Wrong Sandals Can Cause Heel Pain, Achilles Tendonitis and Other Ailments

Footwear has come a long way since Roman armies conquered an empire wearing only sandals on their feet. But what’s old is new again. Recent market research reveals sales of men’s sandals jumped 20 percent between 2005 and 2007.

Along with the growing popularity of men’s sandals come more aches and pains for male feet.  The wrong sandal could cause men problems including heel pain, Achilles tendonitis, pain in the big toe and even breaks and stress fractures in some of the foot’s 26 bones.

Men shopping for a man sandal – or “mandal” as some people call it – should look for a sturdy, cushioned, supportive sole and padded straps. Men with diabetes should refrain from wear of sandals.

Despite what many men may tell themselves, foot pain is not normal. So please contact my office for further evaluation and treatment.

Love Flip Flops in the Summer????

Flip flop sandals in every color, design and material are always popular in the summertime for everyone. But, while these types of sandals are fun, they shouldn’t become the mainstay of your footwear wardrobe.

Wearing flip flops too often can result in foot problems. With no arch support, and no stability, flip flops cause abnormal stress on the plantar fascia (the band of tissue that extends from the heel to the base of the toes). The resulting condition, known as“plantar fasciitis,” usually causes pain in the heel immediately upon arising in the morning or after periods of inactivity during the day.  Plantar fasciitis can be a persistent problem that takes a long time to effectively treat.  The best way to deal with the condition is to avoid it in the first place by wearing supportive footwear that provides sufficient shock absorption. 

It’s not necessary to completely avoid the popular footwear style. But, to save yourself from a lot of unnecessary pain, think of your flip flops as your dessert, not the main dish in your summer wardrobe and wear them sparingly.

Copyright © 2012 American College of Foot and Ankle Surgeons (ACFAS)

Don't let your feet ruin your day at the beach!

As millions of Americans hit the beach this summer, please read the safety tips from the American College of Foot and Ankle Surgeons listed below:

Puncture wounds and cuts: Wear shoes to protect your feet from puncture wounds and cuts caused by sea shells, broken glass and other sharp objects. Don’t go in the water if your skin gets cut – bacteria in oceans and lakes can cause infection. To avoid complications from a puncture wound, see a foot and ankle surgeon for treatment within 24 hours.

Sunburns: Feet get sunburn too. Rare but deadly skin cancers can occur on the foot. Don’t forget to apply sunscreen to the tops and bottoms of your feet.

Burns: Sand, sidewalks and paved surfaces get hot in the summer sun. Wear shoes to protect your soles from getting burned, especially if you have diabetes.

Ankle injuries, arch and heel pain: Walking, jogging and playing sports on soft, uneven surfaces like sand frequently leads to arch pain, heel pain, ankle sprains and other injuries. Athletic shoes provide the heel cushioning and arch support that flip-flops and sandals lack. If injuries occur, use rest, ice, compression and elevation to ease pain and swelling. Any injury that does not resolve within a few days should be examined by a foot and ankle surgeon.
Diabetes risks: The 20 million Americans with diabetes face serious foot safety risks at the beach. The disease causes poor blood circulation and numbness in the feet. A diabetic may not feel pain from a cut, puncture wound or burn. Any type of skin break on a diabetic foot has the potential to get infected and ulcerate if it isn’t noticed right away. Diabetics should always wear shoes to the beach, and remove them regularly to check for foreign objects like sand and shells that can cause sores, ulcers and infections.


For treatment of beach-related foot injuries, please contact our office, 440-946-5858, for a consultation.

Cold Fingers and Toes No Matter What Season

Even on the hottest days of summer, some people find themselves outside, under the scorching sun, walking around with cold feet. The cause of the cold sensation is a foot problem known as Raynaud's Disease.

Raynaud's Disease is a disorder that affects the hands and feet. It is caused by contraction of the smooth muscles controlling the small arteries supplying circulation into the hands and feet. This contraction, called a vasospasm, makes the arteries so small that they restrict blood flow.

How can you combat Raynaud's Disease and make your feet feel warm again?

During colder months, wear a scarf, gloves or mittens and a good pair of socks and boots at all times. A hat is also very important since the body loses a lot of heat through the head.
During the warmer months it is good to have a sweater handy as air conditioning can trigger an attack. If you are indoors, wear socks and lower the air conditioning at home; never walk around barefoot.

Avoid taking cold beverages with your hands, washing vegetables with cold water and taking food from the freezer without gloves

Don't smoke and avoid second-hand smoke as nicotine causes the skin temperature to drop

Exercise frequently to improve circulation

Learn relaxation techniques to reduce stress levels

Do not engage in activities that put pressure on the fingertips (example playing piano or guitar)

Take care of your hands and feet as skin may become very dry from reduced circulation. Hydrate your skin with a lotion containing lanolin and use a soft and creamy soap.

If you or someone you knows suffers from cold fingers and toes, no matter what season, please give our office a call for consultation, 440-946-5858.

Skin Cancers of the Feet

What are Skin Cancers of the Feet?

Skin cancer can develop anywhere on the body, including in the lower extremities. Skin cancers of the feet have several features in common. Most are painless, and often there is a history of recurrent cracking, bleeding, or ulceration. Frequently, individuals discover their skin cancer after unrelated ailments near the affected site.
Causes

We often view the sun’s harmful rays as the primary cause of skin cancer, due to the fact that the condition is often found on parts of the body that receive the most sun exposure. While this may be true of some bodily skin cancers, it does not hold true for those that arise on the skin of the feet. Skin cancers of the feet are more often related to viruses, exposure to chemicals, chronic inflammation or irritation, or inherited traits. Unfortunately, the skin of the feet is often overlooked during routine medical examinations, and for this reason, it important that the feet are checked regularly for abnormalities which might be indicative of evolving skin cancer.

Types and Symptoms

Some of the most common cancers of the lower extremity are:

Basal Cell Carcinoma: Basal cell carcinoma frequently is seen on sun-exposed skin surfaces. With feet being significantly less exposed to the sun, it occurs there less often. This form of skin cancer is one of the least aggressive cancers in the body.  Basal cell cancers may appear as pearly white bumps or patches that may ooze or crust and are similar in appearance to an open sore. On the skin of the lower legs and feet, basal cell cancers often resemble non-cancerous skin tumors or benign ulcers.

Squamous Cell Carcinoma: Squamous cell carcinoma is the most common form of cancer on the skin of the feet. Most types of early squamous cell carcinoma are confined to the skin and do not spread. However, when advanced, some can become more aggressive and spread throughout the body. This form of cancer often begins as a small scaly bump or plaque, which may appear inflamed. Sometimes there is a history of recurrent cracking or bleeding. Occasionally, it begins as a hard, projecting, callus-like lesion. Though squamous cell cancer is painless, it may be itchy. Squamous cell cancer may resemble a plantar wart, a fungal infection, eczema, an ulcer, or other common dermatological conditions of the foot.

Malignant Melanoma: Malignant melanoma is one of the deadliest skin cancers known. Nonsurgical treatments are rarely effective and many remain experimental. This type of skin cancer must be detected very early to ensure patient survival. Melanomas may occur on the skin of the feet and on occasion beneath a toenail. They are found both on the soles and on the top of the feet. As a melanoma grows and extends deeper into the skin, it becomes more serious and may spread through the body through the lymphatics and blood vessels.
When to Visit a Podiatrist

Learn the ABCDs of cancer. If you notice a mole, bump, or patch on the skin that meets any of the following criteria, see a podiatrist immediately:

•Asymmetry - If divided in half, the sides don't match

•Borders - They look scalloped, uneven, or ragged

•Color - They may have more than one color. These colors may have an uneven distribution

•Diameter - They can appear wider than a pencil eraser (greater than 6 mm). For other types of skin cancer, look for spontaneous ulcers and non-healing sores, bumps that crack or bleed, nodules with rolled or "donut-shaped" edges, or discrete scaly areas

Diagnosis and Treatment

The investigation for skin cancer will be done through clinical examination and skin and/or punch biopsy. A skin biopsy is a simple procedure in which a small sample of the skin lesion is obtained and sent to a specialized laboratory where a skin pathologist examines the tissue in greater detail.  If a lesion is determined to be malignant, your podiatrist will recommend the best course of treatment for your condition.

If you or someone you know has a questionable lesion, please give the office, 440-946-5858, for further evalaution and treatment.




Informatoin provided above can be found at APMA and/or BAKO Labs.

Rare Fleshing Eating Bacteraia

With the Georgia graduate student, making headlines with a rare bacterial infection, I felt in this week's blog I would discuss necrotizing fascitis.  This type of infection destroys muscles, skin, and underlying tissue. The word "necrotizing" refers to something that causes body tissue to die.

Many different types of bacteria can cause this infection. A very severe and usually deadly form of necrotizing soft tissue infection is due to Streptococcus pyogenes, which is sometimes called "flesh-eating bacteria."

Necrotizing soft tissue infection develops when the bacteria enters the body, usually through a minor cut or scrape. The bacteria begins to grow and release harmful substances (toxins) that kill tissue and affect blood flow to the area. As the tissue dies, the bacteria enters the blood and rapidly spreads throughout the body.

Symptoms include:

• Small, red, painful lump or bump on the skin
• Changes to a very painful bruise-like area and grows rapidly, sometimes in less than an hour
• The center may become black and die
• The skin may break open and ooze fluid

Other symptoms can include:

• Feeling ill
• Fever
• Sweating
• Chills
• Nausea
• Dizziness
• Weakness
• Shock

Your doctor may diagnose this condition by looking at your skin. You may be diagnosed in an operating room by a surgeon. Tests that may be done include:

• CT scan
• Blood tests
• Skin tissue biopsy

Immediate treatment is needed to prevent death. Treatment includes:

• Powerful, broad-spectrum antibiotics given immediately through a vein (IV)
• Surgery to drain the sore and remove dead tissue
• Special medicines called donor immunoglobulins (antibodies) to help fight the infection in some cases

Other treatments may include:

• Skin grafts after the infection goes away to help your skin heal and look better
• Amputation if the disease spreads through an arm or leg
• 100% oxygen at high pressure (hyperbaric oxygen therapy) for certain types of bacterial infections

How well you do depends on:

• Your overall health (especially if you have diabetes)
• How fast you were diagnosed and how quickly you received treatment
• The type of bacteria causing the infection
• How quickly the infection spreads
• How well treatment works

This disease commonly causes scarring and skin deformity.
Death can occur rapidly without proper treatment.

If you or someone you know, have a soft tissue infection, please go to the ER immediately and/or call our office, 440-946-5858, for an appointment.

Hammertoe Correctional Surgery

Many people seek the help of their doctor in hopes of fixing their hammertoes. It is common for podiatrists to receive patients who want to do something about their “ugly toes.” In truth, hammertoes can also be quite uncomfortable when they lead to such thing as corns, calluses, and swelling. The good news is surgery can be performed if necessary.

Depending on what stage the deformity is in, a hammertoe can be either flexible, semi-rigid and/or rigid. When they become painful, normally, after they have the reached the rigid state, hammertoe surgery will be necessary to alleviate the problem.

Different Types of Hammertoe Surgery

Surgeries to correct hammertoes do not require an overnight stay at a hospital. The procedure can be done as an out-patient, where you go home after completion of the procedure. Prior to the procedure, local anesthetic and/or mild sedation is administered to allow you to sleep through the procedure. The surgery entails a small incision on the top of the toe and either a soft tissue correction, digital arthroplasty (removal of a small piece of bone), and/or digital arthrodesis (joint fusion).

Soft tissue corrective surgery redirects the tendons and joint capsule of your toe which will correct the position.

 Digital arthroplasty involves correcting the soft tissue and removing a piece of bone in order to straighten the toe.

Digital arthrodesis techniques involved fusing two bones together in order to straighten the toe.

Often hammertoe surgery requires a mental wire or other implant to be inserted into the toe that will hold it into place while it heals. The end result will be a straightened toe.

How Long Does it Take to Recover from Hammertoe Surgery?

Recovery is patient dependent and compliance dependent, on average  most people wear a surgical shoe for approximately 3 weeks.

It seems to be that time of year when people are becoming more active,engaging in sports and working hard to get in shape for the summer season. In our Mentor office, we have seen a recent increase in stress and overuse injuries over the last month or so, likely attributed to this increase in exercise and activity. Therefore, in the blog below we will discuss some of the most common injuries seen and preventive measures to keep you healthy and active.

Common stress and overuse injuries of the foot and ankle:

Sever’s Disease

Most commonly seen within children between the ages of 10 and 14.  This condition invovles heel pain that is due to inflammation of the growth plate at the back of the heel. The Achilles tendon, which is the largest and strongest tendon in the body, inserts into the back of the heel bone, just behind the growth plate. Kids in track, soccer, gymnastics and other sporting activities, who are spending several days a week in these activities will often develop this condition, know as “Sever’s disease” or “calcaneal apophysitis.”

Stress Fracture
Runners training for a marathon, or those walking on a treadmill several times a week can both develop a stress fracture. This often happens when someone abruptly increases their mileage or number of times per week they are exercising. A stress fracture is usually an overuse type of injury that produces acute bone swelling leading to a crack in the bone. It is due to either normal amounts of stress to a weakened bone (as in the cases of osteoporosis), or abnormal amounts of stress to a normal bone (such as with increased mileage). Pain is usually worsened with increased or repetitive activities. Stress fractures are usually not seen on initial x-rays, and sometimes require an MRI or a bone scan to confirm the diagnosis. They are treated with a period of non-weight bearing to the affected area, and usually require crutches and a cast and/or cast boot until the bone heals.
Tendinitis

Tendinitis, similar to a stress fracture, can develop with an increase in mileage or with any repetitive activity. In the foot and ankle, we commonly see tendonitis develop in the Achilles tendon, or on the inside or outside of the ankle depending on the foot type and mechanics. If you have an area of your ankle that swells up with activity, and becomes very sore, you most likely have a case of tendonitis. Controlling foot mechanics with the proper shoes and possibly with arch supports or custom orthotics, can often prevent or be used to treat a case of tendonitis.

Prevention of overuse injuries is the smartest approach. The following are some tips to keep yourself active and exercising, and will help you avoid a period of recovery.

• Foot and ankle stretching excercises are very import before and more importantly, after exercising.

• Appropriate shoes for your activity

• Make sure your shoes are not too worn

• Ease into an exercise program (going from no exercise to 7 days a week all of a sudden is unwise)

• Ice the affected area after a work-out

If you or someone you know if suffering from any of the above aliments, please give our office a call for evaluation and treatment, 440-946-5858.

Achy Feet?????

It's not uncommon to experience foot pain after a long day of work or a vigorous sport activity, especially as we age. A long day of shopping or yard work can leave feet tired, heavy, swollen and achy: A problem we can all relate to at one time or another.

Some factors which contribute to achy feet, include:
-Age
-Gender
-Dehydration

Some causes which contribure to this condition include:
-Strenuous walking or standing for long periods on your fee
-Ill-fitting, poorly padded shoes
-Tight socks, stockings and/or garters
-Reduced blood circulation to the ankles and feet also causes tired aching feet.

5 Simple Ways to Relieve Tired, Aching Feet:
1. Elevate your feet to heart level for 15-20 minutes
2. Soak your feet in warm water with epsom salts if possible for 15-20 minutes
3. Massage your feet or have someone massage your feet for you
4. Exercise your feet, to tones muscles, strengthen the arches and stimulate blood circulation
5. Wear OTC and/or custom insoles in your shoes. Please see your podiatrist for their recommendation.

When foot pain persists, it's important to visit our podiatric office for a thorough examination. The cause of your foot pain may be more serious than simple stress and over work and we will work with you to determine a treatment plan that will put an end to your tired, achy feet for good!

Achilles Tendon Injuries

There are many issues relating to the Achilles tendon. It does not always result in the wince-inducing highlight reels from professional sports. While the tears and ruptures are the most notable and produce the best stories, there are other types of injuries that are just as common and not as severe. Many go undiagnosed as basic soreness and temporary injuries.

The Achilles tendon is the largest and toughest tendon in the body and it connects the heel to the calf muscles. Because it connects those two, it is responsible for moving the foot up and down, which is a motion used in just about every movement of a standing body. Because of its usage, it is very susceptible to injury, but also usually easy to diagnose and treat.

There are three basic types of Achilles tendon injuries:

Achilles Tendinosis:
There are many different words used to describe this condition. It has been referred to as tendinosis and tendinopathy. In this condition, the terminology which will be used is a degenerative tendinopathy. This term is used because it is a chronic condition, and is associated with gradual degeneration of the Achilles tendon.

There are times when the Achilles tendon does not function correctly because of multiple, minor microscopic tears of the tendon and the limited ability of the tendon to heal and repair itself. The blood circulation to the Achilles tendon in some patients is not always as good as it should be and microscopic tears begin to occur inside the tendon approximately six-centimeters from the attachment on the heel bone. Because of poor blood supply, the ability to heal these microscopic tears is limited and tearing of the tendon continues. Eventually, the tendon begins to thicken and weaken, and gets quite painful.

Achilles Tendonitis:
This injury is a result of continual stress on the tendon over time and can affect athletes and those not-so-athletic. Tight calf muscles, bone spurs, and increased physical exertion can lead to increased pain in the heel.

Achilles Tendon Rupture:
This is the Achilles injury that is often seen sidelining professional athletes. This is when the tendon tears partially or completely, and can result in inability to walk or even stand. It is often a result of Achilles tendonitis.

If you or someone you know has any questions and/or is seeking treatment for an Achilles tendon injury please give the office a call, 440-946-5858, for a consultation.

Got Heel Pain?????

Heel pain is a common presenting complaint causing patients to seek a foot and ankle surgeon or doctor. One of the most common etiologies of heel pain is mechanical and/or repetitive overuse injury causing inflammation of the plantar fascia, termed Plantar Fasciitis.

Symptoms of Plantar Fasciitis can include:
• Pain on the bottom of the heel
• Pain in the arch of the foot
• Pain that is usually worse upon arising
• Pain that increases over a period of months
• Swelling around heel

Causes for Plantar Fasciitis Include:
• Repetitive loading or exercise
• Change in activity level, duration, or training surfaces
• Recent activity/long walking in un-supportive shoes or sandals
• Faulty structure of the foot.
• Recent weight gain or obesity
• Acute trauma or injury

Conservative treatment options for Plantar fasciitis include:
• Stretching of the Achilles tendon and plantar fascia complexes
• Avoid going barefoot.
• Ice.
• Limit activities.
• Custom orthotics or over-the-counter orthotics
• Supportive and comfortable shoes
• Oral anti-inflammatories
• Physical therapy modalities
• Heel injections
• Night splints

Plantar fasciitis generally resolves with conservative management, however, certain cases can fail 6 months of conservative treatment, therefore, require surgical intervention to help alleviate the symptoms. Podiatry Research has demonstrated that chronic injury and inflammation to the plantar fascia leads to micro-tears and degeneration of the plantar fascia, termed plantar fasciosis. Plantar fasciosis lacks acute inflammatory tissue, accordingly, rendering conservative options unsuccessful at times.

Surgical options for Recalcitrant Plantar Fasciitis and Plantar Fasciosis can include:
•Topaz (ArthroCare) Microdebrider
•Platelet Rich Plasma injection
•Shockwave therapy
•Open and Endoscpoic Realease

Topaz Coblation Microdebrider procedure is a minimally invasive surgical technique utilizing small holes to break up the scar tissue and attempt revascularization of the plantar fascia. By "burning holes" into the ligament, the Topaz will turn a chronic process into an acute inflammatory process to cause an influx of inflammatory healing cells directly into the ligament.

The procedure is performed in the operating room. The anesthesia team will administer sedation medications and then a local nerve block is performed by the foot surgeon. The surgeon will then mark the area of the plantar fascia and make holes in the skin. The topaz probe is then placed through these holes into the plantar fascia. The patient is then placed into a walking boot for a period of 2 to 3weeks during the healing process.

The procedure only requires small holes compared to a larger open incision and surgery. This lends to quicker healing and less pain and scar tissue and faster recovery.

Think the Topaz procedure might help you? For help with your heel pain, please contact our office, 440-946-5858, to set-up a consultation.

Toning Shoes....Worth the Hype?

In an recently published article, Reebok International Ltd., which is owned and operated by Adidas, has been ordered to return $25 million to consumers over reported false advertising with its’ toning shoes, which include “EasyTone”, “RunTone” as well as several types of flip-flops and clothing.

These so-called “toning” shoes, which have been available for the last couple of years, have been a popular trend, and are manufactured by many of the big shoe companies such as Sketchers, New Balance, Reebok, and MBT. However, Reebok is the first company to be penalized for making advertising claims that the shoes can result in measurable changes in muscle tone and size, specifically in the buttock and upper legs. Apparently, there was a lack of scientific evidence to support these claims.

Many of my patients have tried similar toning shoes, and the overwhelming response has been negative. I recommend to my patients to refrain from wear if they have any underlying foot deformity and/or pain due to wear of shoes further exacerbating the condition.

If you or someone you know is suffering from foot pain due to wear of toning shoes please give our office a call, 440-946-5858, for evaluation and treatment.

Achilles Tendonitis

The Achilles tendon is the large tendon that attaches the powerful calf muscles to the back of the heel bone. It is important for stabilizing the foot during jumping and running and is a common area where injury occurs. Achilles tendonitis typically occurs at the tendon's weakest spot which is a few centimeters above the heel bone. This is also the area where weakening and tearing of the tendon usually occur(tendinosis).

Achilles tendonitis/tendinosis can be aggravated or caused by tight calf muscles. Calf muscle stretching on a daily basis can help prevent tendon problems. Adding heel lifts to shoes helps reduce strain on the Achilles tendon. Be sure to add heel lifts to both shoes to maintain postural stability.

Achilles tendon pain may not mean inflammation is present. Tendon pain is often caused by micro-tears and weakening of the collagen within the tendon and shows minimal (if any) inflammation at the cellular level. This gives insight as to why anti-inflammatory drugs may not alleviate the pain.

Pain at the heel bone where the tendon attaches, is more than likely not tendonitis and/or tendonosis, but bursitis. Bursitis is inflammation of a pocket of fluid (bursa) near the bone.

For more information about common types of tendonitis that affect the foot and ankle, please visit our website, www.drrobertrosenstein.com and/or give our office a call, 440-946-5858, for a consultation.

High Heels....Dangerous for Women

As a podiatrist, much of my day involves treating fellow ladies who have fallen victim to fashion with frequent wear of high heel shoes.

The human foot was once described by Leonardo Da Vinci as “a masterpiece of engineering and a work of art”, and this is evidenced by our ability to walk, run, jump, and play. However, it doesn’t take much to upset the fine balance between precision function and disaster. High heels, by their nature shift the body’s anatomy into foreign territory, causing marked postural and alignment strain.

By elevating the heel bone (calcaneus) there is an immediate change in the distribution of weight under the feet from the heel to the forefoot – the percentage of which is directly proportional to the height of the heel. With regular use, the calf muscles in the lower leg can permanently shorten, leaving you unable to comfortably wear flat shoes and further increasing pressure under the ball of the foot.

Habitual high heel wearers will invariably, at some point, suffer pain and disability because of this alteration in the way our body adapts to the ground and distributes weight.
Common complaints can include calluses, corns and blisters to more permanent deformities including bunions, hammer toes and acquired flat feet. It additionally can contribute to increased incidences of fractures of the ankle and metatarsals (forefoot), arthritis, pinched nerves, tendonitis and other soft tissue injuries and inflammation.

Before you lose faith and trust in all things fashionable, here’s some tips on how to minimise risk while wearing your heels:

• Moderation is the key: Avoid wearing heels when walking to and from work. Also, kick off the pumps in the office and replace with flats.
• Pick shoes that suit the activity for the day: Flats or shoes with only a slight heel are best for standing and walking, whereas heels may be suitable during a seated meeting or dinner date.
• Keep the heel height sensible: Anything over 5cm is hazardous and should be for only special occasions.
• Stilettos: A dangerous shoe for ankle sprains and fractures. Try broader heels with more stability and tread on the ground.
• Stretch your calf muscles regularly to improve fl exibility and reduce the likelihood of muscle contraction.

Seek immediate assistance from our office, should you experience pain, swelling or a change in shape of any part of your foot. Our office number is 440-946-5858.

March is Women's Health Month

In spirit of March being Women's Health Month, I have a created a list of 10 things all women should know before they go to pamper them self with a pedicure at their local salon.
1. Bring Your Own Instruments:
This will help decrease the risk of catching viruses, bacteria and fungus. Things to bring include: nail nipper, cuticle nipper, cuticle pusher and curette cleaner.
2. Ask About Instrument Cleaning:
Does the salon sterilize their instruments or do they just disinfect? Sterilization of instruments by autoclaving is the better choice.
3. Ask What Type of Foot Bath is Used:
Usually the whirlpool foot bath is either piped or pipe-free. It is thought that pipe-free is better because piped whirlpool foot baths have been found to contain bacteria in their pipes, jets and water filtration systems. The pipe-free whirlpool foot baths can easily be removed for cleaning. If the foot bath uses a liner, make sure that a new liner is being used each time.
4. Ask If Disposable Items Are Used Only Once:
Items such as nail files, foot files, buffers and toe separators should be used only once. You may want to consider bringing your own disposable items with you.
5. Make Sure Technician's Hands Are Clean:
The nail technician should wash their hands in between clients. If they do not wash their hands, request that they do or that they wear gloves. Be cautious of a technician with fake (artificial) fingernails. It is hard to clean the area between the fake fingernail and the real fingernail.
6. Ask If the Salon and Technician Are Licensed:The salon and technician should both be licensed by their state governing board. Usually the board of cosmetology. The licenses should be clearly displayed at the salon.
7. Don't Shave Legs 24 Hours Before Appointment:Nicks and cuts from shaving create small openings in the skin where bacteria can enter. If you have any open sores, wait until they heal before getting a pedicure.
8. Tell Technician Your Medical Conditions and Medications:
Certain medical conditions and medications can increase the risk of infection. Examples include: diabetes, lymphedema, peripheral vascular disease (PVD), neuropathy, HIV and autoimmune diseases like lupus. Examples of medications include: chemotherapy agents and blood thinners such as coumadin.
9. Check If the Salon is Clean:
The salon itself should be clean and well kept. This is usually a good indicator of how well they take care of their instruments and other salon equipment.
10. You Should Have No Pain:
Getting a pedicure at the salon should not be a painful experience. Just like any business, there are good salons and not so good salons. Find a pedicure salon that follows strict sterilization procedures and find a technician who does not cause pain or bleeding.

Please keep the tips listed above in mind when treating yourself to a mani/pedi. However, if you fall victim to a bad experience resulting in a nail and/or toe issue, please give our office a call for consultation, 440-946-5858.

Stabbing Pain in Your Heel????

Do you feel a stabbing pain in your heel with your first steps out of bed in the morning? You’re not alone! Every day, thousands of Americans suffer from this condition. Plantar fasciitis, more commonly known as heel pain, is by far, the most common complaint seen in my office.

Aching heels can truly affect your lifestyle and disrupt essential activities and prevent you, to a large extent, from playing sports or simply going for a walk. An accurate and expedient diagnosis of the cause of your symptoms will help you receive the appropriate treatment.

There are several causes of heel pain. The most common include:
Plantar Fasciitis – Inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar) surface of the foot, from the heel to the ball of the foot. Both heel pain and heel spurs are frequently associated with plantar fasciitis.
Heel Spurs – A bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. Heel spurs can result from strain on the ball of the foot and repeated tearing away of the lining or membrane that covers the heel bone. Contrary to popular belief, heel spurs are generally not the cause of pain—the pain you may feel is from inflammation of the plantar fascia.
Excessive Pronation – Excessive inward motion can create an abnormal amount of stretching and pulling on the ligaments and tendons that attach to the bottom back part of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.
Achilles Tendinitis – Pain at the back of the heel is associated with Achilles tendinitis, which is inflammation of the Achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone.

Other possible causes of heel pain include rheumatoid arthritis and other forms of arthritis (e.g., gout); Haglund’s deformity (a bone enlargement at the back of the heel bone in the area where the Achilles tendon attaches to the bone); inflamed bursa (“bursitis”), a small, irritated sac of fluid; neuromas (nerve growths) or other soft-tissue growths; and bruises or contusions, which involve inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.

Some contributing factors associated with heel pain are:
-Age: With increasing age, often there is decreasing flexibility.
-Any sudden change in activity: Particularly activities that increase weight bearing or pressure on the foot
-Flat, pronated feet or high-arched feet
-A sudden increase in weight: Such as pregnancy
-stress from an injury: A bruise incurred while walking, running, or jumping on hard surfaces

Seeking medical attention is the first line of defense in treating heel pain. However, there are several steps you can take to avoid heel pain in the first place:
-Wear shoes that fit well and have shock-absorbent soles, rigid shanks (the part of the shoe that supports the foot and helps give a shoe its structure), and a supportive heel counter (the rear-most part of the shoe, at the back of the heel above the sole)
-Wear the proper shoes for each activity
-Do not wear shoes with excessive wear on heels or soles
-Begin exercises slowly
-Wear athletic shoes with good shock support in the heels
-Purchase shoes that fit
-Avoid activities that may put constant strain on the foot
-Avoid going barefoot on all surfaces

A variety of treatment solutions are available to provide short and long-term pain relief. Begin treating heel pain by avoiding all sorts of pressure or tension on the inflamed area, giving your feet ample rest. Applying ice and heat packs in alternating fashion will greatly accelerate the process of healing. Another option is the use of custom insoles. Custom insoles may assist with treating active conditions of heel pain and likewise reduce the risk for reoccurrence. The custom insole will restore body balance and prevent the plantar fascia from experiencing strain when you walk. If all non-invasive treatment solutions do not work, surgery is probably the best next option.

Regular exercise for calf muscles and the plantar fascia is necessary to alleviate pain and improve flexibility of the affected muscle. These exercises are advised for both legs even if the pain is in one heel only. Some of the most beneficial exercises are:
Towel stretches – This exercise should be done every morning before you leave your bed. Make a loop with a towel and use it to pull your toes toward your body, while keeping the knee straight. Stretch each foot three times, and hold each stretch for 30 seconds, if possible.
Stair stretches – Stand tall on a staircase with the balls of both feet on
the edge of the step. Place hands on the railing or the wall for balance and support. Slowly lower heels toward the floor until you feel a stretch in your lower leg and heels. Maintain the stretch for 10 to 15 seconds. Repeat this exercise six times, and perform the stretches twice every day.
Wall-leaning Stretch – Stand an arm’s length away from a wall, place both hands on the wall at shoulder height, with the feet slightly apart and one foot in ront of the other. Your front knee should be bent, but the back knee should be straight while you lean toward the wall. Hold the position for 10 seconds at a time for up to 15 or 20 repetitions per leg.

If you are unsure of the cause of your symptoms, if pain is severe, or if you have the following symptoms, please call our office immediately:
_ Inability to bend your foot downward.
_ Inability to rise on your toes.
_ Inability to walk comfortably on the affected side.
_ Swelling or discoloration of the back of the foot.
_ Heel pain that occurs at night or while resting.
_ Heel pain that persists beyond a few days.

Heel pain does not always subside quickly after medical attention is received. Unfortunately, it may take several months before the pain is actually gone. In most cases, heel pain can be treated at home under a podiatric physician’s supervision.

If you or someone you know is suffering from heel pain, please give our office a call for consultation, 440-946-5858.

Ankle Sprain......Common Atheletic Injury....Ask Daniel "Boobie" Gibson

Daniel "Boobie" Gibson, a guard for the Cleveland Cavaliers, is benched with an ankle sprain. An ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Ligaments are bands of tissue – like rubber bands – that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement.

Some ankle sprains are much worse than others. The severity of an ankle sprain depends on whether the ligament is stretched, partially torn, or completely torn, as well as on the number of ligaments involved. Ankle sprains are not the same as strains, which affect muscles rather than ligaments.

Sprained ankles often result from a fall, a sudden twist, or a blow that forces the ankle joint out of its normal position. Ankle sprains commonly occur while participating in sports, wearing inappropriate shoes, or walking or running on an uneven surface. In Boobie's case, it was during a basketball game.

The symptoms of ankle sprains may include pain or soreness, swelling, bruising, difficulty walking and/or stiffness in the joint. These symptoms may vary in intensity, depending on the severity of the sprain. Sometimes pain and swelling are absent in people with previous ankle sprains. Instead, they may simply feel the ankle is wobbly and unsteady when they walk. Even if there is no pain or swelling with a sprained ankle, treatment is crucial. Any ankle sprain – whether it’s your first or your fifth – requires prompt medical attention.

There are four key reasons why an ankle sprain should be promptly evaluated and treated. First, an untreated ankle sprain may lead to chronic ankle instability, a condition marked by persistent discomfort and a “giving way” of the ankle. Weakness in the leg may also develop. Second, a more severe ankle injury may have occurred along with the sprain. This might include a serious bone fracture that, if left untreated, could lead to troubling complications. Third, an ankle sprain may be accompanied by a foot injury that causes discomfort but has gone unnoticed thus far. Fourth, rehabilitation of a sprained ankle needs to begin right away. If rehabilitation is delayed, the injury may be less likely to heal properly.

When you have an ankle sprain, rehabilitation is crucial—and it starts the moment your treatment begins.The available treatment options include:

•Rest: Stay off the injured ankle. Walking may cause further injury.
•Ice: Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
•Compression: An elastic wrap may be recommended to control swelling.
•Elevation: The ankle should be raised slightly above the level of your heart to reduce swelling.
•Early physical therapy: A rehabilitation program will be started as soon as possible to promote healing and increase your range of motion. This includes doing prescribed exercises.
•Medications: Non steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. In some cases, prescription pain medications are needed to provide adequate relief.

In more severe cases, surgery may be required to adequately treat an ankle sprain. Surgery often involves repairing the damaged ligament or ligaments.

If you or someone who know has sustained an ankle sprain and/or commonly "rolls their ankle" please give our office a call, 440-946-5858, for evaluation and treatment, so you are not benched.

Foot Facts

* 3 out of 4 Americans experience serious foot problems in their lifetime.

* The foot contains 26 bones, 33 joints, 107 ligaments and 19 muscles.

* 1/4 of all the bones in the human body are down in your feet.


-When these bones are out of alignment, so is the rest of your body.

*Only a small percentage of the population is born with foot problems.
-It's neglect and a lack of awareness of proper care-including ill fitting
shoes that bring on problems.

* Women have about four times as many foot problems as men.
-High heels are partly to blame.

* The average person takes 8,000 to 10,000 steps a day, which adds up to
about 115,000 miles over a lifetime.
-That's enough to go around the circumference of the earth four times.

* Women on average walk 3 miles farther per day than the opposite sex.

* There are 250,000 sweat glands in a pair of feet.
-Sweat glands in the feet excrete as much as a half-pint of moisture a day.

* Your two feet may be different sizes.
-Buy shoes for the larger one.

* Your feet mirror your general health.
-Conditions such as arthritis, diabetes, nerve and circulatory disorders can show
their initial symptoms in the feet. Therefore, foot ailments can be your first
sign of more serious medical problems.

* Walking is the best exercise for your feet.
-It also contributes to your general health by improving circulation,
contributing to weight control and promoting all-around well being.

If you or someone you know is having foot problems, please give our office a call at 440-946-5858.

February is Heart Month.....So Please Read Article Below

Do you get pain in either leg when you walk?

Does the pain go away when your stop walking (within 10 minutes)?

According to the World Health Organization if you answered yes to both of these questions your likelihood of PAD is 95%

What is PAD you ask?

Commonly referred to as “poor circulation,” Peripheral Arterial Disease (P.A.D.) is the restriction of blood flow in the arteries of the leg. When arteries become narrowed by plaque (the accumulation of cholesterol and other materials on the walls of the arteries), the oxygen-rich blood flowing through the arteries cannot reach the legs and feet.

The presence of P.A.D. may be an indication of more widespread arterial disease in the body that can affect the brain, causing stroke or the heart, causing a heart attack. According to The Journal of Vascular Surgery, 60-80% of patients with PAD have blockage in one coronary vessel and 21% of these patients will have a MI, stroke, cardiovascular death or hospitalization within 1 year.
Based upon the guidelines of the American Heart Association and American College of Cardiology, the following individuals would benefit from an ABI test:

- Exertional leg symptoms
- Non-healing wounds
- Asymptomatic patients at high risk
o Adults 70 years old
o Adults 50 years of age with diabetes or tobacco use

Testing for this condition is non-invasive: It utilizes blood pressure cuffs and is painless. If interested in being tested, please call our office to schedule an appointment.

Advancements in Treatment of Big Toe Arthritis

There has been a great advancements in the treatment of great toe arthritis, also known as hallux limitus and/or hallux ridigus. The terms commonly used refer to the latin term for limited to no motion, which is the main complaint that patients will have when they present for this condition. There is no clear understanding of the cause of hallux limitus/rigidus, but the main understanding is it may be due to trauma or chronic mechanical overload of the joint with abnormal weight bearing. The limited motion in the great toe joint is due to bone spurring and arthritis of the joint which causes jamming and pain.

Presenting symptoms for this include, but are not limited, to stiffness/pain/swelling/limited motion and cracking and/or grinding of the great toe joint.

Patients who present initially with mild complaints are often treated with shoe modifications and orthotics or custom insoles. Patients will often state that this improves their pain because they are not placing as much weight through the great toe region. However, over time, a certain number of patients will get increasing pain as the arthritis gets worse. This diagnosis is made through examination and x-rays of the foot to see the level of arthritis and joint damage to the great toe. It is rare but in some cases of local cartilage damage of possible cartilage lesions of the great toe, an MRI may be performed.

In most cases, surgical treatment of bone spurs and great toe arthritis is necessary. As the arthritis gets worse, the surgery is more difficult and requires more invasive options.

Advancements in surgical options for hallux limitus/rigidus are growing and getting better and better, offering a multitude of treatment options based upon the patient's needs. These procedures can include cheilectomy of bone spur removal, osteotomy for realignment and joint decompression, midfoot fusion for 1st metatarsal repositioning, hemi base implant joint resurfacing and great toe fusion

In general, early cases of spurring with limited joint damage do well with cheilectomy. As the problem proceeds, less cartilage is avaliable to work with, therefore an implant or great toe fusion is required If the 1st metatarsal bone is very loose and seems to be drifting upwards resulting in jamming of the great toe joint, then a fusion of the metatarsal at the base is a good option to realign the first metatarsal and prevent the jamming at the great toe joint.

For more information or to schedule an appointment, please call our office at, 440-946-5858.

Can Your Feet be Trying to Tell You Something?

Fungal Nail
Reason: Trauma or infection to the nail that makes it thickened, discolored, loose or deformed. Often caused by the spread of athlete’s foot, but may also be an indication of conditions such as diabetes or arthritis.
Response: Medications, such as Ker¬alac Gel and Lamasil tablets, have proven effective treatment.

Tendonitis
Reason: Overuse due to increase in physical activity, such as an increase in walking time or distance. May also be caused by wearing worn out or improperly-fitted shoes.
Response: Rest and ice, however in some cases, over-the-counter arch supports or anti-inflam¬matories may be indicated.


Blisters
Reason: Friction from shoes that don’t fit right or are too stiff.
Response: Instruct patients to keep feet dry and wear socks with properly-fitted shoes. Additionally, instruct them never to pop a blister and if painful, to seek medical attention.

Ingrown Toenails
Reason: Improper trimming or too much pressure on feet in tight-fitting shoes, resulting in redness, pain or swelling around the nail. Can also result from poor foot structure, heredity, trauma or foot deformities.
Response: Instruct patients to avoid tight-fitting shoes and socks and inspect nails daily. Additionally, instruct patients to trim nails straight across using toenail clipper.

Bromohydrosis (Foot Odor)
Reason: Increased perspiration from the more than 250,000 sweat glands in the foot due to increased body temperature.
Response: Instruct patients to rub corn starch or spray anti-perspirant directly onto the soles of the feet and spray Lysol into shoes daily. Additionally, instruct patients to keep shoes and socks dry and change shoes regularly.

Bunion (Hallux Abducto-Valgus Deformity)
Reason: A bump at the base of the big toe that is swollen, tender or painful when in the shoe, often caused by misalign¬ment of the joints. Ill-fitting shoes, heredity, trauma, biomedical abnormalities, neuromuscular disorders, inflammatory joint disease, congenital deformities or arthritis can also be culprits.
Response: Instruct patients to avoid pointy and narrow shoes or shoes with stitching or seams that rub bony areas of the foot. If painful, bun¬ions can be surgically removed by a podiatrist.

Plantar Fasciitis
Reason: Excessive weight gain resulting in pain on the bottom of the heel or in the arch. May also be caused by bony overgrowth on the heel, muscle imbalance, high or low arched feet, improper shoe gear, exces¬sive activity or trauma.
Response: Instruct patients to exercise, stretch their feet daily and wear strong, supportive shoes that don’t put undue stress on the ball or heel. If these measures are unsuccessful in relieving pain refer to a podiatrist for further examination and treatment.

If you are experiencing any of the above conditions, please do not hesitate to call and/or schedule an appointment at our office, 440-946-5858.

Keep Your Feet Safe at the Gym in the New Year

In the New Year, don’t forget to keep your feet in tip-top shape while following through with your resolutions to get fit. Follow the tips provided below to ensure heatlhy feet and maintenance of your resolutions:

Start new workouts gradually— Increase your stamina and the length of your workouts gradually to avoid overuse injuries such as stress fractures or tendon strains and sprains. Stretching your muscles before and after workouts also helps prevent these types of injuries. If you do feel you’ve sprained your ankle, be sure to seek treatment right away: Untreated or repeated ankle sprains may lead to chronic ankle instability, a condition that causes persistent pain and a ‘giving way’ of the ankle.

Wear the right shoe and sock— Wear well-fitting athletic shoes designed for the exercise or sport. Shoes that don’t support the arch of the foot and provide cushion for the heel can cause heel pain (plantar fasciitis). Shoes that are too small can also cause a neuroma, or a thickening of the nerve tissue, in the foot and may require injections, medication or physical therapy. Wearing cotton or non-slip socks are also key to help avoid painful blisters, which can become infected and cause more serious issues.

Use good technique— Improper exercise techniques can result in injury to the tendons or ligaments in your feet and ankles. Incorrect posture or misuse of exercise equipment can cause decreased stabilization in the foot and ankle, leading to joint sprains and muscle strains.

Gym Safety- Protect yourself from bacteria—Sweaty shoes, public showers, exercise equipment and the pool deck at the gym are breeding grounds for fungus, viruses and bacteria, including drug-resistant strains like MRSA (methicillin-resistant Staphylococcus aureus) which has become increasingly more common. Never go barefoot while in public areas; water shoes can provide a great barrier between your feet and the wet surfaces. “It’s also best to cover cuts and cracks in the skin or ingrown toenails since these minor tears in the skin’s surface can act as entry points for bacteria. If you have a cut or scrape that becomes red or swollen and is not healing in a timely manner, don’t hesitate to call our office for an appointment.

Above all, it’s important to listen to your body. If you experience an injury or pain, call our office at 440-946-5858 for an evaluation immediately!

Snow and Ice Can be Dangerous for Many Women

As a female, I too, like to wear fashionable shoes or boots, however with the onset of snow and ice after the 1st big snow storm hitting Northeastern Ohio it can be very dangerous. The treacherous snow and icy conditions we endure, can lead to falls, which are not only embarrassing but can result in a number of injuries. If your ankle rolls inward or outward, a bone can be broken or if your ankle twists, ligaments can be stretched or torn causing an ankle sprain. If this does happen to you, collect your belongings, brush off your designer duds and get somewhere where you can immediately begin “R.I.C.E.” therapy– rest, ice, compression and elevation – to help reduce swelling, pain and further injury. Then pick up your phone and call my practice in Mentor to be seen, 440-946-5858. If treatment is delayed long-term complications, such as chronic ankle instability and pain, arthritis, or deformity can develop.

Also, please do not believe the misnomer, if you can walk on it, it is not broken. If you develop pain, swelling, or bruising this is an indication of a serious injury requiring medication attention, so please don't hestiate and come into the office for evaluation.