Foot, Ankle & Lower Leg Center: February 2012

Monday, February 27, 2012

High Heels Are Leading Cause of Ingrown Toenails

Posted on: Newswise; Source:Loyola University Health System

Newswise — High heels can cause a number of foot problems, yet most women aren’t willing to give their shoes the boot, according to podiatrists at Loyola University Health System (LUHS). Ingrown toenails are among the most common problems that result from high heels. This condition, also known as onychocryptosis, occurs when the toes compress together making the big toenails grow into the skin.

High heels and tight-fitting or pointed-toe shoes are a leading cause of ingrown toenails. These shoes create chronic pressure on the big toenails and prevent them from growing properly. Additionally, shoe pressure can cause the nail to puncture the skin leading to infection. Other causes can include trauma to the nail or fungal infections.

“Ingrown toenails can be painful, but many women are willing to cope with the discomfort in order to continue wearing their high heels,” said Rodney Stuck, DPM, professor of Podiatry Medicine, LUHS. “However, more serious complications can arise and cause permanent damage to the toenail, if they are left untreated.”

Dr. Stuck encourages women who wear heels to take these steps to manage ingrown toenails and prevent infection:

•Cut out a cardboard tracing of each foot and attempt to place it in the shoe when shopping for a new pair. If it does not fit, then the shoes are too narrow;
•Refrain from wearing tight hosiery;
•Limit the amount of time in heels;
•Wear heels on days that require limited walking or standing;
•Trim toenails straight across the top;
•Short soak of feet in lukewarm, soapy water or Epsom salts;
•Dry feet and toes thoroughly with a clean towel;
•Use a mild antiseptic solution on the toes.

If pain, swelling and discharge develop, the toe is likely infected. It will need to be treated by a podiatrist who may remove a portion of the affected nail to aid in treating the infection. If the condition recurs or persists, permanent removal of the nail can be accomplished with a minor, in-office surgical procedure.

Dr. Stuck warns that people with diabetes should be particularly careful of ingrown toenails. These individuals may have poor circulation, which makes healing difficult. They also may be more susceptible to nerve damage from their diabetes, which can prevent them from feeling pain in their feet.

“If diabetic women do not feel discomfort, they may neglect to treat the ingrown toenails until it is too late,” Dr. Stuck said. “If ignored, this condition, which is easily treatable, can lead to an amputation.”

In general, if you give your feet the attention they need, they will look and feel healthy. A bit of extra care will allow women who prefer fashionable high heels to continue to wear them.

Please call the Foot, Ankle & Lower Leg Center office in Las Vegas anytime @702-878-2455 between Monday – Friday and we would be happy to set up an appointment for you. Please visit our website @ www.FallCenter.com. The Foot, Ankle & Lower Leg Center has Diagnostic imaging: Digital X-Rays, Ultrasound or Advanced Imaging will be used to aid in the diagnosis.

Dr. Anthony Ricciardi at the Foot, Ankle & Lower Leg Center has completed training in endoscopic/minimally invasive surgery for chronic heel pain and nerve pain, foot and ankle joint replacement for restoring pain free motion, arthroscopic surgery, bunion surgery, fracture repair, flat foot correction, external fixation for complex deformities and extensive experience in peripheral nerve surgery including diabetic peripheral neuropathy and reconstructive surgery of previously failed foot surgical procedures. In addition to his surgical training Dr. Ricciardi focuses on sports medicine of the foot and ankle through regenerative techniques using the patient’s own blood/platelets for healing chronic foot and ankle problems (pain) as a result of repetitive sport injuries. This cutting edge technology enables patients to continue training with little or no down time. Dr. Ricciardi continues to be active in teaching and training other podiatric surgeons on innovative surgical techniques in foot surgery. Dr. Ricciardi is Board Certified by the American Board of Podiatric Surgery, a Fellow of the American College of Foot and Ankle Surgeons and Fellow of the Association of Extremity Nerve Surgeons. Dr. Ricciardi’s vision is to bring each patient the most current state of the Art Technology and personalized treatment options to meet their Foot and Ankle needs (from conservative care to surgical options). Dr. Ricciardi believes in quality service and puts his patients first!

Wednesday, February 15, 2012

Take the right steps to deal with bunion pain

Published: The Patriot-News

High heels can contribute to bunion pain.

Julie Rich had been battling a bunion since she was in middle school.

The 35-year-old Hampden Twp. woman recounts years of frustrating shopping trips to find shoes that she could tolerate and painful years of suffering with those she couldn’t.

“I kept wearing high heels; you know, sometimes fashion is important. But it got to the point where I couldn’t wear high heels anymore or any shoes at all, really,” said Rich, who, as a medical resident several years ago, finally elected to have surgery.

Rich isn’t alone in suffering with bunions. Statistics from the National Institutes of Health say almost 4.5 million people deal with them annually.

What exactly is a bunion?

“A bunion is a slow dislocation of the big toe joint,” said Dr. Helen Gold, podiatrist with Zlotoff, Gilfert, Gold & Associates in Hampden Twp. “The big toe is moving laterally toward the other toes and the metatarsal bone is moving away from the foot. The bump you see is actually the joint sticking out of the bone.”

Bunions are often thought of as being hereditary, but it’s really the foot structure that makes one prone to bunions that is hereditary, said Dr. Allan Grossman of the Harrisburg Foot and Ankle Center, with locations in Lower Paxton and Hampden townships.

The bunion is “a symptom of things like flat foot, abnormal foot structure, alignment or injury,” he said.

Certain shoes, particularly high-heeled, narrow or tight shoes and those with no support, such as flip-flops, can bring bunions on faster, podiatrists say. Both men and women can get bunions, but women tend to get them more because they won’t give up their fashionable heels.

Michelle Altland puts herself in that category. The 45-year-old Dillsburg woman said she wore heels constantly even after she started developing a bunion in her early 30s.

“I noticed my toe was starting to turn toward the other toes, but I didn’t do anything about it. At that age, I was still thinking I was invincible and assumed everything would be fine,” she said.

After she began working for a podiatrist, she got a foot X-ray and found out she had something called hallux ridgidus, which is decreased joint space in the big toe that causes pain and can contribute to a bunion, she said. She tried a cortisone shot and custom orthotics and finally gave up her heels — to no avail.

She had a successful bunionectomy several years ago and remains bunion free. “It took about three months after surgery until I realized, wow, I’m walking with no pain,” she said. “I wish now that I would’ve done it sooner.”

Doctors said they see bunions in patients of all ages, even those as young as 8 to 10 years old. Initial symptoms are often aches in the joint of the big toe when walking or standing. Other symptoms include the classic red bump on the side of the big toe, pain aggravated by pressure from shoes and the big toe turning toward the other toes.

“I advocate seeing a podiatrist as soon as you see symptoms because if you get help young enough, you can stop or slow down the deformity by doing strengthening exercises to build up the muscles. You can also wear an insert to hold the foot up to where it should be,” Grossman said.

On an initial visit, Grossman said he does a gait evaluation first to look for the mechanism that is causing the bunion and then look for ways to address it.

Before surgery, there are other things that people suffering with bunions can try.

“The most important thing is the type of shoe you wear,” Gold said. “The best type is a wide, smooth shoe with good arch support. Collapsing of the arch makes bunions happen faster.”

Flip-flops are about the worst type of footwear possible for people with bunions, she said. She also cautioned against shoes with a heel of more than two inches and shoes that are narrow in the front.

Patients can also try splints or pads, which will not correct the bunion but can ease the pain, or orthotics, which are custom-molded plates for the shoe that control the motion of the foot and prevent the metatarsal bone from moving away from the toes.

“If we see a bunion starting in a young person, we try orthotics right away to try to avoid surgery,” Gold said.

Of the hundreds of people they treat for this common foot problem, the minority opt for surgery, doctors said.

“Plenty of people live just fine with their bunions their entire life. However, if a bunion hurts so much that it is interfering with ability to do things or if it’s starting to push on the second toe and go under it, causing a hammer toe of the second toe, then we look at surgery,” Gold said.

There are about 100 kinds of bunionectomies that doctors perform, depending on what X-rays show about the structure of a person’s foot. The surgeries, which are usually outpatient, can involve breaking the metatarsal bone, removing the bump and realigning the soft tissue and joint. Sometimes a pin is inserted to hold the bone in place.

Rich began physical therapy before her surgery and continued it afterwards for a total of two to three months. “When you have a bunion, you adapt your walking to it so you need to readapt,” she said.

She was on crutches for three months after her surgery and took two weeks off work. “The surgery I had was very involved and intense, but in retrospect, it was worth it,” said Rich, who is still bunion free.

Living with bunions:

· Wear comfortable shoes that conform to the shape of your foot.

· Wear shoes with a wide and deep toe box.

· Always fit the larger foot — caused by the bunion — and have your feet sized each time you purchase shoes.

· Apply a commercial, non-medicated bunion pad around the bony prominence.

· If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling.

· Avoid high-heeled shoes over 2 inches tall.

· Seek professional podiatric evaluation and assistance with uncomfortable or noticeable bunions.

Source: American Podiatric Medical Association

Wednesday, February 8, 2012

What your feet could be telling you about your heart

If your feet and legs show signs of peripheral arterial disease, it's possible your heart health is at risk as well
Posted on: Michigan Live

If you’re wondering about the health of your heart, try looking at your feet.

The lowly, stepped-on, shoe-squished foot could very well hold clues about the state of your coronary arteries. If your feet show signs of poor circulation – or peripheral arterial disease – your heart could be suffering as well.

The feet may not invoke the same romantic notions as the heart – few sonnets or love songs are written in their honor – but they deserve a little love, podiatrists say.

The Michigan Podiatric Medical Association, as part of February’s heart health emphasis, is urging people to have a simple test to check circulation in their feet for signs of PAD, which occurs when the arteries become narrowed by plaque.

Many people have no symptoms of PAD during the early stages. By the time symptoms are noticeable, the arteries often are significantly blocked.

The classic symptoms of PAD – pain in the legs when walking or at rest – occurs in only 10 percent of the patients, said Dr. Gregory Pellizzon, an interventional cardiologist with Saint Mary’s Health Care. And even those symptoms can be confusing. Patients often wonder if the ache in their legs comes from aging or arthritis.

Some also have symptoms of heart disease, such as shortness of breath and discomfort in the chest, but don’t realize it because the pain in their legs limits their activity.

“It’s really hard sometimes to quantify what is slowing someone down,” he said.

“I think podiatrists are great at picking up on PAD,” Pellizzon added. “They know what to look for in terms of skin changes, leg changes and the signs on their feet. Nine times out of 10, they’re right.”

Dr. Marisha Stawiski, a Grand Rapids podiatrist, says she regularly checks patients for the subtle signs that could indicate PAD.

A loss of hair on the feet is one possible sign of poor circulation. That doesn’t mean that people who have always had smooth, rather hairless feet have PAD, she said.

“But if you have somebody with a lot of body hair and none on their feet and ankles, it could indicate an arterial issue,” she said.

Different pulses, very cold feet or a change in color also could indicate a problem.

If she sees any signs of PAD, Stawiski recommends a simple, non-invasive test called an ankle-brachial index. It compares the blood pressure in the ankles to the blood pressure in the arms.

The earlier PAD is diagnosed, the more likely treatment will be effective.

Patients might enroll in a supervised exercise program, which can improve PAD and their heart health, Pellizzon said. Medication can help the arteries relax so they can walk farther.

In some cases, patients have ulcers and sores that are not healing, which can indicate tissue loss in the legs. Intervention is needed to restore circulation and save the limb. Treatments include angioplasty, stents, a bypass or procedures to remove plaque from the arteries.

Stawiski said many of her patients see cardiologists and family doctors regularly because they have diabetes or other conditions that put them at high risk for PAD. But in many cases, she sees the patients’ feet more often – every two to three months.

“It’s good to have another set of eyes on them,” she said.

Those with risk factors for PAD should be screened or tested, podiatrists say. The risk factors include:
• Being older than 50
• Smoking (currently or previously)
• Diabetes
• High blood pressure
• High cholesterol
• Personal or family history of PAD, heart disease, heart attack or stroke
• Sedentary lifestyle (infrequent or no exercise)

SOURCE: Michigan Podiatric Medical Association

Tuesday, February 7, 2012

The Best Cross Training Shoes for Women with Knee Problems

Posted on: LiveStrong.com

Cross training simply refers to participation in a variety of workouts or training regimens in addition to your specialty. Cross-training shoes, then, must provide support during activities such as jogging, bicycling, weightlifting and sprinting. If you have knee or other joint problems, be careful to choose shoes that can properly protect and support you. Check with your doctor or therapist to confirm that your shoe selection is sufficient for your needs.

Features

More than anything else, cross-training shoes need to provide support and cushion for your body. If you have knee problems, seek help from a specialist to determine if you supinate, which is leaning out with the foot, or pronate, which is rolling the foot inward. Finding this out will help you determine how much and what type of arch support you need for your cross-training shoes.

Women's New Balance 1225

The women's New Balance 1225 cross training shoe is ideal for women of average weight. The arch support and extra cushion can be particularly beneficial for women who over pronate. They are lightweight and perfect for dancing or aerobics classes, as well as for more intense, high-impact exercises.

Orthaheel Women's Action X-Trainer

If you tend to have severe knee pain, choose a cross-training shoe geared specifically to support the impacted joints. Orthaheel shoes were invented by a podiatrist. The Orthaheel Women's Action X-Trainer can provide impressive support during a wide range of workout types.

ASICS GEL-Fluent TR 2

A lot of knee pain in women is caused or aggravated by the constant shock of intense movements. Wearing the ASICS GEL-Fluent TR 2 means that each step is cushioned with a scientifically formulated gel that absorbs much of this shock, helping relieve knee pain.

Nike Women's Free Trainer 7.0.IV

The Nike Women's Free Trainer 7.0.IV is primarily designed for women who routinely do cross training that is lower impact or involves lots of lateral movements. It is an extremely lightweight shoe that provides enough support for problematic knees without slowing you down.

Thursday, February 2, 2012

New hazards for high heel wearers

Study by American Podiatric Medical Association

APMA’s survey data on women and footwear was recently featured on NBC’s Today show.

http://video.today.msnbc.msn.com/today/46235875#46235875