because of the many afflictions that contribute to heel pain.

Heel Spurs

A common cause of heel pain is the heel spur, a bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as "heel spur syndrome."

Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.

Plantar Fasciitis

Both heel pain and heel spurs are frequently associated with an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. The inflammation is called plantar fasciitis. It is common among athletes who run and jump a lot, and it can be quite painful.

The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where it attaches to the heel bone.

The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.

Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.

Excessive Pronation

Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern.

As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation—excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.

Disease and Heel Pain

Some general health conditions can also bring about heel pain.

Rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint, can cause heel discomfort in some cases.
Heel pain may also be the result of an inflamed bursa (bursitis), a small, irritated sack of fluid; a neuroma (a nerve growth); or other soft-tissue growth. Such heel pain may be associated with a heel spur or may mimic the pain of a heel spur.
Haglund's deformity ("pump bump") is a bone enlargement at the back of the heel bone, in the area where the achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe and can be aggravated by the height or stitching of a heel counter of a particular shoe.
Pain at the back of the heel is associated with inflammation of the achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. The inflammation is called achilles tendinitis. It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.
Bone bruises are common heel injuries. A bone bruise or contusion is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.

Stress fractures of the heel bone also can occur, although infrequently.

Children’s Heel Pain

Heel pain can also occur in children, most commonly between ages 8 and 13, as they become increasingly active in sports activity in and out of school. This physical activity, particularly jumping, inflames the growth centers of the heels; the more active the child, the more likely the condition will occur. When the bones mature, the problems disappear and are not likely to recur. If heel pain occurs in this age group, podiatric care is necessary to protect the growing bone and to provide pain relief.

Make an appointment

What Is a Bunion?

A bunion is an enlargement of the joint at the base of the big toe—the metatarsophalangeal (MTP) joint—that forms when the bone or tissue at the big toe joint moves out of place. This forces the toe to bend toward the others, causing an often painful lump of bone on the foot. Since this joint carries a lot of the body’s weight while walking, bunions can cause extreme pain if left untreated. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A bunion–from the Latin "bunio," meaning enlargement–can also occur on the outside of the foot along the little toe, where it is called a "bunionette" or "tailor’s bunion."

Symptoms

Development of a firm bump on the outside edge of the foot, at the base of the big toe.
Redness, swelling, or pain at or near the MTP joint.
Corns or other irritations caused by the overlap of the first and second toes.
Restricted or painful motion of the big toe.

How Do You Get a Bunion?

Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This can lead to instability in the joint and cause the deformity. They are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk, and our inherited foot type, our shoes, or other sources.

Although bunions tend to run in families, it is the foot type that is passed down—not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type on to their children, who in turn are prone to developing bunions. The abnormal functioning caused by this faulty foot development can lead to pressure being exerted on and within the foot, often resulting in bone and joint deformities such as bunions and hammertoes.

Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition.

Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women.

What Can You Do For Relief?

Apply a commercial, nonmedicated bunion pad around the bony prominence.
Wear shoes with a wide and deep toe box.
If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
Avoid high-heeled shoes over two inches tall.
See your podiatric physician if pain persists.

Conservative Treatment For Bunion Pain

Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. Podiatric medical attention should be sought at the first indication of pain or discomfort because, left untreated, bunions tend to get larger and more painful, making nonsurgical treatment less of an option.

The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity. A podiatric physician may recommend these treatments:

Padding & Taping
Often the first step in a treatment plan, padding the bunion minimizes pain and allows the patient to continue a normal, active life. Taping helps keep the foot in a normal position, thus reducing stress and pain.

Medication
Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammations caused by joint deformities.

Physical Therapy
Often used to provide relief of the inflammation and from bunion pain. Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement.

Orthotics
Shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.

Surgical Options

When early treatments fail or the bunion progresses past the threshold for such options, podiatric surgery may become necessary to relieve pressure and repair the toe joint. Several surgical procedures are available to the podiatric physician. The surgery will remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.

A simple bunionectomy, in which only the bony prominence is removed, may be used for the less severe deformity. Severe bunions may require a more involved procedure, which includes cutting the bone and realigning the joint.

Recuperation takes time, and swelling and some discomfort are common for several weeks following surgery. Pain, however, is easily managed with medications prescribed by your podiatric physician.

Bunion Tips

Wear comfortable shoes that conform to the shape of your foot.
Wear shoes with a wide and deep toe box.
Always fit the larger foot and have your feet sized each time you purchase shoes.
Apply a commercial, nonmedicated bunion pad around the bony prominence.
If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
Avoid high-heeled shoes over two inches tall.
Seek professional podiatric evaluation and assistance with uncomfortable or noticeable bunions.

Make an appointment

What is a Hammertoe?

A hammertoe is a contracture—or bending—of the toe at the first joint of the digit, called the proximal interphalangeal joint. This bending causes the toe to appear like an upside-down V when looked at from the side. Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammertoes are more common to females than males.

There are two different types:

Flexible Hammertoes:

These are less serious because they can be diagnosed and treated while still in the developmental stage. They are called flexible hammertoes because they are still moveable at the joint.

Rigid Hammertoes:

This variety is more developed and more serious than the flexible condition. Rigid hammertoes can be seen in patients with severe arthritis, for example, or in patients who wait too long to seek professional treatment. The tendons in a rigid hammertoe have become tight, and the joint misaligned and immobile, making surgery the usual course of treatment.

Symptoms

Pain upon pressure at the top of the bent toe from footwear.
The formation of corns on the top of the joint.
Redness and swelling at the joint contracture.
Restricted or painful motion of the toe joint.
Pain in the ball of the foot at the base of the affected toe.

How Do You Get a Hammertoe?

A hammertoe is formed due an abnormal balance of the muscles in the toes. This abnormal balance causes increased pressures on the tendons and joints of the toe, leading to its contracture. Heredity and trauma can also lead to the formation of a hammertoe. Arthritis is another factor, because the balance around the toe in people with arthritis is so disrupted that a hammertoe may develop. Wearing shoes that are too tight and cause the toes to squeeze can also be a cause for a hammertoe to form.

What Can You Do for Relief?

Apply a commercial, nonmedicated hammertoe pad around the bony prominence of the hammertoe. This will decrease pressure on the area.
Wear a shoe with a deep toe box.
If the hammertoe becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
Avoid heels more than two inches tall.
A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. It is important to remember that, while this treatment will make the hammertoe feel better, it does not cure the condition. A trip to the podiatric physician’s office will be necessary to repair the toe to allow for normal foot function.
Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes rapidly.
See your podiatric physician if pain persists.

What Will Your Podiatrist Do to Treat a Hammertoe?

The treatment options vary with the type and severity of each hammertoe, although identifying the deformity early in its development is important to avoid surgery. Podiatric medical attention should be sought at the first indication of pain and discomfort because, if left untreated, hammertoes tend to become rigid, making a nonsurgical treatment less of an option.

Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.

Padding and Taping:
Often this is the first step in a treatment plan. Padding the hammertoe prominence minimizes pain and allows the patient to continue a normal, active life. Taping may change the imbalance around the toes and thus relieve the stress and pain.

Medication:
Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the joint deformity.

Orthotic Devices:
Custom shoe inserts made by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the hammertoe deformity.

Surgical Options:
Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus relieving pain.

Severe hammertoes, which are not fully reducible, may require more complex surgical procedures.

Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery. Any pain, however, is easily managed with medications prescribed by your podiatric physician.

Your Feet Aren’t Supposed to Hurt

Hammertoe Tips

Apply a commercial, nonmedicated hammertoe pad around the bony prominence of the hammertoe. This will decrease pressure on the area.
Wear a shoe with a deep toe box.
If the hammertoe becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
Avoid heels more than two inches tall.
A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. It is important to remember that, while this treatment will make the hammertoe feel better, it does not cure the condition. A trip to the podiatric physician’s office will be necessary to repair the toe to allow for normal foot function.
Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes rapidly.
See your podiatric physician if pain persists.

Make an appointment

Ingrown Toenails

2010-06-20T11:58:00.001-07:00

Ingrown nails, the most common nail impairment, are nails whose corners or sides dig painfully into the soft tissue of nail grooves, often leading to irritation, redness, and swelling. Usually, toenails grow straight out. Sometimes, however, one or both corners or sides curve and grow into the flesh. The big toe is usually the victim of this condition but other toes can also become affected.

Ingrown toenails may be caused by:

Improperly trimmed nails (Trim them straight across, not longer than the tip of the toes. Do not round off corners. Use toenail clippers.)
Heredity
Shoe pressure; crowding of toes
Repeated trauma to the feet from normal activities

If you suspect an infection due to an ingrown toenail, immerse the foot in a warm salt water soak, or a basin of soapy water, then apply an antiseptic and bandage the area.

People with diabetes, peripheral vascular disease, or other circulatory disorders must avoid any form of self treatment and seek podiatric medical care as soon as possible.

Other "do-it-yourself" treatments, including any attempt to remove any part of an infected nail or the use of over-the-counter medications, should be avoided. Nail problems should be evaluated and treated by your podiatrist, who can diagnose the ailment, and then prescribe medication or another appropriate treatment.

A podiatrist will resect the ingrown portion of the nail and may prescribe a topical or oral medication to treat the infection. If ingrown nails are a chronic problem, your podiatrist can perform a procedure to permanently prevent ingrown nails. The corner of the nail that ingrows, along with the matrix or root of that piece of nail, are removed by use of a chemical, a laser, or by other methods.

Make an appointment

2010-04-08T13:02:00.001-07:00