I had the opportunity to attend my friends' children's high school graduation this week. The school is a small private school in Houston, TX with a graduating class of 17. It was an inspiring ceremony and I wish my best to all graduates this commencement season.
Of the female graduates, almost all of them were wearing the highest heels I have seen. It hurt me to watch as they walked across the stage to receive their diploma. People ask me what i think of such shoes. My answer is "They're great for business!" At some point these young ladies will have foot issues and I'll be there to treat them.
The most common injury that comes from wearing high heels is a Morton's Neuroma. This is an inflammation of the nerve that travels between the metatarsal bones and provides significant pain in the forefoot.
Treatment for a Morton's Neuroma can include anti-inflammatory medication, cortisone injections, custom orthotics, and nerve sclerosing injections. A recent study appearing in the Journal of the American Podiatric Medical Association also showed the effectiveness of shockwave therapy (ESWT)on neuromas, previously used only on heel pain. There is also surgery to remove the painful nerve, of course as a last resort.
Wearing high heels occasionally is unlikely to provide problems. Habitual use, however, can cause significant trouble. Moms...be sure to tell your daughters...they won't listen to us dads!
Thursday, July 9, 2009
Wednesday, July 8, 2009
Another New Video About Orthotics
The videos just got up on the website, so I can't call this one a sneak preview. This video discusses the use of a custom orthotic to control the biomechanics of the lower extremity. When we deal with the multitude of foot and ankle injuries, mechanics plays some role. From heel pain, to neuromas, to chronic ankle sprains, controlling the mechanics with an orthotic is the best long-term investment to keep those injuries from reoccurring.
Tuesday, July 7, 2009
Guest Blogger: My 8 Year Old Son Ariel
I'd like to introduce everyone to my 8 year old son Ariel. Ariel has been wearing orthotics since he was four and is incredibly diligent about making sure he transfers them from shoe to shoe. Today, however, he forgot and found his feet to be aching. Of course, when we were walking home he said...Dad, should you blog about me forgetting to wear my orthotics? I thought we'd do one better and make a short video with him telling everyone in his own words.
Monday, July 6, 2009
How To Treat Blister on Your Feet Safely
A blister is a small pocket of fluid contained in the outer layers of the skin. A blister is caused by irritation of the skin from excessive rubbing, burning, freezing, chemicals toxic to the skin, or infection. It can contain blood, serum, or pus within it. If you are athlete you are probably very familiar with blisters. They commonly appear at places that get repeated irritation. The location of blisters depends on the activity you are doing. If you are a golfer, weight lifter or baseball player the most common places to get blisters are on your hands, a skier or snowboarder on your shins or lower legs, and a runner or walker on your feet.
Once people realize that they have a blister the most common issue is not knowing what to do. Do I pop the blister or do I leave it alone? Some people say don't pop a blister because it can get infected and it will just get worse. Other people say pop a blister as soon as it forms otherwise it will keep getting bigger. I can see why there is confusion as to pop or not pop a blister because there is a little truth in both of these statements. As far as what a trained health care professional will tell you, such as a podiatrist, it is better to pop the blister, but doing it in a clean and sterile manner. If you need to drain a blister because you are going to continue the type of activity that caused the blister, follow the following guidelines to do it safely
1) Gather the following supplies: washcloth, soap, sterile needle, gauze, antibacterial ointment, Band-Aid
2) Clean the area over and around the blister with a washcloth, soap and water.
3) Carefully hold the sterile needle in your dominant hand and gauze on your non-dominant hand. Puncture the blister on the side then immediately apply pressure over the blister with a gauze pad until you have drained all the liquid from the blister. Be sure to leave the “roof “ of the blister intact.
4) Properly dispose of the needle and gauze pad.
5) Apply a thin layer of topical antibacterial ointment to the area where the blister was located.
6) Put a Band-Aid over the area to help prevent infection.
7) Figure out what caused the blister to form and find a way to stop the irritation from continuing. This will prevent additional blisters from forming.
Blisters are common occurrences, especially in active people. Most blisters are easy to treat but if you feel uncomfortable treating it on your own, or think that your blister may be infected, contact your local podiatrist for a professional opinion.
Once people realize that they have a blister the most common issue is not knowing what to do. Do I pop the blister or do I leave it alone? Some people say don't pop a blister because it can get infected and it will just get worse. Other people say pop a blister as soon as it forms otherwise it will keep getting bigger. I can see why there is confusion as to pop or not pop a blister because there is a little truth in both of these statements. As far as what a trained health care professional will tell you, such as a podiatrist, it is better to pop the blister, but doing it in a clean and sterile manner. If you need to drain a blister because you are going to continue the type of activity that caused the blister, follow the following guidelines to do it safely
1) Gather the following supplies: washcloth, soap, sterile needle, gauze, antibacterial ointment, Band-Aid
2) Clean the area over and around the blister with a washcloth, soap and water.
3) Carefully hold the sterile needle in your dominant hand and gauze on your non-dominant hand. Puncture the blister on the side then immediately apply pressure over the blister with a gauze pad until you have drained all the liquid from the blister. Be sure to leave the “roof “ of the blister intact.
4) Properly dispose of the needle and gauze pad.
5) Apply a thin layer of topical antibacterial ointment to the area where the blister was located.
6) Put a Band-Aid over the area to help prevent infection.
7) Figure out what caused the blister to form and find a way to stop the irritation from continuing. This will prevent additional blisters from forming.
Blisters are common occurrences, especially in active people. Most blisters are easy to treat but if you feel uncomfortable treating it on your own, or think that your blister may be infected, contact your local podiatrist for a professional opinion.
Friday, July 3, 2009
Sneak Preview...New Sports Medicine Video
I just got my newest video for my website back from the editor and thought you'd like a sneak preview. It'll be on my website shortly, but I got it up on YouTube so you can take a look now.
Thursday, July 2, 2009
Pain on the Convention Floor
We all have those things we come across and say "I should have thought of that!" A few years ago, when in the exhibit hall for the Houston Livestock Show and Rodeo, I had such a moment.
Among all the tractors, ranch supplies, hot sauces, and other vendors you'd expect, I came across a guy selling insoles. The product was much more supportive than one you would find in a pharmacy but a far cry from a custom orthotic. Plus, knowing his audience, he had some that would fit into western boots.
As with most conventions and exhibit halls, there is a ton of walking on hard concrete floors. Surely the number of attendees with foot pain increases as the day wears on, and there the vendor is to provide instant relief at a premium price...Genius!
As you head off to such a conference, go prepared with either some good insoles, such as Powerstep or Superfeet. If you are already experiencing foot pain, see your podiatrist for relief before you go and do all of that walking.
Among all the tractors, ranch supplies, hot sauces, and other vendors you'd expect, I came across a guy selling insoles. The product was much more supportive than one you would find in a pharmacy but a far cry from a custom orthotic. Plus, knowing his audience, he had some that would fit into western boots.
As with most conventions and exhibit halls, there is a ton of walking on hard concrete floors. Surely the number of attendees with foot pain increases as the day wears on, and there the vendor is to provide instant relief at a premium price...Genius!
As you head off to such a conference, go prepared with either some good insoles, such as Powerstep or Superfeet. If you are already experiencing foot pain, see your podiatrist for relief before you go and do all of that walking.
Monday, June 29, 2009
Athletes Foot: What It Is and How To Treat It
Athletes foot is a fungal infection, known as Tinea Pedis, that grows in damp sweaty environments. This is a common condition that occurs in many runners that can be very irritating to deal with. The infection commonly causes itching, stinging, and burning between toes, as well as peeling, cracking and blistering skin on the feet. This fungal infection is common in runners as well as many other athletes (hence it's name) because of the environment it grows in.
The fungus that causes athletes foot can be found on damp contaminated surfaces such as in locker rooms, bathrooms, and pool areas. It is also contagious, so if a family member has the infection, it can remain on surfaces to infect others. Athletes foot grows rapidly between toes since it is a moist and warm area. Runners who pick up athletes foot will then put on socks and shoes and run causing an even more ideal environment for the fungus to grow in since your feet become even more warm and sweaty. Add to that the hot and humid weather in Houston, TX and you have the ideal circumstances for the fungus to thrive.
There are a couple of things you can do to prevent getting athletes foot. Always wear flip-flops or shower shoes when bathing in public facilities and in bathrooms that you share with someone who has athletes foot. Whenever you get out of the shower or pool make sure you dry between each toe to eliminate excess moisture that Athletes foot can thrive in. Do not wear all-cotton socks because they cause your feet to be damp when they sweat. Buy socks made of a synthetic fiber that are thoroughly able to wick away any excess fluid, such as CoolMax and DryMax.
If you get Athletes foot there are over-the-counter antifungal products, such as Lamisil cream, to treat the infection. To treat the infection, begin by washing your foot, making sure to wash and dry the areas between the toes. Apply a thin layer of an anti-fungal medication to the affected area as directed on the label. Most over-the-counter anti-fungal medication can take up to two weeks to heal completely. If you are not sure which medication to use, or if the over-the-counter medication is not working, contact your podiatrist.
You should also be sure to treat your shoes. Having fungus in your shoes will cause you to reinfect yourself after the Athletes foot has cleared up. Spraying your shoes with a disinfectant spray, such as Mycomist, will allow the fungus to be controlled and will help to prevent the infection for reoccurring.
The fungus that causes athletes foot can be found on damp contaminated surfaces such as in locker rooms, bathrooms, and pool areas. It is also contagious, so if a family member has the infection, it can remain on surfaces to infect others. Athletes foot grows rapidly between toes since it is a moist and warm area. Runners who pick up athletes foot will then put on socks and shoes and run causing an even more ideal environment for the fungus to grow in since your feet become even more warm and sweaty. Add to that the hot and humid weather in Houston, TX and you have the ideal circumstances for the fungus to thrive.
There are a couple of things you can do to prevent getting athletes foot. Always wear flip-flops or shower shoes when bathing in public facilities and in bathrooms that you share with someone who has athletes foot. Whenever you get out of the shower or pool make sure you dry between each toe to eliminate excess moisture that Athletes foot can thrive in. Do not wear all-cotton socks because they cause your feet to be damp when they sweat. Buy socks made of a synthetic fiber that are thoroughly able to wick away any excess fluid, such as CoolMax and DryMax.
If you get Athletes foot there are over-the-counter antifungal products, such as Lamisil cream, to treat the infection. To treat the infection, begin by washing your foot, making sure to wash and dry the areas between the toes. Apply a thin layer of an anti-fungal medication to the affected area as directed on the label. Most over-the-counter anti-fungal medication can take up to two weeks to heal completely. If you are not sure which medication to use, or if the over-the-counter medication is not working, contact your podiatrist.
You should also be sure to treat your shoes. Having fungus in your shoes will cause you to reinfect yourself after the Athletes foot has cleared up. Spraying your shoes with a disinfectant spray, such as Mycomist, will allow the fungus to be controlled and will help to prevent the infection for reoccurring.
Friday, June 26, 2009
Yao Ming's Broken Foot is Not Healing
Word has gotten out that Yao Ming did not get great news about the broken bone in his foot at his six week checkup. The bone does not seem to be healing properly, although he has no pain. He still is laid up and won't be playing for the Chinese national team. It remains questionable when he'll be ready to play for the Houston Rockets.
According to the article that I read at ShanghaiDaily.com, a bone scan done recently shows the fracture as still unhealed. I happen to know who Yao's doctor is, so I certainly trust his assessment. I think the story gives a false impression, though. A bone scan is a test that shows bone activity. It is great because it's sensitivity can pick up fractures and other bone issues that may be hard to see on a plain x-ray. A problem, though, is that it is so sensitive that it can still give a false positive signal for things like arthritis, past surgeries, and old fractures. I would expect to still see the fracture on the bone scan.
It certainly is possible for the fracture to not heal quickly, especially on a big guy like Yao. Bone has a blood supply...it's living tissue. Some areas of bones have a greater blood supply than others and if the fracture occurred in a weaker area, it likely has a poorer supply. This can cause a condition known as avascular necrosis. This is a deterioration and non-healing of the fracture site due to a poor blood supply. Often, the use of a bone stimulator can be helpful for this. A bone stimulator is a device that sends waves to the bone to stimulate blood flow and bone healing. It is a non-invasive device that works well to get a bone to heal faster and stronger.
A bone stimulator is not just for professional basketball players, it is covered by most insurance companies and can be prescribed by your podiatrist.
UPDATE 6/30/09: As more details emerge, the first article had it wrong...while he might have had a bone scan, the determining test was a CT scan. This is a much more appropriate test and would be able to assess the status of healing of Yao's fracture. It seems like it's possible that he'll miss much or all of next season. I'm hoping he'll be able to have this fracture ultimately heal without surgery. With all the surgery Yao has already had, another could really damage his career.
According to the article that I read at ShanghaiDaily.com, a bone scan done recently shows the fracture as still unhealed. I happen to know who Yao's doctor is, so I certainly trust his assessment. I think the story gives a false impression, though. A bone scan is a test that shows bone activity. It is great because it's sensitivity can pick up fractures and other bone issues that may be hard to see on a plain x-ray. A problem, though, is that it is so sensitive that it can still give a false positive signal for things like arthritis, past surgeries, and old fractures. I would expect to still see the fracture on the bone scan.
It certainly is possible for the fracture to not heal quickly, especially on a big guy like Yao. Bone has a blood supply...it's living tissue. Some areas of bones have a greater blood supply than others and if the fracture occurred in a weaker area, it likely has a poorer supply. This can cause a condition known as avascular necrosis. This is a deterioration and non-healing of the fracture site due to a poor blood supply. Often, the use of a bone stimulator can be helpful for this. A bone stimulator is a device that sends waves to the bone to stimulate blood flow and bone healing. It is a non-invasive device that works well to get a bone to heal faster and stronger.
A bone stimulator is not just for professional basketball players, it is covered by most insurance companies and can be prescribed by your podiatrist.
UPDATE 6/30/09: As more details emerge, the first article had it wrong...while he might have had a bone scan, the determining test was a CT scan. This is a much more appropriate test and would be able to assess the status of healing of Yao's fracture. It seems like it's possible that he'll miss much or all of next season. I'm hoping he'll be able to have this fracture ultimately heal without surgery. With all the surgery Yao has already had, another could really damage his career.
Wednesday, June 24, 2009
Podiatrist...Coming Soon to a Foot Care Aisle Near You
I was reading an article in the UK Daily Mail entitled "Check Out Your Bunions While Buying Your Onions" this morning and I was intrigued. It described a podiatrist who has set up clinic in a grocery store a couple of days a week. Would this work here in Texas? If people are too busy to go to the podiatrist, should podiatrists just station themselves to where the people are?
This model is not unfamiliar to the US. Several years ago, WalMart was exploring a partnership with podiatrists in their stores. That program ended up fizzling. You will find, however, walk-in clinics popping up in Walgreens, CVS, WalMart, and other stores and pharmacies. They are often staffed by a nurse practitioner or physician assistant to administer minor treatment or prescribe medication for an illness. They are marketed to people without insurance, but the convenience is attractive to many.
Podiatry, along with other specialties, require specialized and expensive equipment. For optometry, stores like WalMart and Target seem to have realized that the investment in this equipment is worthwhile. I don't think the same will hold true for podiatrists. Having a podiatrist in these types of situations will be providing fairly limited services, like caring for toenails, corns, and calluses, such as what was described in the article. If someone truly required more advanced foot care, such as treating a diabetic ulcer or bunion surgery, a visit to the office will still be best.
This model is not unfamiliar to the US. Several years ago, WalMart was exploring a partnership with podiatrists in their stores. That program ended up fizzling. You will find, however, walk-in clinics popping up in Walgreens, CVS, WalMart, and other stores and pharmacies. They are often staffed by a nurse practitioner or physician assistant to administer minor treatment or prescribe medication for an illness. They are marketed to people without insurance, but the convenience is attractive to many.
Podiatry, along with other specialties, require specialized and expensive equipment. For optometry, stores like WalMart and Target seem to have realized that the investment in this equipment is worthwhile. I don't think the same will hold true for podiatrists. Having a podiatrist in these types of situations will be providing fairly limited services, like caring for toenails, corns, and calluses, such as what was described in the article. If someone truly required more advanced foot care, such as treating a diabetic ulcer or bunion surgery, a visit to the office will still be best.
Wednesday, June 17, 2009
Choosing the Best Socks for Warm Weather Running
The type of sock that you wear when you run is crucial to the comfort and health of your feet. It is important that you are running in the right type of socks that can stand up to whatever weather condition you may be running in. If you are running in cold conditions you will want a sock that will keep your feet dry and warm. In warmer conditions you want a sock that can keep your feet dry and cool. If you are a trail runner you will want a thicker more durable sock If you are a short distance runner you are going to want a more lightweight sock.
During the summer months, when it is warm outside, you sweat more when you run. It is very important to have a sock that has certain characteristics to deal with the heat. You must be certain that the sock is able to wick away this extra perspiration from your foot; otherwise you will acquire excess moisture against your skin that will cause blisters to form.
The most crucial factor on deciding which type of sock to wear during these warm months of the year is the material of the sock. You want to stay away from anything that is made of mostly cotton. Cotton is a great lightweight material but does not dry quickly. Cotton socks absorb the moisture from your feet and remain damp. This can cause blisters to form from the rubbing of the wet socks against your feet as you run. Some better materials for socks to use during warmer conditions are polyester, acrylic, and CoolMax. These synthetic materials are more expensive than cotton socks, but they really stand up to the heat. These materials will help to wick away your perspiration while keeping your feet cool and blister free.
Another thing to consider when buying warm weather running socks is to look at the design of the sock. A good running sock is made up of two layers. The inner layer of the sock should help to wick the moisture away from your feet and the second outer layer should remove the water from the first layer and aid in evaporation. This design will keep your feet as dry as possible so blisters will not form.
Runners are so concerned about running in the right shoe, they don’t give much thought to their socks. The next time you go to purchase running socks, make sure that they check what the sock is made of and its design. All socks are not created equal.
During the summer months, when it is warm outside, you sweat more when you run. It is very important to have a sock that has certain characteristics to deal with the heat. You must be certain that the sock is able to wick away this extra perspiration from your foot; otherwise you will acquire excess moisture against your skin that will cause blisters to form.
The most crucial factor on deciding which type of sock to wear during these warm months of the year is the material of the sock. You want to stay away from anything that is made of mostly cotton. Cotton is a great lightweight material but does not dry quickly. Cotton socks absorb the moisture from your feet and remain damp. This can cause blisters to form from the rubbing of the wet socks against your feet as you run. Some better materials for socks to use during warmer conditions are polyester, acrylic, and CoolMax. These synthetic materials are more expensive than cotton socks, but they really stand up to the heat. These materials will help to wick away your perspiration while keeping your feet cool and blister free.
Another thing to consider when buying warm weather running socks is to look at the design of the sock. A good running sock is made up of two layers. The inner layer of the sock should help to wick the moisture away from your feet and the second outer layer should remove the water from the first layer and aid in evaporation. This design will keep your feet as dry as possible so blisters will not form.
Runners are so concerned about running in the right shoe, they don’t give much thought to their socks. The next time you go to purchase running socks, make sure that they check what the sock is made of and its design. All socks are not created equal.
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