Healthy Steps For Your Feet For Your Life

Finding the good shoes...

2012-01-25T06:01:00.000-08:00

"Good shoes are hard to find unless I spend a lot of money.”

Sound familiar? The thing is, finding good shoes are not hard to find and you don’t have to spend a lot of money. It comes down to a little bit of research, a little bit of patience and being prepared. Here is a top ten list to consider in making your next shoe shopping event a productive, positive experience:

1. Know your budget for purchasing shoes, and the types of shoes you are looking for. This practice can be helpful to keep your budget in check.

2. Shop for shoes mid afternoon or at the end of the day. This is typically when feet are most swollen. Bring existing shoes to review wear patterns with the fitter.

3. Bring the appropriate socks or hosiery you plan to wear with the shoes. I am amazed how many folks will drop in not wearing socks with their shoes yet expect to find the perfect fit by wearing disposable nylon try on hosiery.

4. Do you wear orthotics or inserts? Be sure to bring them with you. The fit of the shoes can be altered by orthotics or inserts.

5. Never use try on socks at the store – eww gross. Think about it, even if the store claims to wash the socks daily, how many feet were in the socks before your visit? If you forgot your socks, spend a few bucks and purchase socks while in the store. It’s not worth picking up a fungus by trying on used socks.

6.Shop at a store where you are fitted by a shoe fitter or Pedorthist. Both feet should be measured in both length and width.

7. Plan to spend time in the store. Use up the carpet or flooring in the store. If the sales associate appears annoyed with you taking your time, work with another person or simply shop somewhere else.

8. Try on as many brands of shoes in the style you are considering. Do not try on only the brands you are familiar with or what the associate tells you are the best shoe in the store. By the way, the best shoe for you is the shoe that fits correctly on your foot, not the best seller.

9. Know the return policy of the store. Do you need a receipt? Is there a time frame to return? Is the return amount credited to your credit card, issued as a check or only for even exchange? Also know the return policy for sale items. Many stores have final sale only.

10. If you are unsure of the purchase, ask the associate to hold the shoes while you look elsewhere. If you do elect this option and decide not to purchase, be considerate and phone the store to let the staff know to return the shoes to stock.

Finally, have a positive outlook with your shopping adventure. Even with challenging foot fitting, the attitude can walk you into the right shoes for you!

Heels, Glorious Heels!

2012-01-24T06:47:00.000-08:00

Heels, glorious heels! Just the act of wearing a heel puts women in a different state of mind. It could be another form of “shoe therapy”! We are taller, feel more confidant, sexy, powerful! Telling some women to stop wearing heels is like telling Sampson to cut his hair before battle! It takes away that psychological “fix”!

How can something that makes you look so good be “not so good” for your feet? Not that it matters for some, but for those of you on the fence about how much heel and how often, here is a list of conditions we most commonly see in women who wear heels:
bunions, hammer toes, neuromas (nerve injury causing pain, burning and sometimes numbness to the toes), metatarsalgia (pain under the ball of the foot), Achilles tendonitis, heel pain, ingrown toenails, ankle sprains, fractures (yes, fractures), corns and calluses. Because the foot bone is connected to the rest of the body, chronic knee pain and back pain can also be linked to high heeled shoes.

Without having to completely give up on your stilettos, how can we “still let the toes” (had to got there LOL!) survive in this environment?

We can start by keeping the height of the heel to no more than 2 inches. Anything over that will put 75% of your body weight on the balls of your feet. This will slowly wear away the fat pad underneath the balls of your feet and give you pain in return! Gee, thanks! A lower heel also helps keep the toes from cramping into the shoe and hammertoes from getting worse. Keeping the heel lower will also keep the spine from swaying and the knees from straining, a bonus for those suffering from these conditions.

Have bunions or look like some are getting started? Stick with a heel that has at least a more rounded toe box or a square one. The pointier the shoe, the more you “train” your toe in the wrong direction and the bigger your bunion becomes. This type of shoe also helps keep ingrown toenails and neuromas at bay.

Getting pain to the back of the heel or in the Achilles? Before heading out for the day in those heels and when you get home and take them off, please give your Achilles tendons some time and stretch them out. This helps to compensate for the shortening of the Achilles tendon that occurs from chronic wearing of high heel shoes. Your body weight will strain your shortened tendons and ligaments and give you tendonitis and heel pain!

Those nasty corn and calluses are there to stay as long as you are wearing heels. Do your best to keep them softer with lotion to your feet daily. A cream with an exfoliant is a must with those thicker corns and calluses. There are also a variety of pads you can use to cushion the toes. If the stores don’t have one that works, your podiatrist may have just what you need!

Wearing a chunkier heel rather than a slim one will better stabilize your foot on your ankle. This will help to avoid some of those sprains.

Buy leather shoes, not synthetics. Leather is more forgiving. Make sure the shoe feels good in the store. Take your time walking around the shoe section to get a feel of how they really feel! Giving your feet the job to stretch them out at home can give you blisters, calluses and pain!

Always buy shoes and measure your feet in the afternoon or at the end of the day. Your feet swell throughout the day. Measuring your feet gives you some place to start. Remember shoes are like clothes, different brands have different fits! A size 8 in one shoe does not necessarily mean a size 8 in all! Go by fit, not size!

2012 Journey to IronMan Mont Tremblant

2012-01-16T10:57:00.000-08:00

I hope your new year is starting off in a focused and positive direction for you. Are you goals for the New Year in place? If not, there is no better time than the present so hop to it!

I managed to finish my goals on New Year’s Day and one of the goals should be no surprise if you have followed this blog. Once again, Dr. Crane and I are going after another full distance IronMan.

Yep, base training has begun. We invite you to join us as we blog and video this year’s journey. While much was learned from IronMan Texas that we finished last year, this year the course has a few more “bumps” in elevation. The 2012 race will take place August 19th in beautiful Mont Tremblant, Quebec Canada…yea; we are heading to the mountains my friends.

So how did we end up in Canada? We originally tried to enter IronMan New York City. To our dismay, the race sold out in eight minutes, with us unfortunately not obtaining a spot. After breaking the news to Dr. Crane, she pops over to me later in the day and says “here is what we are doing”, naturally, I gulped and replied “what pray tell are we doing?” “We are signing up for IronMan Mont Tremblant” she states. So I figure what the heck. After signing us both up, I took a peek at the course. Hmm, do you think I would have learned to check the course first? Nope, I sure did not. Note to self, check the course when she does this to you again next year…

The course at IronMan Texas was flat as a pancake. Mont Tremblant’s course…oh, so the opposite. For your viewing pleasure, I have captured the bike elevation for you to view, stare then laugh if you so choose:

It is pretty safe to say we are in for a challenge eh? So get ready for some fun reading while we train. We will take you to a few warm up races before the IronMan, help you learn more on bio mechanics of the foot and keeping your feet healthy. Who knows, with a bit of luck, we might just inspire you as you meet your own goals.

Happy New Year…here we go!

Time for new shoes?

2012-01-11T09:54:00.000-08:00

Have you checked your running shoes lately? Chances are, if they are more than six months old and worn on a regular basis whether it be for daily errands or dedicated exercise, you may be due for a new pair of shoes.

Typically, running shoes last anywhere from three to six months with four and half to five months on average. Replacing your shoes will greatly reduce the chance of overuse injuries such as Achilles tendinitis, hamstring strains, heel pain, illiotibial band syndrome, knee pain, shin splints, stress fractures, and tight calves to name a few.

Although your shoes may look fine on the outside and even on the bottom of the shoes, it’s the interior components that break down first. Inside your shoes, there is a mid sole. The mid sole will provide cushioning or that bouncy feeling along with stability. The levels of stability vary based on the type of shoe you are wearing.

We recommend visiting with your local Podiatrist for a yearly foot exam or Certified Pedorthist especially if you wear orthotics with your shoes to ensure you are wearing the appropriate category of running shoe.

When you visit your local running shop, make sure you try on all brands of the category of shoe you are wearing. Your feet should be measured each time you purchase shoes as they can change in size and width. Don’t be surprised you may take a slightly different size from what the associate measures your feet as styles can vary in sizing.

Enjoy the New Year with new shoes; your feet will thank you for it!

Why Diabetic shoes?

2011-12-02T12:56:00.000-08:00

It is well known the importance of properly fitting shoes for persons diagnosed with diabetes. Everyday use of diabetic (also known as therapeutic) shoes along with customized inserts will support and protect feet from injury thus reducing ulceration which can lead to amputation of part or all of the foot.

Properly fitting shoes and inserts can help a diabetic manage areas of excess pressure, reduce shock and shear, stabilize and support deformities and limit joint movement.

Excess pressure. When areas of excessive pressure reside at the bottom of the foot, ulceration can occur. The use of customized inserts can help spread out the areas of pressure throughout the foot.

Reducing shock. This is especially important for the foot especially those with bony areas or abnormal bone structure. Limiting the amount of vertical pressure by wearing a shoe with appropriate cushioning can reduce shock.

Shear reduction. Horizontal movement of the foot within the shoes is an additional area of focus in ulceration prevention. Proper measurement of the width and length of the shoe during a professional shoe fitting is an important part of shear reduction.

Stabilize and support deformities. Many feet not only have diabetic related issues, there can be structural issues as well. Ensuring the feet are supported and stabilized often with the use of customized inserts and supportive shoes can avoid pain or further destruction.

Limit joint movement. Limiting joint movement can reduce swelling, reduce pain and allow for a more functional foot. The combination of the shoe and customized insert can assist in limiting joint movement.

Now that you know the factors of the diabetic shoe, here are a couple of additional tips to consider:

It is best to have at least two pair of shoes one can change daily or even in the middle of the day.

Diabetic shoes should be seamless and allow for both the foot and insert to fit properly. Even a tiny seam can cause pressure leading to an ulcer. When multiple pairs of shoes are worn, the chances of continued pressure are reduced.

The shape of the shoes matters as well. Shoes that are tapered or have a pointed toe box are undesirable choices for a diabetic. Wearing too narrow of shoes can cause callousing, ulcers and in some cases, alter the foot shape. We see many patients at the practice particularly those with neuropathy (loss of sensation) in the feet wearing too tight of shoes or a smaller size of shoe.

Properly fitting shoes should offer a shock absorbing sole and depending on the type of foot, a depth shoe such as an oxford or athletic shoe style. Depth shoes can accommodate foot deformities such as hammer toes, claw toes and other types of bony prominence.

Let’s not forget about socks. Socks should be seamless, nonbinding and constructed of breathable materials. Check your local specialty footwear store or pharmacy for diabetic specific socks.

Being armed with the right tools to protect diabetic feet is key. It could very well save your life!

Pedal in comfort...

2011-10-19T05:41:00.000-07:00

Cycling is a rapidly growing sport with all shapes and sizes joining in on the fun. Whether you ride every day or on the weekends, cycling is a great way to burn calories, reduce stress and enjoy the beautiful outdoors.

Proper fitting cycling shoes are a key component of your cycling gear and can greatly reduce the chance of foot pain or injury. Visit with your local bike shops and learn about the brands offered. Discussing factors such as the amount of use, type of riding, budget along with foot size and shape will help the specialist fit you in the right brand for you.

Cycling cleats are typically stiff soled devices. The advantage is the foot is held securely in place allowing for even distribution of pressure as you complete each rotation and have better efficiency. Your bike should be with you when you are shopping for cycling shoes as the fit is not only important on your feet, it is also important positioning while riding on the bike especially if you select the clip in style cleats.

Hot spots, numbness or burning in the forefoot may be in relation to forefoot nerves. Wearing cycling shoes too tight or too thick of a sock could be the culprit. Typically, those with narrow feet can wear a thicker sock and those with fleshier feet may find comfort with a thin sock.

After loosening the shoes and/or changing the socks yet the issue is still present, return to your specialist for a review of the foot positioning while on the bike. An adjustment of the cleat is sometimes all you need for a better fit. If however the fit is still an issue, it may be a foot related problem. See your local Sport Podiatrist or Pedorthist in your area for further treatment or advice.

Getting the Right Fit

2011-10-03T10:26:00.000-07:00

Tis the season of change from hot muggy temperatures to cooler fall weather. This change brings on the need for warmer clothing and shoes. For most, clothing is pretty easy however shoes can be a completely different experience. To make the most of your shoe shopping, being prepared can help you alleviate stress and give confidence you are buying the right shoes for your foot type.

Here are a few tips to help you get the right fit:

1. Take inventory of your current shoe selection. Are the shoes worn and in need of replacement or repair?

2. How old are your shoes? As a rule of thumb, sport shoes particularly running shoes should be replaced every six months or 300-500 miles. Dress and casual shoes should be replaced on a yearly basis if seasonal or every 8 months if worn every day.

3. Do you wear orthotics? Bring them along when you shop for shoes. This way, you will be able to judge if the shoe will accommodate your feet and the orthotics. Remember, not all shoes are created for orthotic wear.

4. Keep your feet healthy by having your feet examined at least once a year by a Podiatrist.

5. Consider your shoe shopping location. Pulling shoes off the shelf can be convenient however many times; the wrong shoe type is selected. Shop at a shoe store where fitters are available to fit you in the shoes. Ask if there are certified shoe fitters on staff. You will have a better shoe shopping experience working with a person who is familiar with shoe fit.

6. Always have your feet measured each time you shop for shoes.

7. Shop in the late afternoon when feet tend to swell from the day’s activity.

8. Bring socks for trying on shoes. Dress socks for dress shoes, everyday socks for casual shoes and athletic socks for sport shoes.

9. Be prepared to advise the fitter of your activity level, how often you will wear the particular shoes and any style requirements (i.e. business dress code or color requirement).

10. Spend time in the store and walk around in the shoes. If you have small children, consider a babysitter so you are not distracted from making purchase decisions.

Being prepared can make or break your next shoe shopping experience so get ready and have fun!

Love the Right Shoes for Tennis!

2011-09-28T06:23:00.000-07:00

Tennis is a great activity especially for youngsters developing coordination along with cardio fitness. The body movements in tennis required start and stop actions along with side to side movements. Wearing the right shoes for the game is important to overall foot health.

Tennis shoes are much different than running shoes in that tennis shoes have specific qualities to support the foot type and protect feet. Tennis shoes have more cushioning along the sides of the shoe for added stability for side to side movements. To assist in moving players serving to moving up toward the net, the shoes have a thicker sole.

For those starting out in the game, cross training shoes may be an option. If however the athlete progresses in the sport, tennis shoes ultimately would be a better choice.

Running shoes should not be worn while playing tennis. A running shoe is meant for forward propulsion as with the action of running. Running shoes have a narrower base and cannot adequately support side to side movements resulting in ankle instability. Injuries such as ankle sprains, tendonitis, and stress fracture as well as growth plate injuries are common when running shoes are worn for tennis activity.

There are many tennis shoes on the market. First, start by visiting with your local Podiatrist or Certified Pedorthist to know your foot type, shoe size and the type of support needed based on your level of activity.

Next, shop around from local pro shops to sporting stores to try on different brands. Tennis shoes vary based on the manufacturer. The shoes you select should give you proper support and feel comfortable on your feet and not what fellow players are wearing. Remember, your feet are unique.

Based on the amount of play will determine how often you replace your tennis shoes. Anywhere from three to six months is typical. Inspect your shoes weekly for proper wear of the treads. While wearing the shoes, make sure you untie your shoes after use and tie your shoes when putting on the shoes. Tennis shoes should never be slipped on and off as support is weakened.

Keeping your tennis shoes in check will let you feet love the game!

Pedicures aren’t just for ladies….men have feet too!

2011-06-19T18:15:00.001-07:00

More and more men are indulging in pedicures and with good reason. Pedicures can be very helpful with proper nail growth and enhancing overall foot health. Proper nail maintenance can reduce foot issues such as ingrown toenails when properly groomed on a regular basis.

So what does a mens pedicure consist of along with a chance for him to relax? Here are basic steps:

A foot soak.
Buffing of dead skin for callous removal.
Shaping of nails and cuticle push back.
Lotion applied to the foot and calf with massage.
Buffing of all toenails and if desired, clear nail polish may be applied.

It is recommended pedicures are completed on a monthly basis. Many spa menus are now offering male specific treatments with treatment rooms for privacy. Choose the spa location carefully ensuring cleanliness. Look for a location that offers a certified medical nail technician(MNT). MNT’s obtain additional training beyond a nail technician license and are specifically trained in aseptic techniques.

So if you have a guy in your life that has everything.....treat his feet with a men’s pedicure. He along with his feet will thank you for it!

Here's to his foot health!
Janet Dixon, C.Ped.

The Road to Ironman Texas: Part Two

2011-05-25T19:43:00.000-07:00

The race is not officially over until the FAANT girls get their Ironman tattoos!

The Last Road to Ironman Texas

2011-05-25T10:48:00.000-07:00

Follow Janet and Dr Crane on their journey to Ironman Texas in this video

The Journey to a Texas IronMan

2011-05-23T14:53:00.000-07:00

Hi Everyone,

IronMan Texas is officially in the books! Dr. Crane and I both finished a very long day last Saturday of 140.6 miles. Now it is Monday and just this morning, it is hitting me that we both have the title of IronMan.
Was it worth it?
Yes.
Was it hard?
Yes.
Would you do it again? Initally we both stated no. Now that I have slept…well, lets just say I have time to think about it. ;)

I set rules for myself the night before the race: One, keep a consistent swim stroke. Two, hold back on bike speed and keep it consistent. Three, walk the run portion with a consistent stride. The steps were key in allowing me to cross the finish line Saturday night.

The cloud cover truly gave us a break for most of race day. Had the sun been out with the humidity, I will say things may have not been so stellar. The swim start was a little scary since this was my first mass swim start. When the gun went off, I was still on the ramp and was pushed into the water. Two bodies swam right over me. For a split second I thought I was going to freak out, then something inside told me to focus and I fought to get above water and push for space. Soon the swim stroke began, consistent and non stop. After awhile 2.4 miles were complete.

Standing upright after the swim was funny. My left foot wanted to keep kicking however not lift upright to the stair case. I laughed getting up the stairs and then walked/jogged to the transition tent. It was amazing how calm I felt and how the body was telling the brain to just hang out today and let me do this race. Once in the tent, the volunteers were amazing. I can’t for the life of me remember the volunteers names, but let me tell you – they were EXCELLENT! I was assisted from start to finish to prepare for the bike and within a few minutes, I picked up Celeste and off we went on the bike journey.

The first half of the ride was wonderful. The sky was overcast and in pockets, rain fell which was cooling. The scenery was soothing. I held back on the bike speed and just enjoyed the ride. The second half was flat and I was starting to get figity in the seat. I kept rolling through waterstop after waterstop and did not stop all 112 miles. I kept my promise to keep it easy and enjoy every minute.

Rolling into transition two was bitter sweet. I was sad to dismount after a great ride however this was the point where I knew I was going to be an IronMan. After another awesome transition, I was off for a three loop walk. I kept timing pretty consistent and received very large blisters on both feet. I won’t gross you out but walking on a bed of water in your shoe is not an enjoyable task. I stopped at every water stop, high fived the crowds and just smiled.

Last lap I made sure I thanked every volunteer. They had a long day also and each person was spectacular. Walking down the final path, I smiled and tipped my visor to all of the people screaming and yelling words of joy to myself and other race participants. I saw my husband Dennis and held back tears. I heard Sherpa #2, my friend Laurie screaming at the top of her lungs. We hugged and I was handed Ms. Kitty (beanie baby) that I had all through training. I actually picked up my feet and jogged (this hurt a lot) through the finish line and I heard it – Janet Dixon, you’re an IronMan! A friend of mine name Scott was volunteering and waited for me as I crossed the finish line. We hugged and high fived. Volunteers were smiling with one stating I looked so happy. I can’t describe the feeling but I will never forget that moment. Dennis caught up to me after the finish line chute and I just kept smiling.

The next day, the only thing that hurt was my feet and the blisters. My knee was annoyed since I kept rolling my foot out to avoid walking on the blisters. I expected to be in a lot more pain but it was not happening. That tells me I paced myself exactly as planned however, I could have taken in more nutrition before and during the race as I was hungry on the swim and on the run. That’s okay, I finished in time and 10 minutes faster than I anticipated.

So that’s it my friends – the journey has come to a close. I hope it was fun for you. So what’s next? Let me think a bit on that one. ;)

Talk to ya……soon!
Janet, IronMan 2011

Sunburned Feet Can Lead to Skin Cancer

2011-05-15T14:15:00.000-07:00

It’s that time of year again! Lots of my Facebook friends are posting pictures with sunburned feet! Seems like no one ever remembers to apply sunscreen on their feet. Sandal season exposes our often lily white feet to way too much sun exposure. So what about a little sun on your feet? Well, even though skin cancer on your feet is rare, it is often nasty and pretty deadly! Protect your feet with sun screen or you may regret it!

Not all brown or pink skin spots are melanomas, and they are rarely in the feet; but when they are, they are usually nasty! Melanoma is a cancer that begins in the cells of the skin that produce pigment or color. It is often called malignant melanoma because it spreads to other parts of the body as it grows beneath the surface of the skin. Unlike many other cancers, it can strike at any age.

Melanoma that occurs in the foot often goes unnoticed during the earliest stage, when it would be more easily treated. By the time melanoma of the foot is diagnosed, it has frequently progressed to an advanced stage and is quite deadly. Early detection is the key to decreasing the death rate from melanoma.

Who is at risk of melanoma? All of us, but certain factors can make you more at risk: fair skin, especially with freckles, blond or red hair, blistering sunburns before the age of 18, and numerous moles. (Sounds like my entire family, especially the red-head!)

What should I look for? Melanoma usually looks like a brown or black spot on the skin or even under or near the toenails, but occasionally it can be red, pink or even white.

Melanoma symptoms are known as "ABCD".
A: Asymmetry, meaning abnormal and uneven shape;
B: Border irregularity meaning it looks like it had a ragged or blurred edge;
C: Color, usually a mix of colors instead of uniform throughout; and
D: Diameter, melanoma is usually getting bigger where a mole stays about the same. If you have any of these symptoms or a dark spot under your toenail that wasn’t caused by banging or dropping something on your toe, call or contact the office immediately!

Early detection is critical in melanoma! Critical steps towards early detection and prevention include wearing shoes at the beach (flip flops just aren’t going to do it); use sunscreen on your feet; inspect your feet daily; if you wear toenail polish, take it off at least once a month to inspect the nails; avoid sun exposure during the height of the day (Thank God we wear shoes biking and running in triathlon!).

Remember, if you think any spot on your foot or ankle has the "ABCD’s" of melanoma, call or contact the office immediately for a skin and nail inspection. Early detection is the key to successful treatment!

The Journey to a Texas IronMan

2011-05-13T21:09:00.000-07:00

Well folks, at this time next week, Dr. Crane and I will experience the 2011 Texas IronMan course. As expected, time flew right on by and geez, what a difference life has become since we registered for the event back on June 25th of last year.

This week at the practice, multiple IronMan friends stopped in to cast well wishes. Finally today, I felt a few jitters then again, maybe it was the air conditioning. Seriously though, I am now excited on top of curious and it is probably safe to say many participants are in the same boat. So bring it May 21st, there is a course of 140.6 miles to be consumed.

Now we know what it takes to train for a full IronMan. IronMan training takes strength, endurance, determination, speed, risk, power, preparation, perseverance, courage, persistence, dedication and attitude. Let’s not also forget to tack on eating and sleeping!

I am hooked on this sport which doesn’t take a rocket scientist to figure out. I do hope however each week of this blog, you were able to take bits and pieces of this journey and apply this in your life. At the practice, we promote healthy lifestyles which inevitably leads to healthy bodies and guess what? That healthy body includes healthy feet!

If you read this blog then felt the need to go for a walk, a run or make a positive change in your life, then my work here was a success. Knowing you followed along each week fueled me to keep going, so I must thank you for the virtual push. I am in awe of all the twitter followers (we even went international with followers), the wonderful emails and facebook posts. After next weekend, I promise to update you on the event then we move forward with a new twist to this blog...but more on that later.

Talk to ya next week after IronMan,
Janet

The Journey to a Texas IronMan

2011-05-06T13:00:00.000-07:00

Hi Everyone,

“The taper” has arrived. In a nutshell, taper means to reduce the training volume while maintaining or in some cases slightly increasing your intensity. So for months, the muscles have been broken down then rebuilt. You would think I would be all over the fact I get to have a breather and rest up before the race….not so fast.

It was exciting to see another day off added to my weekly workouts. It turns out the extra day off replaced sweat with guilt. I kept thinking I needed to workout! I stared at Celeste, the super tri bike. I walked around the house looking to clean something however the housekeepers already took care of that for us. So I did my best to “taper” by playing with the dogs and have conversations with the members of the household who were also surprised at my being at home. I thought to myself, what the heck am I going to do post IronMan? Instantly, my mind responded “plan the next IM silly”. I thought that was a pretty cool response.

The goal for the next two weeks is to stay healthy and don’t over do things. I really hope I am prepared enough to finish this race. Finishing 140.6 miles before the cut off is the goal and trust me, I take nothing for granted. I made myself stop following the strings of online comments about the race, the route and the weather. Let’s face it, Houston in May is humid and hot, the lake is shallow and turns into a canal, and the bike route is pretty flat which can be mentally challenging (I actually like hills now – nutty eh?). Considering I cannot change any of the above, all there is to do is roll with it.

Am I nervous? In all honesty, my answer is no. If anything, there is curousity about race day. A lot of patients and friends stop in to check on me and I hear repeated feedback of how relaxed I am about the race. I can’t figure out why I am not nervous. Then again, I have busted my tail over the past year so maybe it’s a way the body is telling me that we will be good on race day. I like that and I like the fact others are feeding off my calmness throughout the work day and at home. So if you would, do me a favor and keep your fingers crossed the calmness stays through race day and beyond.

Talk to ya next week,
Janet

You Know You Are A Triathlete When?

2011-05-02T18:40:00.000-07:00

The following is a reprint from my blog that I couldn't help posting to Janet's blog for her followers. I have had a running gag going for the last few years on and off on my website and it makes up the last chapter of my book. “You know you are a runner when….” Lots of my friends contributed to the list from 2008 to late 2009, when we published the first book…. I felt it was fitting to add this year, especially since Janet and I are less than three weeks away from Ironman Texas, “You know you are a triathlete when…” Feel free to send comments back and I will add them to the list. This inaugural list was compiled by Janet and I emailing each other and drinking wine at the same time. Please do not be offended and you are required to laugh. If you do not get it, you need to ask a triathlete……

You know you are a triathlete when…

You think it’s normal to wear spandex 24/7.

You can blow your nose while on the bike without using tissue. (runners call this a snot rocket)

You know the psi needed for your tires, yet can’t remember the garage door code.

You have found even more areas to apply body glide you didn’t think were possible.

You have no problem loaning body glide or chapstick to a triathlete you don’t even know.

You come to the realization there is justification for public nudity in transition, and you are OK with it.

You feel that receiving a drafting penalty hurts worse than a tax bill.

You think swimming through pee is not so bad, and you pee often in your wetsuit and/or in the lake.

You contemplate how to pee on the bike when riding, and you are a girl.

You can speed on your bike, eat a gel and yell “on your left” to a pedestrian or other cyclist, all at the same time.

You put your helmet on backwards leaving transition and don’t want to stop and fix it because it takes too much time.

You think it’s sexy to have your race number sun burnt into your calf and show it off like a badge of honor.

You have worse tan lines than a farmer’s tan.

Your cycling race wheels are worth more than your neighbor’s car….or your car.

You realize flatulance is pretty funny in a wetsuit and warm on cold swim days.

You plan for your first Ironman tattoo before you even sign up for the race.

You press your race bibs with an iron and file or display for future admiration.

You find yourself yelling “on your left” as you pass other carts in the grocery store.

You find that a six hour bike ride is a warm up.

You wash your bike more than you wash the dog.

You look forward to aging as this will be your only way to stand on the podium in an older age group or qualify for Kona.

You realize you look like a squid or a sperm in your aero helmet and kinda like it.

You realize salt tablets on hot race days are like crack for triathletes.

You conveniently happen to have your race medal on you at work for “show and tell”.

New tri gear websites make you salivate.

You’ve been known to check your Training peaks log even more often then your email on your IPhone.

When you start to think it is normal to go to bed before 9pm and get up at 5am.

You can’t remember the last time you slept in past 6 am on a Saturday.

You rationalize that somehow it’s not completely crazy to try the first open water swim of the season when the lake water is only 58 degrees.

You own at least ten swim suits, five pair of goggles, a dozen bathing caps, swim fins, a pool buoy and at least a wet suit and speed suit if not two.

You have an entire chest of drawers full of running and biking clothing; but still shop for more practically weekly or even daily.

You have more pair of athletic socks with “wicking action” then you have pantyhose or dress socks.

You own more than a dozen pairs of running shoes and can justify why you need each and every one.

Your inventory of hats and visors equals your running shoes or greater.

You have at one time documented and tallied everything you eat or put in your mouth, even a tic-tac, in order to evaluate your nutrition even though you are at least 20 pounds under your “ideal weight”.

You have a plan “A”, plan “B”’, and a “try not to die” race plan.

You start to think an Ironman is not such an insurmountable challenge and start figuring out how you can qualify for Kona.

You regularly have to explain that you are not a victim of domestic violence, those are just your “crash bruises”.

Your biggest fear is skin cancer even though you practically bathe in sunscreen.

Even your kids start to think they have to swim, bike or run just to spend quality time with Mommy.

You have more water bottles than wine glasses in your cupboards.

Your refrigerator has more protein shakes and Gatorade in it than milk or soda.

You have a following on Facebook that lives vicariously through your training and racing ups and downs.

You have peeps that you feel like you have known forever through training, but they may not even know your last name (or your first, come to think of it).

Blisters, chaffing, road rash and sunburn (an the occasional broken toe) are just a minor annoyance.

You show off your peeling sunburn and chip holder tan line on your ankle with pride on the Monday after a race.

All of your t-shirts say things like 70.3, 140.6, etc…and you have at least 100+ you can’t part with.

When you wake up in the morning with every muscle and joint in your entire body hurting and think, “I had a great work out yesterday”.

When you know the exact distances that make up a sprint, Olympic, Half-Ironman, and Ironman race segments by heart and keep explaining to your friends that they are not all an Ironman and not all in Hawaii.

When your workouts have taken the pace of any kind of social life.

When you cross the finish line of your first triathlon.

Smile…..and add to the list!

Dr. Scholl's Inserts...Deal or Dud?

2010-07-05T18:11:00.000-07:00

So is the kiosk in Walmart touting “revolutionary footmapping technology” really a good product? According to their advertising, this technology identifies unique foot pressure points and arch type, then suggests a “Custom Fit Orthotic”.

Where do we begin! Let’s start with the “revolutionary footmapping technology” part. This machine has you step on a computer mat and senses high pressure areas. But it doesn’t know if those high arch feet when standing still collapse like a pancake when walking. So the fancy machine suggests an insert with a high, firm arch. Once that patient starts walking with the large rock like thing in their shoe, and their arch collapses against it with every step, what pain they had before is then replaced with a brand new one!

Let’s move on to the “Custom Fit Orthotic” part. There is nothing “custom fit” about this process. A custom fit would require not only dispensing an orthotic made directly from a mold or 3D impression of both feet, but also a biomechanical exam including gait analysis. This is what allows a patient to wear an orthotic that is made specifically for their foot type AND gait pattern.

There are people who will find these type of OTC inserts comfortable and can have pain relief. But the majority end up in our office with more pain then when they started.

At Healthy Steps, we offer the same footmapping technology, but also combine that with the expert advice from our certified pedorthotist, Janet Dixon. We make sure you are getting the best product for your foot and your lifestyle.

Soapbox...no. Wanting the best possible for our patients...yes.

The Journey to a Texas IronMan

2010-07-02T11:27:00.000-07:00

So we are over the shock of enrolling for the race, now it’s time to get down to business.

During one of our training rides, someone who shall remain nameless for now…and it was not me, started the cycling out great. At one point, I checked to see we are still in a group and notice we are down one. Turning around, we head back and low and behold only twenty minutes into the ride, we have a flat tire. Puzzled we stare at each other and think jeez – we have not dealt with this in any race or ride. So who knows how to change a tire? We did not.

Naturally we turn to the male rider of the group and stare which in turn he stares back hinting he is not about to change the tire and we are going to have to change this tire ourselves. Better yet, it’s not my bike so I immediately offer to hold the bike while the tire is changed. I am a smart one I tell you.

After all is said and done, we have one person with more grease on the hands and legs than on the bike and one successful tire change.

Toward the end of our three hour ride, we encountered grasshoppers on the road. I don’t know how this happened and I am sure the grasshopper is still trying to figure this out but the little guy flew at me landing through the air vent of my helmet and on to my head. So I found out the brakes on my bike work quite well and I have definetly improved my helmet removal time which ought to cut time in transition. After flicking the little guy out of my hair, the helmet was back on and off we go to finish the ride.

The rest of the week was typical for training. One morning of open water swimming equaling just over a mile, two evenings of indoor pool workouts, and mix in some running and cycling. I typically have one day off a week from training and that day is Friday.

As far as dietary changes, I gave up soda over a month ago and drink –A LOT- of water. I am trying to make small improvements in my diet over time rather than a shock and awe campain. I even gave up chocolate…I mourned that loss for a good week or so.

So that’s it for this week. By the way….check out this pic – Dr. Crane changed the tire….grease and all.

2010-06-27T18:10:00.000-07:00

In previous blogs, you have heard from our Doctors along with myself discuss proper foot care, shoe gear, biomechanics and pretty much everything to do with your feet.

So we decided it is time to change things up a bit. I am inviting you along with friends and family to take a journey. Each week I will be updating you on the trials and tribulations associated with a “task” we elected to do for the next 11 or so months. The task is completing our first full ironman distance race to be held on May 21, 2011 at the inaugural Texas Ironman.

It is our hope as you read this blog you think about not only your feet but to also think about what you can do to live the healthiest life. We hope to inspire you as well as have a few laughs along the way. Alas, the journey begins!

The Journey to a Texas Ironman…..
by:Janet Dixon

So Dr. Crane pops over to my desk last Thursday and with a smile says “Guess what you are doing for us tomorrow morning?” I reply back to her “What am I doing for us tomorrow morning?” She replies “You are enrolling us in the Texas Ironman”. I freeze and again try to understand how the human stomach can literally fall all the way down your leg and wind up in your big toe. I am sure I looked at her with a get out of town look. I sat at my desk bewildered. How I am going to complete a 2.4 mile open water swim, 112 mile bike ride and a 26.2 mile run all in the same day?

For the rest of the day and night, in the back of my head questions of can I do this or will I be strong enough to go a total of 140.6 miles or really…Me?? After much discussion with previous Ironman finishers, a lengthy conversation with my triathalon coach and my family the air began to clear. The race date is May 21, 2011 which is just under a year from now. Sure I can finish….gulp!

I wake up Friday morning nervous actually it was more like scared straight. Of the folks I am to enroll online which includes myself I receive text messages and notes not to be late – I have to be online ready to enroll at 8:00am. So here I am sitting at my desk – READY! I attempt online registration with an immediate response to try again later. Thinking this was an obvious sign, I soon realized the registration opens at 10:00am pacific and that would be noon central time zone. Jeez, the group is so wound up no one realized the correct time to enroll including myself. ;)

Eventually the noon hour strikes and once again I am online. After filling in online forms, we are registered for the 2011 Inaugural Texas Ironman! Whoo-hoo! Word spreads like wildfire and folks are either in complete support or believe we have lost a majority of our gray matter.

It’s going to be okay……right? Next week we start reporting on our training, I already have a few "incidents" just from this weekend. Stay tuned! ;)

Ah, now it’s the shoes that can rid you of body fat….……

2010-06-06T16:04:00.000-07:00

Lately, you may have seen an influx of advertisements regarding shoes to help you lose weight, tone and firm. So much for the magic pill to achieve perfect thighs, abs of steel or that healthy glow. Now the rage is a pair of shoes. Really?

Many people may think if the product is advertised in fitness magazines or blasted on every channel that this just might be the answer to lose unwanted pounds. Well folks, it does not. If you are looking to lose weight or tone up, your diet and activity level are what you need to focus on and not a pair of shoes.

What the shoe manufactures have done is taken the rocker bottom sole that has been around for ages and are spinning them as the weight loss answer. Rocker bottom soles purpose is to offload areas of pressure. Here are a couple of rocker bottom examples and the intended use:

Forefoot Rocker Sole:

In this style, the foot is propelled from the metatarsal head forward. It is utilized to reduce pressure on the ball of the foot along with forefoot joint issues such as bunions.

Heel to Toe Rocker Bottom Sole:

A heel to toe rocker bottom sole limits ankle and midfoot motion. This style can be particularly helpful if you have ankle arthritis or midfoot arthritis.

So where do you find rocker bottom shoes? Consider the Dansko line of shoes. They are available in stores and online. Also, many shoe repair shops can add a rocker bottom to your existing shoes.

Brands currently pushing the weight loss and toning are MBT, Sketchers and now New Balance. You may wish to try all the brands listed to see if the shoes do assist you in relieving pressure areas however look past the fancy marketing of shaping and toning.

So remember, to lose weight you need to stick with the basics. Eat right, exercise regularly and get plenty of rest. That is what your body really needs.

Healthy Steps…..for your feet…..for your life!

Where you receive your therapeutic shoe gear matters.

2010-05-02T19:14:00.000-07:00

Each year, thousands of people receive shoes and inserts via the therapeutic shoe bill. Medicare patients with part B coverage who are under the care of a Physician for Type I or Type II Diabetes and have one or more of the required conditions can receive approved diabetic footwear and inserts each calendar year.

While this benefit is available, there are unfortunately suppliers whom improperly bill or provide less than adequate shoe gear. So who do you trust your feet or your loved ones feet to offer appropriately fitting shoes and inserts? Here are a few tips to guide you:

Consult your Physician or Podiatrist for a resource. Many Podiatrists have shoes onsite or can offer you a referal along with a perscription for obtaining shoes and inserts.

Avoid mail order programs. The final fit is crucial to ensure an appropriate fit. Both feet need to be measured along with a review of each foot in consideration of accomodations for appropiate support. The shoes must be issued by a Certified Pedorthist, Orthotist or Podiatrist.

Patients living in skilled nursing facilities may have a person who will fit patients in the facility. Ask who is completing the fitting? Are they certified? Who will check to make sure the fit of the shoes and inserts are appropriate?

More and more you will see Podiatrists and Certified Pedorthists working together to solutionize your shoe gear needs. The medical expertise of your Podiatrist along with the fitting expertise of a Certified Pedorthist are proving to offer patients a safe and proper fit of protective inserts and shoes.

If you are referred to a therapeutic store location, facilities are now required to complete an accreditation process in order to bill Medicare for therapeutic shoes and inserts. This process must be completed every three years to ensure compliance. The accreditation requires standards that are grouped into categories and include topics such as:

organizational process
patient care
performance management
product safety
facility safety and supplier compliance

Each of these categories contains multiple standards unique to the specific type of accreditation an organization is seeking. For more information on accreditation, access www.abcop.org.

Accreditation is a privilege and can be revoked at any time. Once a location has been revoked, the location has sixty days to correct inadequacies then be reinspected. During this time, the facility will not be permitted to dispense therapeutic shoes and inserts and bill Medicare.

So the next time you or someone you know are in need of therapeutic shoes and inserts, do yourself a favor and ask questions. You have two feet – protect them!

Cutting the Grass

2010-04-06T18:43:00.000-07:00

Spring is here and for those who love lawn and gardening care, it’s time to cut the grass!

After tuning up the lawnmower and the edger…. off you go to play with the lawn. So what do feet have to do with cutting the grass? Actually, quite a bit if you wish to continue your drive for the greenest lawn on the block. Below are safety tips for your feet during the lawn and garden season.

If you store your lawn and garden shoes in a garage or pantry, check the inside of the shoes prior to placing them on your feet. Small rocks even bugs amongst other things may quietly reside in your shoes. In particular, those who have a loss of feeling in their feet should be diligent in checking the inside of their shoes. Remove the internal liner of each shoe and feel the insides of the shoes…you might be surprised what you find.

Always wear shoes or work boots when mowing. Far too many severe foot injuries occur from lawn mower blades in part to wearing inappropriate shoe gear. Never wear open toe shoes such as flip flops or even worse, walk barefoot pushing the mower across the grass.

Wear socks with your shoes. As the summer temperature heats up so will your feet. Wearing socks will reduce the chance of blistering while working outdoors. If you still tend to have blisters on your feet even with socks, have the fit of your shoes checked to make sure they are adequate. Use anti chafing products such as body glide or similar that can be applied to the feet prior to the days activities. Using such products will greatly reduce friction yet still allow skin to breathe unlike Vaseline or other pore clogging products.

Make sure the shoes you are wearing are not old tennis shoes from last year. Even your lawn and garden shoes should provide support and protection from challenges such as uneven ground, pesky insect bites and sharp blades. If your shoes are broken down, consider donating the shoes at your local shoe recycling programs then purchase appropriate fitting shoes dedicated to yard work.

Remove debris from the shoes such as mud by rinsing with cold water. Caked on mud can limit the flexibility of the shoes. Shoes should be completely dry prior to wearing for the next lawn encounter.

When you are finished with your lawn tasks, remove your shoes and socks and rinse off your feet. Eliminating debris accumulated from a days work in the yard will prevent you from dragging in pebbles, dirt and maybe even a few other little critters into your home and prevent your feet from further trauma.

Taking care of your feet is something you need to do each and every day no matter what the activity. Following smart, simple tips for your feet will allow you to enjoy the seasons activities.

Happy Gardening!

Are you wearing the Correct Shoe when Exercising??

2010-03-31T09:43:00.000-07:00

Commonly I find myself having the same conversation with my patients and even my friends and family. We will be talking about exercising, or maybe sports that we play and someone will complain of their foot hurting. It might be arch pain, ball of foot pain, toe pain, tightness, or even just tired feet.

Most people do not realize that just because you are wearing a "name brand gym shoe" you may actually be wearing a shoe that is very wrong for your foot. I remember when I was younger, had not been to school and educated about different types of shoes I would walk into a shoe store and pick my new shoes by the look of the shoe or the color of the shoe. I would think to myself, I love purple I want that shoe.

Here is the problem:

All brands of gym shoes make shoes that are structured for different foot types. There are four main categories:
Neutral, Stability, Motion control, and Walking shoe.

Each shoe is made for a specific "foot type". Lets say you are wearing a asics shoe that is a neutral, but you pronate during the gait cycle... this could lead to a lot of foot issues.

You are probably thinking.. How do I know which foot type I have.

Most running stores now have trained people that are able to evaluate your gait and determine if you are wearing the correct shoe. If you are having pain in your back, legs, or feet your best option would be to see a Podiatrist. They are able to evaluate your gait cycle and your biomechanics and help you find the correct shoe for your foot type.

Are Orthotics Just An Arch Support?

2010-03-27T12:52:00.000-07:00

Lots of patients in our Grapevine, TX office ask, "What is the difference between an orthotic and a simple arch suppoprt? Why should I spend that much more money when I can go to Wal-mart?" This is a great question with a simple, but yet complex answer.

As opposed to an arch support that can be purchased at many stores, an orthotic has some distinct advantages:

1. Orthotics are designed to last for years, instead of months from an arch support.

2. An arch support (and most shoes) are designed for the average foot, but an orthotic is custom made for your foot.

3. Although an arch support will provide support to the arch, the orthotic supports the entire foot and cradles the heel.

4. An arch support may flatten with running or increased pressure, where an orthotic will be firm and maintain the position of the foot.

5. An orthotic actually improves or optimizes walking or running patterns by rotating the foot into "neutral position". In this position, the foot functions at the highest level.

Bottom line: If your doctor says you need a custom foot orthotic, there is a distinct performance difference between an orthotic and a simple arch support. Believe me, your feet will thank you!

That thing to measure your feet....

2010-03-04T08:59:00.000-08:00

When you shoe shop, are your feet measured each time you enter the shoe department? Most likely, the answer is occasionally to never. When you shop for shoes, insist on your feet being measured for there is good reason! Plain and simple, your feet change in shape and size. Wearing the wrong size shoes whether they are too small or too large in length and width can drastically affect your foot health.

The tool used to measure your foot has quite a history. The Brannock device has been in use since 1927. Developed by Charles Brannock, it is the most widely used instruments in measuring feet to this very day. The device is made in different colors of green, purple, red or black with each color representing a specific foot such as Men, Women and Children. There are also Brannock devices for Ski Boot and Athletic shoe options.

When Mr. Brannock released his invention, no one else could match the shoe fit. In a short amount of time, word traveled of the exactness of the device. During World War II, the Army hired Mr. Brannock to ensure that boots and shoes fit enlisted men. From that request, he expanded his manufacturing facilities to allow his creation to service proper shoe fitting nationwide.

The Brannock device has an accuracy rate of ninety five to ninety six percent. Based on a linear size system, the difference in each size marker on the device is approximately 1/3 inch. For example, a Men’s size one is seven and two thirds inches. Each additional size is one third inch longer.

Measurement of width on the Brannock device works the same way. Each marker for width is separated by a distance of 3/16 of an inch. Nine widths are offered in the U.S. system and vary according to foot length. The widths are: AAA, AA, A, B, C, D, E, EE, and EEE.

You owe it to yourself to shop in a location where a representative assists you in fitting shoes in lieu of selecting shoes from a display on your own. Never measure your feet by yourself as the tool is designed for a trained representative to measure your feet. Once your feet are measured, ask the representative for the length and width of each foot. You may be surprised to learn your feet may differ in size and that my friend is OK. The key is the shoe size you receive will be based on the longest and widest foot.

So now you know about the Brannock device...now go get your feet measured!

Posterior Tibial Tendonitis

2010-01-31T16:43:00.000-08:00

May people have begun a vigorous exercise program to start their New Year’s resolution of losing weight and getting in shape. But with this, comes unexpected pain that stops the workout sessions and ultimately prevents them from fulfilling their goal.

Pain along the inside of the ankle that extends to the inside arch is often due to strain of the posterior tibial tendon. The main job of this tendon is to prevent overpronation of the foot and stabilize the arch and ankle. Overuse of this tendon, particularly in people with flat feet, causes the tendon to swell and become painful so that exercise activity is not possible. Ultimately, this type of injury can lead to tear of the tendon and possible surgery. The pain is often sharp, stabbing and radiates along the course of the tendon. Often the entire ankle will be swollen.

Treatment for this begins with rest. This doesn’t mean you have to stop exercising, but no weight bearing exercise until the pain subsides. Ice daily and apply compression to reduce swelling. When pain is gone, then gradual return to an exercise program with appropriate shoes and brace as needed. A complete lower extremity exam will help determine what types of shoes are best for your workouts and what type of inserts can prevent recurrence of the pain. Often with flat feet, custom orthotics are the best devices that support the ankle and arch and prevent overpronation, thus reducing the likelihood that the pain will return.

If left untreated, posterior tibial tendonitis leads to tear of the tendon and often extensive foot and ankle surgery. It is best to treat this pain as early as possible.

Missing toenails?

2010-01-31T11:50:00.000-08:00

Believe it or not, spring is just around the corner and that means warm weather shoe styles will soon appear. Sandals are a welcomed vision letting you know the cold days of winter will soon pass. For others however, sandals or open toe styles can be a challenge especially for those who are embarrassed by missing or damaged toenails.

There is good news for those with toenail woes. Thanks to new technology, damaged and missing toenails can be a thing of the past. Our Certified Medical Nail technician (CMT) can create a removable event nail or apply a safe prosthetic layer over existing damaged nails. The results are the appearance of a natural nail that can be painted with regular nail polish if the patient desires color on the nails.

Prosthetic Toenails are a great solution for those dealing with:
Dystrophic Nails
Misshapen Nails
Horizontal plate ridges
Spoon shaped nail
Damaged nail
Brittle and splitting nails
Post Onychomycosis or In treatment
Shedding nails

So what is the difference between acrylic nails obtained at a local nail salon versus prosthetic nails applied by a CMT?

Prostetic Nail Gels do not contain harsh chemicals versus acrylic nails such as:
HEMA (2-hydroxyethyl methacrylate) known sensitizers: Methyl methacrylate, Acrylic acid, Methyl acrylate, Ethyl acrylate, Ethyl methacrylate, Bisphenol A-glycidyl methacrylate, n-Butyl acrylate, 2-Hydroxypropyl, Methyl 2-cyanoacrylate, and thyl cyanoacrylate. Quite a mouthful eh?

Prostetic nail gels are natural-looking, while light and non-porous, providing a beautiful nail you will enjoy wearing. The gels are appropriately flexible, though strong, and thin to provide a natural appearance.

The UV light utlized during the nail creation process is state of the art and maintains the correct cure distance important to fully polymerize the product. It also allows the foot to be easily placed under the light, and has 4/9w bulbs inside, equaling 36w of light for maximum curing. The lamp cover also protects the eyes of the practitioner from exposure to UV rays.

At Healthy Steps spa, our nail specialist staff are certified MNT. The certification is obtained after study and successful completion of nail creation, application and testing.

In about an hour, the nail will be created, applied and ready for wear. This painless procedure takes place right in our spa so you can relax and let your worries of ugly toenails be a thing of the past. Most clients request a pedicure during the appointment for beautiful open toe shoe ready feet!

Now cveryone can enjoy beautiful toes year round. For more information or to schedule an apopintment, please contact us at Healthy Steps.

Healthy Steps
for your feet...for your life!

2010-01-12T14:54:00.000-08:00

Study Finds Women Wear Shoes That Cause Pain:

Women really love their shoes, and I can relate. There is nothing better than buying a new pair of shoes. They make you feel sexy and confident. And shoes always fit; even after weeks of holiday eating. But do they have to hurt??

There is a new study that correlates chronic foot pain and shoe choices. It questioned a group of women about their shoe choices past and present. Researchers found that smart choices paid off in the long term: women who had mainly worn supportive shoes and sneakers in their younger years cut the risk of common foot pain later in life by more than half!! Women who had chosen high heels, pumps and sandals were at a greater risk of the most common foot problems that occur including Achilles tendinitis, bunion pain, and ankle/rear foot pain.

So what does this mean? Am I stuck in gym shoes or ugly shoes for the rest of my life?

I think that this study is eye opening. Most women don't realize that you can be smart about the shoes that you pick to wear and that they don't have to hurt. Don't get me wrong. A 5 inch heel is not a good fit for anyone, but there are plenty of shoes available these days that are both sexy and practical.

Look for shoes that have a wedged heel, or a 3 inch heel. Toe box space is important, if it is to narrow you run a risk of damaging your toenails as well as your toes. A specialty shoe store will also more likely have shoes that can accommodate foot deformities and will be more supportive. Most important save the killer shoes for the times you really want to wear them like a special occasion. All other times be practical and choose a gym shoe that has stability and support.

Resolve To Own the Right Shoes!

2010-01-01T08:14:00.000-08:00

2010 is upon us – Happy New Year to all!

As we reflect on the old and look forward to the new, many of us have to do lists or even resolutions in mind. We are over the hump of the holidays and for many, thoughts are driven to think about goals, losing the holiday weight, and paying off debt. Typical of each holiday season now isn’t it?So lets think of something a bit different from the norm.

Think about your feet in the new year. Once you finish reading this article, send it to people you know then shut down your computer. Proceed to that ominus room in your house – your closet. You will need an open mind, a piece of blank paper and a pencil or pen.As you flip on the light to your closet, what do you see? Are there shoes lined up like soldiers or are they piled up like a bunch of old laundry? Are they residing in a organizer protected from the elements or can you blow off last years accumulation of dust bunnies?

Shoes need protection from the elements. To maintain your shoes appearance, you should have a shoe care kit consisting of cleaners for various shoe materials, clean soft cloths and applicable shoe polish. If your shoes are not protected in a shoe organizer, consider shopping for one that will protect your shoes and also allow breathability for the shoe materials.

Next, it’s time to take inventory of your shoes…

Athletic shoes
What do your athletic shoe look like? If you wear them daily and are more than six months old, consider donating them in lieu of throwing them away. Athletic shoes, particularly running shoes have a life of approximately 300-500 miles or six months. Wearing athletic shoes that are broken down can lead to foot health issues.

Dress shoes
Ah, now this is can be a touchy subject. Do you have sore feet after a day at the office or an evening event? Here is an exercise that may help you understand why:
Outline your foot on a piece of paper with a pen or pencil. Place your dress shoes over the outline. Trace an outline of your shoe over the foot tracing. Do you see any tracing of your foot? Hopefully you do not but odds are, especially for the ladies, you may see your foot outline much wider than the shoe outline. Think about it, if your foot, particularly the forefoot is squished into your favorite dress shoes, could this be the reason why your feet hurt thus leading to pain in other areas of your body?

The answer is yes – it’s hard to accept but yes….you need better fitting shoes!Shopping for well fitting shoes is not as hard as you think. Sure, you may need to shop around a bit but once you have the right shoe for your foot, it will truly make all the difference. Have your feet measured at least once a year. Feet change whether you choose to accept it or not. Here’s another tip, once you find the right fit, buy a few pair versus just one. The investment will be worth it long term.It’s time to let go of ill fitting, worn down, incorrectly sized shoes and ring in the new year with properly fitting shoes.

You CAN part with ill fitting shoes no matter how cute they are….remember “if the shoe doesn’t fit, you must aquit”. As you say goodbye to the old shoes, take a picture of them. Later in the year, as your feet feel great, pull out the pictures. Relish in your poor shoe investment then look at your feet. Saving your feet is the right thing to do!

Over the Counter or Custom...what do I do?

2009-11-10T13:08:00.000-08:00

Many patients and customers ask what exactly is the difference between an “over the counter orthotic” otherwise referred to as a “foot insert”, “foot correction device” or “foot cushion” versus custom foot orthotics besides the vast difference in price.

Over the counter (OTC) orthotics are items that are prefabricated and do not require a prescription. If you are having initial foot pain and shoes that are correct for your foot type have not assisted with your foot issue, OTC orthotics may be of help.

From therapeutic shoe stores, running shoe stores to super centers, chances are you will see a vast selection of over the counter options. Are OTC’s effective? Yes, they can be as long as you have the right type of orthotic to work in concert with the right shoes for your feet.

While you can attempt to purchase over the counter orthotics on your own, it is highly recommended you work directly with a professional such as a Podiatrist or Certified Pedorthist to determine the level and type of orthotic for your feet. Once the OTC orthotic is in the shoe and on the feet, a gait evaluation completed by a professional is important to ensure the orthotics addressing your foot issue. In some cases, accommodations can be added to an OTC by a professional to further tweak the amount of correction.

If after a period of time you are still experiencing foot issues, custom orthotics maybe a consideration. A custom orthotic sometimes called a total contact insert is a custom made over a model of the foot. The orthosis achieves total contact with the plantar (bottom) surface of the patient’s foot.

A properly custom designed orthosis can:
Relieve areas of excessive plantar pressure by evenly distributing pressure over the entire plantar surface.
Reduce shock through the use of shock-absorbing materials.
Reduce shear since the total contact minimizes horizontal foot movement.
Accommodate deformities with the use of soft, moldable materials in the shell.
Stabilize and support deformities and limit joint motion.

First, meet with your local Podiatrist for a complete foot exam. If a decision is reached between your Podiatrist and yourself for you to receive custom orthotics, an actual cast or a high level foot scan is completed for custom orthotics. A foot scan is beyond what you will see in a retail environment as the Podiatrist or Pedorthist utilizes specialized software programs to adjust the amount of correction or offloading pressure areas of the foot. In most cases, the scan or custom casts are sent out to a laboratory for processing. The normal turn around time is anywhere from 2-6 weeks depending on the lab volume, amount of correction or special materials requested for your custom orthotics.

At Healthy Steps, we utilize both traditional casting and electronic scanning methods. Stop in and visit with our staff to learn more about our in store solutions for your feet!

Dark callus in a diabetic patient leads to amputation

2009-10-18T15:09:00.000-07:00

I was consulted on a diabetic patient in the hospital last week who was admitted because of a foot infection. They did not know how or why the foot infection came about, only that there was a dark callus on the bottom of their foot for at least a month. They didn’t think anything of it until the foot became red and swollen, then within 24 hours there was significant drainage from the callus, redness that streaked up the leg, fever and flu-like symptoms. They also noticed their sugars running very high. This is what brought them to the emergency room. And it was this draining callus that caused me to amputate part of this patient’s foot the very next day. What was this dark callus and why did it have to end up with losing part of the foot?

With diabetes comes the loss of sensation called neuropathy. And with this comes the inability to feel increased pressure on the bottom of the foot. With this increased pressure to prominent areas, like the ones found under the big toe joint, comes callus formation. If the callus turns dark, that means there is enough pressure to the area to cause bleeding under the skin. This bleeding is what causes the callus to be dark. Any callus that goes unchecked in a diabetic patient with neuropathy can become soft underneath allowing the skin to breakdown and form an open hole called an ulcer. This can become infected, thus leading to possible amputation.

Let’s go back to the patient in the hospital. When I asked how long the callus had been there, the reply was uncertain, “maybe a month”. Daily foot inspection is the number one thing you can do as a diabetic, neuropathy or not, to save your feet. If this callus had been evaluated as soon as it was discovered, he would not have lost part of his foot.

When asked about their last podiatric foot check, the patient responded that they had never seen a podiatrist before, their regular doctor checks their feet every 3-6 months. The next step to saving your feet is to see a podiatrist on a regular basis. Although it is very important to see your primary care physician or endocrinologist (diabetic specialist) to keep your diabetes in control, it is equally important to see a podiatrist. The best thing you can do for your feet is be educated on how to save them. When I explained why I had to amputate part of the foot and how it all came about, the patient said, “If I had only known about that stuff, I would have seen you sooner”.

So why did I have to cut off part of this man’s foot? Once the soft skin under the callus starts to break down, it can become a liquid like goo of bacteria the becomes infected. With a very small opening or crack in the skin, more bacteria can enter thus setting the stage for a really bad infection. The problem is there is no where for this drainage to escape so it starts to eat away at the tissues next to it, working its way to the bone. Once the bone is full of bacteria, the best way to save the foot and usually the entire leg, is to remove the infected bone so it can no longer harbor bacteria. IV antibiotics will reduce the bacteria swimming in your blood stream from the infected foot and hopefully prevent even more bad things from happening.

Once he heals the surgery site, he will be able to walk like a normal person with a special insert inside his shoe. And now he is better educated and understands how important it is to check his feet every day and see me on a regular basis. If he sees anything that looks like a callus, he knows to call me right away. Very simple, but very important.

Getting back to normal after ankle sprains

2009-10-18T14:40:00.000-07:00

You’ve sprained your ankle and it hurts. You’ve put ice on it and it still hurts. You are using crutches and it still hurts. You even wrapped it with an ace bandage. Now what? Ankle sprains are painful. And the worse the injury, the more the pain. But understanding how to rehab ankle sprains can greatly reduce the painful time and get you back in action sooner.

Most ankle sprains occur during sports activity when the foot is twisted on the leg. This causes the ligaments around the ankle to be stretched or torn, thus causing swelling, bruising and pain. Fracture of the ankle bones can occur as well.

First things first…stop your activity, rest and apply ice as soon as possible. Elevating the leg and wrapping the ankle with an Ace bandage will help control the swelling. If you cannot walk without significant pain, use crutches. Taking anti-inflammatories like aleve, advil or ibuprofen with help with swelling and pain. If your pain does not drastically improve over 2-3 days, a visit to your local podiatrist is next. If the sprain is severe, seek immediate treatment at a local emergency room.

So what are we looking for when you come in our office? First thing we want to know, “did you break a bone?”. If not, then our next step is getting that ankle moving as quickly as your pain tolerates to reduce instability of the ankle.

Rehabilitating an ankle sprain is the most important part of getting back to normal. This starts with home range of motion exercises, rest and wearing proper shoe gear. Notice I said nothing about returning to high heels or flip flops! Next, expect ankle pain to be present 3-6 weeks depending on severity, but this can be lessened by attending physical therapy.

Professional physical therapy services provide multiple modalities that can reduce your pain, increase your range of motion and increase your ankle stability, thus reducing your likelihood of another ankle sprain. Physical therapists can perform things like ultrasound, cold laser therapy, positional joint release and deep massage to help get you back to your old self again. Often ankles that have previously been sprained and require surgery several months later, did not properly rehab after the initial ankle sprain.

If you just injured your ankle, don’t wait months for it to get better. Start the rehab today. The physicians at Foot and Ankle Associates of North Texas are happy to help you in the process.

Plantar Fasciitis

2009-10-06T10:16:00.000-07:00

“I work out and my heel hurts.” “I run and I am fine, it’s afterwards, my heel hurts.” “I stand all day at work and my heel hurts.”

Some of you may be familiar with the above statements. Some of you are looking for the quick fix, the magic stretch or device to make the “hurt” go away. I hear this a lot from customers and patients of the practice who visit me at the store. It is hard to see the look of despair particularly of runners who want to eliminate this “hurt” they cannot seem to control themselves. When a patient is diagnosed with Plantar Fasciitis from their Podiatrist, they are in a frantic search to make the pain go away fast. Rightfully so as they want to get back to life prior to the diagnosis.

So lets review exactly what this is and options on what to do once you have been told you in fact have good ole Plantar Fasciitis or also known as PF….

How do you say Plantar Fasciitis?
PLAN-tar fashee-EYE-tiss. It’s intriguing to hear from people their version however, this is the correct way to pronounce the words.

What does the Plantar Fascia do?
The plantar fascia is the thick ligamentous band in the bottom of the foot which is attached to the heel. The band runs forward and inserts into the ball of the foot. The plantar fascia encapsulates muscles in the bottom of the foot, however the main function is to support the arch of the foot by acting as a bowstring that connects the ball of the foot to the heel. This "support" enables us to propel ourselves forward more effectively.

Where exactly is the pain located?
Plantar fasciitis pain is found in the center or toward the inner side of the bottom of your heel. A lot of people notice the pain when they stand up after any period of rest especially after sleeping all night. After walking around for a bit, the pain can lessen or virtually disappear.

The interesting thing about this is PF is not caused by the heel striking the ground. PF is often referred to as heel spur syndrome however the spur is not the actual cause of pain. The spur is a sign the PF has been stressed for a period of time. Heel spurs are deposits of calcium in the plantar fascia where it attaches to the heel. You see, a spur is your body trying to respond to the injury and inflammation. So you really cannot blame the spur for causing the pain. It’s actually pretty common for people to have spurs and not have pain.

What caused my Plantar Fasciitis?
Common situations are:
An increase in activity. I.E. cutting grass in the spring on uneven ground and wearing improper footgear.
Biomechanical issues of the foot
A sudden injury
Wearing the wrong shoes
Weakened/Inflexible calf muscles
BEING OVERWEIGHT
Spending too much time on your feet
Or, quite frankly, it could be just one of those mysteries of life.

Notice the culprit listed in bold capitol letters above? Yep, your weight has a heck of a lot to do with PF. If you think about it, the foot must take on significant weight on a constant basis. Each step taken, the body weight is absorbed through both feet. The heel takes the brunt of the pressure. When the load is greater than what can be physically tolerated, damage starts and PF begins.

Does this mean fit people including star athletes cannot have PF? Absolutely not. Even football greats such as Eli Manning, quarterback of the New York Giants is in fact dealing with PF as I write this blog.We do however notice individuals who could be more fit for themselves often dealing with PF as opposed to those who control their weight.

So how do I fix it?
Here are a couple of thoughts on fixing PF....

You need to have your feet checked out by a Podiatrist to rule out if in fact you have PF or if there is another cause to your pain.

Wear the appropriate shoes. Don’t know what to wear – consult your local Certified Pedorthist.

If determined the appropriate shoe does not resolve the issue, orthotics are often utilized. Over the counter or custom orthotics may be helpful.

Physical Therapy – if recommended by your Podiatrist, PT can provide amazing results. The key with PT is you have to stick with the program!

Patience - Many people are frustrated when they are not seeing immediate results. As mentioned earlier, recovery takes time.

Finally, it all boils down to this...you need to follow your Podiatrist’s recommendations. No cheating here. PF can be controlled. You need to realize this simply does not go away overnight and it takes time. In some cases, surgical interventions are necessary after exhausting all other treatment avenues. If you truly want to get back to your routine whether it be walking or running or simply to stand up without heel pain, you need to follow the course of treatment which may include one or all of the above.

A note to the ladies….During treatment, your shoe fashion may result in quality athletic shoes. Future shoe options may require more focus than the cutest trends or the sale on the buy one get one teasers. It is a hard transition for some, but quite frankly, don’t you owe it to yourself and your feet?

Healthy Steps….for your feet….for your life!

What the Heck is a Sausage Toe?

2009-09-30T11:47:00.000-07:00

A patient came in the other day with a swollen tip of her second toe. She also had a funny looking, thick toenail and really thought that was the cause of her pain and swelling. She related that she had been experiencing throbbing pain, redness and swelling for several months in just the tip of the toe. It had never spread or gotten much worse. She had never experienced drainage or infection symptoms around the toenail. She was unable to wear a closed in shoe and was to the point that she wanted her toe amputated. She had been treated with topical anti-fungals and antibiotics without much result. She was sent to me for another opinion after taking two months of oral anti-fungals and having no change in the nail or toe appearance. What a strange presentation....or is it?

Sausage toe is a whimsical term used to describe a red, hot swollen toe often seen in psoriatic arthritis. It can also be seen in Reiter's syndrome and other seronegative arthropathies. In English, a non-rheumatoid type arthritis. Sausage toe is inflammation of the distal interphalangeal joints (tip of your toe and adjacent knuckle) that looks like a sausage or lollipop. In psoriatic arthritis, it is often accompanied by nail changes that mimic onychomycosis or a fungus in the nails. The nails can be pitted, yellow, thickened, fragmented, and lifting from the tip of the toe. Psoriatic arthritic can occur without the typical skin changes seen in psoriasis, but most patients have some skin lesions.

Sausage toes should be treated aggressively to decrease the inflammation and joint destruction. Long term inflammation can lead to erosive changes and permanent joint pain and stiffness. Joint ankylosis (complete fusion of the joint) can occur in severe cases. Basic treatment starts with nonsteroidal anti-inflammatory drugs, exercise, physical therapy and education. Patient should be taught the "move it or lose it" principal of arthritis management. Exercise and mobilization of the joints, but not overuse and abuse, should be reinforced. Some patients need more aggressive treatment, and this should be part of a comprehensive treatment plan by a rheumatologist.

Sausage toes should not be ignored. They can be caused by many factors such as trauma, infection, osteomyelitis (infection of the bone), and many different rheumatologic disorders as discussed. If you experience a painful, red, swollen toe that just seems to persist; seek the opinion of your podiatrist. Treated early, sausage toe can just be part of a whimsical story instead of a long term disability.

Ankle pain with no sprain?

2009-09-20T19:56:00.000-07:00

I see several patients on a weekly basis that complain of ankle pain that have no history of recent ankle sprain or any trauma. They describe their pain as sharp and burning on the inside of the ankle with swelling and pain that is worse with walking, but continues as aching pain at rest. Some patients can have so much pain that they are unable to walk without crutches.

On exam, I will find that the posterior tibial tendon is swollen and painful usually from behind the ankle bone down to where the tendon inserts in the foot. The job of this tendon is to help the foot swing inward in gait and support the arch. But with flat feet, the tendon is overworked and often then forms small tears in the area just described which then causes pain and swelling. When asking a patient to walk in my office, the affected foot will show minimal to no arch height and the ankle will appear to be falling inward, sometimes almost touching the ground. There is usually pain with isolating this tendon on a muscle exam as well.

So how does this really happen? Overuse is the most common mechanism of injury. Wearing flip flops or going barefoot on a regular basis. Starting a vigorous exercise program when you previously were not exercising. Walking a significant amount on a vacation like Disney World when this is unusual for your daily amount of activity.

Treatment starts with an evaluation and xrays to ensure you do not have anything else that may be causing your pain and to get a better idea of your bone and joint structure. Next, rest, ice and compression are the key to getting your swelling and pain under control. In severe cases, bracing may be necessary to achieve this goal. Once your pain and swelling have resolved, the next thing you need to do is prevent this from happening again. The best way to do that is wear good supportive shoe gear and be fitted for custom orthotics. Without preventative care, this tendonitis can because a chronic dysfunction of the foot and ankle requiring surgical reconstruction.

If you think you may have this condition, the physicians at Foot and Ankle Associates of North Texas are here to help!

Ugly Toenails Linked With Depression! New Treatments Are Available!

2009-08-28T08:54:00.000-07:00

Many people suffer from a common problem: ugly, thick toenails. Often this is caused by onychomycosis, a fungal infection in the nails. Most people actually feel this is simply a minor cosmetic problem and really do not classify this as a disease. Reality is that onychomycosis can actually be a devastating problem for many people. In fact, a recent study has linked onychomycosis with depression in otherwise healthy patients.

Onychomycosis, over a period of time, makes your nails yellow, thick and often extremely disfigured. This is embarrassing and many people hide their toes in closed in shoes due to the disfigurement. Many people will even wear sneakers to the beach to avoid showing their toenails. Surveys have shown a lack of intimacy, decreased feelings of self-worth and depression associated with onychomycosis. With almost 30% of the adult population suffering from toenail fungus, and this number increasing to almost 90% in the elderly, why do most people feel it is just cosmetic? Because it hasn’t happened to them yet!

There is hope for people who suffer from toenail fungus. Traditional topical and oral therapies have been less successful than patient expectations. Lots of unhappy people with sever frustration!

Topical therapies patients have tried encompass a wide variety of products and folklore including the use of Vick’s Vaporub, organic cornmeal soaks, and a variety of over-the-counter products. Even the only FDA approved prescription topical, ciclopirox, is shown to be only 8% effective in their own package insert! Imagine painting your toenail with a topical therapy for over a year, every day, and still having ugly toenails!

After failure of topical therapy, most people discuss oral anti-fungals with their doctors. Common oral therapies include terbinafine, fluconazole, and itraconazole. These are more effective than any topical, but come with possible side effects including many drug interactions and liver problems. They are touted as somewhere between 50 and 70% effective depending on dosage and duration of therapy. Many people after taking these medications still have ugly toenails! More frustration!

Hope has recently increased for patients who have struggled with chronic onychomycosis. New laser therapy for onychomycosis is the most exciting treatment now available. A pulsed UVA laser has been shown in preliminary studies to eradicate much of the fungus and often clearing is seen in 9 to 12 months. This therapy is not widely available, but has been shown to be around 80% effective in these early studies. The FDA is still reviewing the Patholase laser application for approval, but the treatment is available in limited areas as an “off-label” usage. The laser light is painless and only affects the infected tissue. Hope abounds!

Funky looking toenails can also occur from psoriasis, eczema and other nail pathologies. If you have thick, nasty looking toenails, a visit to your local podiatrist for a PAS (Periodic acid-Schiff) stain of a piece of your toenail will determine if you have a fungal infection. If you have a positive PAS stain, look into the new laser therapy before your toenails cause a lifestyle change! There is hope even if you have suffered from embarrassing toenails for years!

Pregnancy and Your Achy Feet

2009-05-13T11:03:00.000-07:00

I'm Pregnant.. My belly is getting bigger, I expected that. What I didnt expect was the swollen feet, the burning arch pain and the change in shoe size.

Did you know that during pregnancy your foot size increases at least a half size per pregnancy and is usually permanent after the 2nd one. Some women would be happy with that, an excuse to buy new shoes.. The problem is that most women dont realize that there shoes are to small. Measure your feet once a month and every time you buy shoes! You would be surprised by the changes in your feet.

Buying new shoes.. an easy fix.. But what about all the pain in my feet, and why are they so achy and tired. I have never had a foot problem before...

As your waist line expands, the weight gain can actually cause a change in your posture. The change in posture can cause you to walk differently.... which leads to abnormal stress on your back, knees, and feet. Your body is not used to this stress and will respond with pain, tenderness and overall discomfort.

The most common complaints that I see in my pregnant patients are: swollen feet, over pronation( foot flattening out like a pancake), arch pain, arch fatigue, heel pain, ingrown toenails and cramping of the feet and legs.

There are some easy fixes to make you a little more comfortable during this wonderful time of pregnancy. Make sure your shoes are the right size.. this will help prevent ingrown toenails, always wear supportive shoes, and never go barefoot. Maternity compression stockings are a good way to prevent swollen feet. Make sure you are stretching your legs and feet, always stretch before any type of exercise and make sure you are taking your prenatal vitamins.

The $2,000 Rusty Nail!

2009-04-30T23:57:00.000-07:00

It all started with a late Saturday afternoon phone call. My hairdresser, Anne, called to ask if I could possibly look at her foot. Now! It seems that she and her daughter were in a creative mood while doing yard work that afternoon. They decided to rip up an old deck and make a new flower bed. Unfortunately, that old deck had a lot of ancient rotted wood held together with rusty nails. Anne was unlucky enough to have stepped on one of those rusty nails and had it stuck in her foot. Her daughter removed the board with the nail, but now, just a few hours later, Anne was quite concerned with the way her foot looked. She had cleansed the area with peroxide and put some ointment on it; but now her foot was red and swollen. Help!

Anne came over to my house so I could look at her foot. She had a typical puncture wound on the bottom of her foot with redness surrounding the wound and lots of drainage. It definitely looked like she may still have part of the nail and even maybe part of her shoe still in her foot. Infection was setting in! Off to the ER she went for x-rays and I scheduled an operating room to clean out the wound.

Her x-rays showed at least 50 small pieces of metal still in her foot. After I performed surgery to clean the wound, spending an hour taking small pieces of rust and metal shavings, as well a piece of sock and shoe out of her foot; Anne’s foot was on it’s way to recovery. Unfortunately, her wallet was $2,000 lighter after paying her deductible. So much for saving money by doing your own yard work!

What have we learned from Anne’s story? Hire yard workers? No, a better lesson is to address puncture wounds immediately! They are often much more contaminated than they look. Puncture wounds are extremely common in the foot. Even though they are extremely common, most people do not treat them adequately. Getting proper treatment within 24 hours is important in decreasing the infections that lead to serious complications.

Foreign bodies embedded in a puncture wound are extremely common. All kinds of things like toothpicks, glass, small pebbles, needles, nails and even wiry pet hair can become stuck in a puncture wound. Even pieces of your own skin, sock and shoe as well as dirt and foliage can be contaminating a puncture wound. Remember that all puncture wounds are considered dirty wounds because they involve penetration of the skin with a non-sterile object. Regardless of the foreign body, anything that remains in a wound can become an abscess and lead to a severe infection.

Treatment of puncture wounds should begin within 24 hours of the wound and start with cleansing of the wound and close monitoring until it is healed. Surgical cleaning with removal of any foreign bodies is often necessary coupled with a week or two of antibiotics, depending on the wound contamination. X-rays may even be needed to evaluate the bone structure for any involvement. A bonus is that metallic foreign bodies can also be detected by x-ray.
Often foreign bodies can be missed in the emergency room, so proper follow up with your podiatrist is important. Infection is a common complication, so your doctor will monitor your wound closely until it heals. Any changes, swelling, redness or discharge should be reported immediately. In diabetics or patients with poor circulation, a puncture wound can lead to an infection so serious that it leads to an amputation. Do not delay treatment! Hindsight is always 20/20, but you don’t want to be the one wishing they had come into the office when they are in the hospital with a severe infection.

Do not play around with puncture wounds, seek medical attention immediately!

Bunion Surgery Revealed!

2009-04-21T13:56:00.000-07:00

Many patients are very apprehensive about bunion surgery. They have heard horror stories of severe pain and bad outcomes. These are usually not true. Bunion surgery is actually quite successful, in the right patient, done by the right doctor. Most patients have a lot of questions about whether they should have surgery and what to expect during and after surgery. This is an attempt to dispel old wive's tales and help you to make a more informed decision about bunion surgery. It is important to remember that every patient is different and this information is just to help you prepare to discuss your surgery with your doctor.

Who should do your surgery? Podiatrist versus orthopedic surgeon? A board-certified podiatric foot and ankle surgeon usually has much more experience in bunion surgery than the average orthopedic surgeon. Make sure your surgeon, no matter what their credentials (MD, DO, DPM), has passed their board certification and has experience in your type of surgery.

Who should consider bunion surgery? If your foot hurts every day, in every pair of shoes, and you have failed conservative treatment which should include: wider shoes, anti-inflammatories, padding, orthotics, and possibly steroid injection; you are a candidate for bunion surgery.

Bunion surgery involves an incision along the top of the big toe joint and the removal and realignment of soft tissue and bone to restore normal joint alignment and to relieve pain. The first metatarsal bone is often cut, realigned and then stabilized with small screws. There are no guarantees that a bunion surgery will fully relieve your pain because of wear and tear arthritic change to the joint and nerve damage from the deformity. Most patients achieve at least 85% relief of their symptoms.

Anesthesia selection is really patient and procedure specific, but light to moderate sedation, to make you sleepy, coupled with a local anesthetic block, similar to the dentist, is often used during the procedure. Some people do require general anesthesia due to a history of local anesthetic complications or other medical problems.

The procedure usually takes a little more than an hour, depending on the type of surgery. A more complicated bunionectomy can take two hours or more.

Bunion surgeries are usually done on an outpatient basis at a free standing surgery center or outpatient center at a hospital.

The most common types of bunion surgery are:
1. Keller: Removal of part of the metatarsal head (the part of the foot that is bulging out) and the base of the proximal phalanx (removal of part of the toe joint). This procedure is called a Keller bunionectomy. These usually work well in an arthritic joint but do not allow for complete joint function after surgery. Usually these are used in the elderly.
2. Austin or Chevron: Realignment of the soft tissue ligaments around the big toe joint. Removal of the part of the metatarsal head (the bump). Then, the first metatarsal bone is cut in a V-fashion then moved laterally to realign the joint. The cut or osteotomy is then stabilized with a pin or two small screws. This is the most common procedure and is known as an Austin bunionectomy.
3. Lapidus: Realignment of the soft tissue ligaments around the big toe joint. Removal of the part of the metatarsal head (the bump). Then, removal of a wedge of bone from the base of the first metatarsal and the bone adjacent to it (the cuneiform) as well as the cartilage surface of the two bones. The first metatarsal cuneiform joint is then reshaped and stabilized with two large screws or a plate. This increases the stability of the area and decreases recurrence of a bunion deformity. This procedure is known as a Lapidus fusion and is usually performed in adolescents or adults with really flexible foot deformities.
4. Other Procedures: Fusion (arthrodesis) of the big toe joint or Total Joint Implant (arthroplasty) are also common, but usually used when the joint is severely damaged and is not repairable.

The usual recovery period after bunion surgery is 8 weeks to 4 months, depending on the procedure and the health of the patient. Compliance also dictates how fast a patient heals. Swelling after surgery can last for up to a year.

In a Keller or Austin, the patient is usually completely off their feet for just a few days, then in a walking cast or special shoe for 4 to 8 weeks. Normal activity is usually resumed in 2 to 3 months.

In a Lapidus fusion, most patients are in a hard below knee cast completely non-weight bearing for 8 weeks, then a walking cast for 2 weeks, then a sneaker for another month. Normal activity is usually resumed in 4 months.

Every patient is different. Some patients have softer bone and require longer immobilization. Some patients require physical therapy after surgery.

There are risks involved in having any type of surgery. No matter how good your surgeon is, if you do not follow directions you may have a bad outcome. Scarring, prolonged swelling, a stiff joint, numbness, shortening of the big toe, degenerative arthritis, infection and continued pain are the most common complications. More serious complications can include non-healing of bone or a severe infection requiring a second surgery.

After having bunion surgery, most people are happy with the results. A survey by the American College of Foot and Ankle Surgeons revealed 95% of patients with good to excellent outcomes form their bunion surgery. After having surgery, your ability to walk and be active is likely to improve. The big toe joint is usually much less painful and functions better.

Some people are disappointed with their surgery results even though their joint looks and functions better. This is usually due to unrealistic expectations. You will still not be able to wear extremely high heeled shoes after surgery and it is unrealistic to think that your joint will be "perfect" or function like it never had a problem. With realistic expectation, most patients are happy with their bunion surgery.

Anti-Fungal Laser Informational Video

2009-04-14T16:46:00.001-07:00

Check out this new video

For more information click here!

Ugg Boots Cause Foot Pain!

2009-04-10T11:48:00.001-07:00

Ugg Boots Linked to Foot Pain!!!

Check out this video...first flip flops, then Ugg boots...the fashion world need to embrace better shoes!!

Click here for video from ABC news

Sound Familiar?

2009-04-02T07:09:00.000-07:00

James “Buster” Douglas – Boxer

Gary Hall Jr. - US Olympic Gold Medalist, Swimming

“Smokin’ Joe” Frazier – Boxing

Chris Dudley- NBA/New York Knicks center

Ayden Byle -Runner/First insulin-dependent man to run 6521.5 km across North America.

Sir Steven Redgrave - Rower/Winner of five consecutive Olympic gold medals

Ron Santo - MLB/Chicago Cubs legend

Kendall Simmons - NFL/Pittsburgh Steelers

Scott Coleman - Swimmer/First man with diabetes to swim the English Channel, (August 17th 1996)

Sherri Turner - LPGA golfer

Chuck Heidenrich – Skiing

The names listed above are pretty well known. They are known for there athletic ability, determination and talent to the sport. I bet you can’t guess what the common denominator is can you? Believe it or not, each person listed above has Diabetes. Surprising eh?

For those with Diabetes, you can control this disease. The combination of understanding the disease, consistent care and proper nutrition as per your physician is proof that a person can live a normal lifestyle to excelling at the elite athlete level.

For every goal, there are three times as many excuses not to obtain a goal. For example, – if a person is told to control their weight, the excuses multiply by the minute. Have you ever told yourself :

I don’t have time.
I don’t know how to lose weight.
My feet hurt too much when I exercise.
I just don’t feel like working out.

The list of excuses goes on and on. Ultimately, the decision is yours on how healthy your live can be. Break the mold and make the choice to place health at the forefront. Small changes can do wonders from diet to level of activity. Think about how many sessions you could have with a trainer or nutrition counselor each time you pick up that carton of cigarettes or sugar loaded snack when shopping or that large platter of food you ordered while at a restaurant.

Start each day with the right choice - your life depends on it.

Janet Dixon, C.Ped
Healthy Steps DFW...for your feet, for your life...

Got Cold Feet?

2009-03-15T08:05:00.000-07:00

And no, I’m not talking about the British TV show or a runaway bride. Are your feet always cold? Is your skin cool, clammy, or extremely dry? Many people experience the symptoms of cold feet on a daily basis, but ignore it thinking that it is a minor complaint. This is a mistake. If your feet are always cold and the symptoms are increasing, you should seek the advice of your podiatrist.

Cold feet can be a symptom of many different disorders including:
1. diabetes
2. hypothyroidism
3. anemia
4. peripheral neuropathy
5. coronary artery disease/aortic dissection
6. peripheral arterial disease
7. raynaud’s phenomenon
8. side effect of heart medications for blood pressure and arrythmias
9. early frostbite
10. restless legs syndrome
11. tarsal tunnel syndrome
12. significant stress

None of these disorders are minor and cold feet can be one of the earliest symptoms.

A closer look at the symptom of cold feet by your podiatrist may include:
1. non-invasive arterial examination
2. neuropathy screening
3. Blood work including a rheumatoid panel, thyroid levels, and blood counts

More advances screenings are sometime warranted and can include:
1. arteriogram
2. nerve conduction velocities
3. EKG or echocardiogram

The most common reason people have cold feet is poor circulation. This is usually described as peripheral arterial disease or hardening of the arteries. Peripheral arterial disease (PAD) is narrowing or blockage of arteries that results in poor blood flow to your feet. Clogged arteries in the legs and feet increase your risk for having a heart attack or stroke. Plaque buildup in the legs does not always cause significant symptoms, so many people can have severe circulation problems and not know it. People who do experience symptoms, such as cold feet, pain or cramping in the legs, often do not tell their doctos, because they believe they are a natural part of aging or due to another cause.

One in every 20 Americans over the age of 50 has arterial disease and it is estimated that over 8 million are undiagnosed. Early detection of circulation problems has been shown to save limbs and lives, so if you have cold feet or any of the risk factors you should undergo screening by your podiatrist yearly or more often if symptoms occur.

Your podiatrist should be able to address your cold feet and send you down the path to warmer days or at least to understanding why you have cold feet.

If all the screening exams are normal, you may just have genetically colder feet than the average. Wear socks to bed! Or you may be experiencing stress. Cold clammy skin can be explained by the release of the hormones, epinephrine and norepinephrine, and is a sympathetic response to stress. Your body is telling you to calm down!

Bottom line: If you are not impending marriage or haven’t just finished a day of skiing, your cold feet are probably trying to tell you something! Listen to them!

Pesky Warts, Why Wont They go Away?

2009-03-04T11:10:00.000-08:00

Pesky Warts... Why wont they go away??

Warts are a virus that are common in both children and adults. Although kids are more prone to warts, adults can get them too! Most commonly warts appear on the hands and feet. Warts on the hands are much easier to get rid of because the skin is very thin on your hands. Most often your pediatrician or dermatologist will perform cryotherapy (freeze) the warts and they will go away.

Warts on the feet?? That is another story..

The skin on the feet is very thick. It helps protect us so when we walk we dont get hurt. Well warts love the feet. The wart virus is attracted to warm wet places, like sweaty feet!

So how do we get rid of them? There is good and bad news. The bad news is that these pesky warts are difficult to get rid of, and usually will not go away with just freezing them. The good news is that we treat them all the time and have been for many years so we have figured out some great tricks to get rid of these pesky things. There are many different treatment combinations that we have found to help speed up the process of getting rid of these pesky things, for more information you can click here.

Toenail Fungus Laser Treatment a Success!

2009-02-15T15:02:00.000-08:00

TOENAIL FUNGUS LASER TREATMENT

TREAT YOUR TOENAIL FUNGUS SAFELY AND PAINLESSLY
with the new PinPointe FootLaser

Coming in May to Foot & Ankle Associates of North Texas LLP in Grapevine!

This new patented laser technology kills the pathogens that cause toenail fungus (Onychomycosis)

The gentle laser light works through the nail

No side effects

Does not harm the nail or skin

Painless-no anesthesia needed

Usually only one treatment required

Shoes and nail polish can be worn immediately after treatment

How does the laser work?
This patented laser is specially designed to shine through your toenail and destroy the specific pathogens embedded in and under your nail causing the infection. The FootLaser operates in the very tight spectrum of near infa red light. Unlike CO2 lasers of the past, this laser safely destroys the fungi, molds and bacteria that often cause onychomycosis.

Is this laser painful?
The gentle laser light beam has no effect on healthy tissue. There is no discomfort associated with the treatment during or after. This treatment does not harm or affect your activity in any way.

Does it really work?
In the first clinical study, earlier this year, 88% of the treated patients grew out a normal looking nail after one treatment. After the one treatment, the nail plate should grow out normally in 6-12 months if there is a healthy nail bed. This result is comparable to the success rate for the oral pill, Lamisil, which you take for three or four months with some risk of side effects. Additional information can be found at www.pinpointefootlaser.com

Is this treatment safe?
There are no age or health restrictions or limitations. In clinical studies there have been no adverse reactions, injuries, disabilities or known side effects. As you may know, the use of the medication available today for treatment of fungus toenails, carries with it possible systemic involvement (commonly the liver and kidney). This laser does not!

Does my insurance pay for this?
Because this treatment is considered aesthetic (cosmetic), health insurance plans do not cover this treatment. We accept major credit cards and personal checks or you may use your Flexible Spending Account from work. We also offer an interest free payment plan through Care Credit.

How Much Does It Cost?
The laser treatment is applied to all of the toenails on both feet, even the ones that appear uninfected. This reduces the chance of re-infection and takes about 30 minutes. There is an initial consultation with the doctor, which costs $75, to see if you are a candidate for the treatment. This is credited towards your procedure fee if you proceed with treatment. The treatment fee is $850. If the infection is resistant or has not responded with normal nail growth, the nails may need another laser treatment. This often occurs when all ten nails are severely infected. An additional treatment within the first six months is discounted to $450.

For more about toenail fungus

or
To make an appointment for your initial consultation, call (817)416-6155 or contactus@faant.com

Bamboo For Who? How about you!

2009-02-13T09:36:00.000-08:00

Lately, the new buzz word in environmentally friendly materials is Bamboo. So what’s the deal with Bamboo? Here is the scoop from our friends at Dr. Comfort labs:

Bamboo Charcoal was discovered during the Ming Dynasty in 1486 A.D. Today Molecular Nano Bamboo Charcoal is made when bamboo charcoal powder is refined by temperatures over 700 degrees. Nano Bamboo Charcoal Fiber (NBCF) is able to release FAR Infrared Rays that may promote blood circulation and increase Anion production.

NBCF is also a natural deodorizer which has innumerable hole structures to absorb and decompose benzene, phenol, methanol sulfides, and nitrides. Bamboo also helps reduce odors from NH3 gas, adjust for moisture, release Anions and restrain microbial growth. The ability for NBCF to regulate skin temperature will also assist in thermoregulating your feet more effectively than traditional materials. As a sustainable natural resource over hardwood charcoal due to its rapid growth cycle, NBCF will protect the environment as no chemicals are required for this product.

Healthy Steps is proud to offer our customers the Dr. Comfort brand Bamboo Seamless Diabetic Socks. Just in this week, we are already selling the socks with positive reviews!

Utilized in the management of Diabetes, Arthritis, Edema, Neuropathy and Circulatory issues, the socks are shaped to fit and contain Nano Bamboo Charcoal fibers. The Bamboo fibers help to keep the foot dry featuring an anti-microbial odor control. The non binding construction is also seamless which can help in the prevention of skin irratations and promote healthy skin production. An added feature is the Y Heel and Toe Gore which eliminates bunching in the heel and toe area.

Visit Healthy Steps and learn more about the new line of Dr. Comfort socks and new spring arrivals.

Janet Dixon, C.Ped.
Healthy Steps DFW
For your feet....for your life!

Vitamin D, the new front runner?

2009-02-09T06:02:00.000-08:00

You have probably heard a blip or two on the news about vitamin D.
It turns out; vitamin D has quite the resume of benefits to keep you on the road to good health.

Your muscles and bones are important in maintaining your balance, posture and mobility. As we age, it is crucial to maintain strong muscles and bones to prevent falls especially to persons who are age 65 and over. Vitamin D can assist in maintaining your muscle and bone strength and has been shown to increase certain types of muscle fibers resulting in greater mobility and balance. Bones benefit as vitamin D helps the absorption of calcium.

In an article published by researchers from Loyola University Chicago Marcella Niehoff School of Nursing concluded that adequate intake of vitamin D may prevent or delay the onset of diabetes in addition to reducing complications of previously diagnosed with diabetes.

Millions of Americans with diabetes have low vitamin D levels. Evidence suggests that vitamin D plays an integral role in insulin sensitivity and secretion. Vitamin D deficiency results in part from poor nutrition, which is one of the most challenging issues for people with diabetes. Another culprit is reduced exposure to sunlight, which is common during cold weather months when days are shorter and more time is spent indoors.

Diet alone may not be sufficient to manage vitamin D levels. A combination of adequate dietary intake of vitamin D, exposure to sunlight, and treatment with vitamin D2 or D3 supplements such as Cooper Complete Vitamin D supplements offered at Healthy Steps can decrease the risk of diabetes and related health concerns.

With no known side effects, vitamin D can be combined with most medications however, ensure you check with your physician prior to taking any supplements.

Janet Dixon, C.Ped.
Healthy Steps DFW
For your feet...for your life!

Puncture wounds

2009-02-02T07:15:00.000-08:00

Did you know that stepping on something could cause an infection? The infection would most likely occur in two to five days, with redness, swelling and pain to the area on your foot.

Puncture wounds happen very commonly in the feet, especially in the summer when you are going barefoot. Most people would not think about it, but stepping on something can lead to an infection if not treated the correct way.

What is the difference between a "puncture wound" and a "cut" in the skin?

A puncture wound has a small entry hole. It can be caused by a pointed object that you step on, like a nail. In contrast, a cut is an open wound in the skin that does not produce a "hole" but rather it produces a "long tear" in the skin.

What can cause a puncture wound?

Foreign Bodies are the most common cause of puncture wounds, most commonly including:

Nails, Glass, Toothpicks, Sewing Needles, Insulin Needles

The biggest concern with a puncture wound is that the wound is considered a "dirty" wound. The reason these are considered dirty is that they involve a foreign body penetrating the skin that is not sterile.

What can happen if I step on a foreign object? Complications are likely, and depend on the severity of the wound. The deeper the wound the more likely an infection will occur. It is very hard to tell how deep a puncture wound is so if you step on something you should seek medical attention as soon as possible.

What will the doctor do when I seek treatment?

The KEY for treatment of a puncture wound is that it is cleaned properly and debrided. It is very easy for debris to get stuck in this hole that you have created in your foot. If the debris is not removed it can lead to an infection. Also part of the foreign body may be lodged inside your foot and you would not know. A doctor might also take x-rays to evaluate bone damage.

No matter what, it is a good thing to be evaluated by a doctor if you have stepped on someting. Proper and early treatment can lead to a full recovery without infection.

What is a Bunion??

2009-01-17T15:56:00.000-08:00

Video blog from Dr Giacalone discussing bunions and their treatment.

For more information on Hallux Abducto Valgus deformities, also known as bunions, click here!

Oh My Aching Toes!

2009-01-09T08:23:00.000-08:00

“My toes are hurting every time I put on a pair of shoes! Even my Crocs hurt! I’ve noticed some little red spots on my toes that seem to be growing. What’s going on? I’ve tried to scrub them off but they hurt! I even tried some pads but they just made my shoes hurt more! Help!”

Sounds like she may have corns! Corns: such a simple name for a relatively complex problem. Corns can be extremely painful and actually are caused by several different foot ailments, so finding the root cause can take some detective work.

What is a corn?

The name “corn” came from the appearance of a bump that looks like a corn kernel on or between your toes. Corns are actually your body’s defense against the rubbing of your shoes. They are protective layers of compacted, dead skin cells. Corns can be “soft” or “hard”. Soft corns are usually seen in between the toes and hard corns are on the tops or tips of your toes.

What causes a corn?

These annoying bumps are caused by repeated friction and pressure from skin rubbing against bony areas or against an irregularity in a shoe like a seam. Either your toes are crooked or the shoe just does not fit properly. The friction and pressure can cause painful burning or aching which makes wearing shoes very uncomfortable.

Why do my corns hurt even without shoes?

If you have pain in a corn, even when you do not have shoes on, you have most likely developed bursitis which is inflammation of the joint under the corn. Bursitis is often treated with an injection of anti-inflammatory into the inflamed area. This type of pain should be evaluated by your podiatrist, because the other reason for pain without shoes is an infection in or around the corn. Toe infections can become serious and may even lead to amputation in some patients. Don’t ignore your toe pain!

How are corns treated?

The pain from corns often may be relieved by moleskin or padding on the affected areas. A good moisturizing cream can also help. Your podiatrist can scrape or “debride” the corn to reduce the thickness, but remember never to cut corns with any instrument at home, and never apply home remedies or “corn remover patches”. These invite infection and can make your corns a foot emergency!

There are only two permanent treatments for corns:
1. Surgically correct crooked toes also known as hammertoes.
Or
2. Find the culprit shoe and stop wearing it!

Don’t ignore your toe pain from corns! Relief is simply a visit to the podiatrist away!

How Long Will it Take to Heal Doc?

2009-01-06T06:48:00.000-08:00

This is the age old question isn’t it? “Doc, so how long will it take for this thing to heal?”

Where to begin on this seemingly so easy a question? There are sooooo many factors to take into consideration. This explains why you will hear doctors say “on average…” or “typically…”. We know from experience, and what we’ve read in the mountains of medical literature, when things are suppose to heal. This is the easy part. Here is a very short list of when certain body parts heal:

Bone: 6-8 weeks
Tendons: 3-4 weeks
Ligaments: 3-4 weeks
Stitches: top of foot or leg: 2 weeks, bottom of the foot: 3 weeks

Simple huh! Now for the fun part; we add the human factor to the equation and suddenly, all this simplicity flies out the window! What most patients don’t understand is why they may not fall into these criteria! There is a LAUNDRY list of the reasons why things don’t heal when they should and the number ONE reason things don’t heal when they should is that many patients (yes, I could be talking to you!) say they are listening but they are not doing what they are told to do to get them better! They cheat! Not a lot (though there is that distinguished class of patients who do!), but just a little bit! Yes, that little bit over the weeks it could take sets you back even more weeks! I have heard every excuse in the book as to why people couldn’t follow through with what I asked from them and believe me sometimes there is good reason. But all too often the reason is not all that worthy. A sampling of my favorites so far: “I walked around school in a regular shoe because the boot is ugly, but I was really good at wearing it around the house!” or “I know you told me not to, but I walked on it because I just wanted to see if it was getting better and now it hurts worse!”

Let’s keep it real. There is no guarantee that anything will heal at all much less in the intended time frame. But by not following instructions, you are just plain sabotaging your healing. We are a very small part of the healing equation. YOU MUST DO YOUR PART! Regardless of the reasons why you think you can’t, if you don’t, it will take you longer to get back to doing what you want to do in the first place! Do your part and at least give your body the chance it needs to work the miracle of healing. It really is trying and us “Docs” are really trying too!

The Demand For Safe Pedicures Spreading

2008-12-28T08:45:00.000-08:00

The demand for safe pedicures is spreading across the country. Recently, "The Foot and Hand Spa" had opened in a podiatry office in Virginia. This is very similar to the spa opened over a year ago at Foot and Ankle Associates of north Texas named "Healthy Steps". There is a great health concern about the safety of pedicures in nail salons. For more information, read Dr Crane's article on "Deadly Pedicures". Book a safe pedicure today! Yout toes will thank you!!

Poor Circulation in Diabetic Feet?

2008-12-27T09:32:00.000-08:00

How do I know if I have poor circulation in my feet?

There is an increased incidence of peripheral arterial disease in diabetics. Peripheral arterial disease (PAD) is narrowing or blockage of arteries that results in poor blood flow to your legs. When you walk or exercise, your leg muscles do not get enough blood and you can get painful cramps. Peripheral arterial disease is also called peripheral vascular disease or simply poor circulation. Just like clogged arteries in the heart, clogged arteries in the legs mean you are at risk for having a heart attack or stroke. Plaque buildup in the legs does not always cause symptoms, so many people can have PAD and not know it. People who do experience symptoms, such as pain or cramping in the legs, often do not report them, believing they are a natural part of aging or due to another cause.

One in every 20 Americans over the age of 50 had PAD and it is estimated that over 8 million are undiagnosed. Early detection of PAD has been shown to save limbs and lives, so if you have any of the risk factors you should undergo PAD screening by your podiatrist yearly or more often if symptoms occur.

The exact cause of plaque buildup in the limbs is unknown in most cases. However, there are some conditions and habits that raise your chance of developing poor circulation.

Your risk increases if you:
1. Are over the age of 50.
2. Smoke or used to smoke. Those who smoke or have a history of smoking have up to four times greater risk of P.A.D.
3. Have diabetes. One in every three people over the age of 50 with diabetes is likely to have PAD.
4. Have high blood pressure. Also called hypertension, high blood pressure raises the risk of developing plaque in the arteries.
5. Have high blood cholesterol. Excess cholesterol and fat in your blood contribute to the formation of plaque in the arteries, reducing or blocking blood flow to your heart, brain, or limbs. 6. Have a personal history of vascular disease, heart attack, or stroke. If you have heart disease, you have a one in three chance of also having PAD.
7. Are African American. African Americans are more than twice as likely to have
PAD as their white counterparts.

What are the symptoms of PAD?

Most patients with PAD have little or no symptoms until the disease is advanced; that’s why screening exams are so important. Those who do experience symptoms have reported these typical signs and symptoms:

1. Claudication: fatigue, heaviness, tiredness, cramping in the leg muscles (buttocks, thigh, or calf) that occurs during activity such as walking or climbing stairs. This pain or discomfort goes away once the activity is stopped and during rest.
2. Rest Pain: pain in their legs at night that often disturbs their sleep
3. Wounds or sores that heal very slowly or not at all
4. Color changes to the skin of their feet and lower legs
5. Cold, pale feet and legs
6. Decreased hair and nail growth on their feet

How is PAD Diagnosed?

Your podiatrist will start with checking the pulses in your foot and ankle, examining the skin for changes and wounds that are poorly healing. Often an ABI (ankle-brachial index) is evaluated which compares the blood pressure in your arms to your ankles. A Doppler exam may be ordered. This test uses sound waves to measure the blood flow in the veins and arteries in your arms and legs. If any of these exams are abnormal, your podiatrist may refer you to a vascular surgeon to discuss options for treatment.

How is PAD Treated?

The overall goals for treating PAD are to reduce any symptoms, improve quality of life and mobility, and prevent heart attack, stroke, and amputation. There are three main approaches to treating PAD: making lifestyle changes; taking medication; and in some cases, having a special procedure or surgery. Your physicians will determine the best treatment options for you, based on your medical history and the severity of your condition.

How Can I Prevent PAD If I am Diabetic?

The cornerstone of prevention is lifestyle changes.
1. Exercise is very important and you should aim for 30-45 minutes of moderate intensity exercise each and every day.
2. Stop smoking immediately and ask your doctor for help if you find you cannot.
3. Keep your cholesterol and blood glucose levels down. Aim for a HgA1C of 6!
4. Keep your blood pressure in the normal range.
5. Decrease stress.
6. If you are overweight or obese, aim for a normal weight and again, ask your doctor for help! A diet low in saturated fats, trans fats and cholesterol is also helpful.

More than anything, talk to your doctors about a comprehensive treatment plan for your diabetes that also decreases your PAD risks.

One in every 20 Americans over the age of 50 had PAD and the incidience is higher in diabetics. Most patients have little or no symptoms until it is too late!

Early detection of PAD has been shown to save limbs and lives, so if you have any of the risk factors you should undergo PAD screening by your podiatrist yearly or more often if symptoms occur.