Foot and Ankle Center Blog

Posts for: May, 2014

By John M. Sigle, DPM
May 27, 2014
Category: Uncategorized
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As we move closer to Mother’s Day, I thought it fitting to dedicate this article to the pregnant moms who are with child. According to a recent article in Glamour magazine, there is a baby boom in Hollywood that includes such stars as Mia Kunis and Ashton Kutcher, Christian Bale and Sibi Blazic, Scarlett Johansson and Romain Dauriac, and Drew Barrymore and Will Kopeman. Like all pregnant moms and expectant fathers, I am sure they too have a lot to think about and do to get ready for the arrival of their new baby. Moms are busy decorating the nursery, making frequent visits to their OBGYN, sending party favors for baby shower gifts, changing diets and thinking about names. Expectant fathers are busy trying to give a little more TLC, making frequent trips to the grocery store to satisfy insatiable cravings and making dry rehearsal runs for the moment they get “the call.”

All these things are essential, but far too little attention is given to mothers' feet, and how to get them fit to carry both her and baby during the pregnancy. As the natural weight gain increases, the center of gravity changes, adding excessive pressures to the knees, ankles and feet. Edema (swelling) and over-pronation (flat feet) are the two of the most common foot problems that are overlooked. In order to make the pregnancy period more comfortable, it is important to learn about foot care, and what can be done to relieve aches and pains.

Edema

Many of my pregnant patients tell me that their feet are noticeably swelling and ache with pain. Some even tell me their feet feel like they are stretching like a balloon and ready to pop. A certain amount of swelling is normal during pregnancy because more water is retained, and there is a change in blood chemistry causing fluid to shift into the tissue. As the uterus expands, pressure increases in the pelvic veins and large vein (vena cava) on the right side of the body that carries blood from the lower limbs to the heart. As the return of blood from the legs is decelerated, fluid is pushed from the veins into the tissues in the feet and ankles.

Some women also experience swollen feet and a larger shoe size due to the release of a hormone called relaxin. Although the feet appear to be growing, it is really a false illusion because the hormone causes the ligaments to become lax and stretched out.

Roughly 75 percent of pregnant women experience edema, especially by the time they reach their third trimester. Edema is considered to be worse during the summer and at the end of the day. Edema is more strenuous for women who are carrying multiples, or for those who have excessive amniotic fluid.

Edema is annoying, to say the least, but it is normal and generally harmless. It is important to pay close attention if there is excessive or sudden swelling to the feet, hands, face and puffiness around the eyes. Call your doctor promptly if these symptoms are present because it could be a sign of preeclampsia, a pregnancy-induced hypertension that occurs in 5 to 10 percent of the time. Also, contact your doctor immediately if one leg is significantly more swollen than the other or if there is pain in the calf area. These conditions could be a sign of a blood clot.

The good news is that most women’s feet will be fine following childbirth and should return to their normal size. Here are some tips to minimize Edema:

— Keep the body hydrated and drink plenty of water to flush your system of excess sodium and other waste products;

— Eat a well-balanced diet with low salt content;

— Elevate your feet and relax;

— Lie on your left side to improve circulation to your lower extremities;

— Avoid long periods of sitting or standing and take breaks if you are on your feet a lot;

— Do not cross your legs or ankles when sitting;

— Take several short walks if you are sitting for any length of time and elevate your feet when sitting;

— Stay away from uncomfortable shoes (high heels) that are too narrow or short ones that constrict circulation;

— Measure your feet regularly and wear shoes to accommodate changing foot sizes;

— Wear seamless stockings that do not restrict circulation and sock fabrics, such as cotton instead of nylon, that allow your feet to breathe;

— Waist-high maternity support stockings are helpful but should be put on early in the morning;

— Walk regularly and exercise with modification;

— Use proper foot care hygiene by trimming your toenails, removing calluses and using moisturizer to avoid dry and cracked skin;

— Give yourself a foot massage or ask your partner, family member or friend to help;

— Take regular foot baths and apply lotion to your feet;

— Use laser therapy on your feet, ankles and calves to reduce edema and aches and pain;

Over-pronation

Over-pronation (flat feet) is another common problem that occurs during pregnancy as a result of added weight gain. It occurs when a person’s arch flattens out during weight-bearing movement (like walking), causing the feet to turn in abnormally. The dense band of tissue that extends from the heel to the forefoot (plantar fascia) becomes strained and inflamed due to increased flattening of the feet. Walking can become very painful, and women may experience increased discomfort and strain on the feet, calves and back. Here are some tips to minimize over-pronation:

Exercises

— Straight-Knee Calf Stretch: stand arm’s length away from a wall. Place the palms of your hands on the wall. Move one foot forward about 12 inches. Keeping toes pointed forward and both heels on the floor, lean toward the wall. Bend your forward leg, but keep you back leg straight. Hold for 10 seconds. Relax and repeat with other leg forward. Repeat exercise for 10 times, three sets a day. Do not arch your back or hunch your shoulders during this exercise.

— Bent-Knee Calf Stretch: stand arm’s length away from a wall. Place the palms of your hands on the wall. Move one foot forward about 12 inches. Keeping toes pointed forward and both heels on the floor bend both knees and lean forward. Hold for 10 seconds. Relax and repeat with other leg forward. Repeat exercise for 10 times, three sets a day. Do not arch your back or hunch your shoulders during this exercise.

— Ankle Circles: Sit straight legged on the floor or another firm surface. Rest your calf muscles on a rolled-up bath towel or blanket. Rotate your ankles in each direction for two minutes. Repeat this exercise three times a day. Elevate your ankle above your hip if it is swollen.

— Reverse Calf Raise: After removing your shoes and socks sit with you heel at the edge of a telephone book or block of wood that is at least three inches high. Raise the front of your foot as far as you can, then lower it back down. Repeat with each foot for twenty times. Do three sets a day.

— Standing Calf Raise: Using a sturdy counter for balance, stand and lift on floor so you are supported by the other foot. Rise up on the ball of your foot and toes and onto your heel. Repeat this 30 times on each foot and do three sets a day.

— Exercise: Walking, swimming, or riding an exercise bike is recommended. Water aerobics classes are also excellent because immersion in water may temporarily help reduce swelling, particularly if the water level is up near your shoulders.

Proper footwear

— Select the proper footwear and avoid going barefoot or wearing sandals or flip flops because they do not provide support for your arch.

— Wear low-heeled shoes that are soft, comfortable, and provide room to move.

— Use ready-made orthotics or custom orthotics to provide arch support and shock absorption.

— Wear seamless socks that do not constrict circulation.

— Use laser therapy on your feet and ankles if you are experiencing plantar fasciitis, tendonitis, achiness and pain.

Pregnancy and pending motherhood should be a pleasant, enjoyable experience. Your feet need to be in good shape to carry you and your baby. Understanding the causes of foot pain and learning easy home remedies can help. Contact Dr. Sigle at (217) 787-2700 for more information or to schedule an appointment or visit myfootandanklecenter.com.


Spring marks the beginning of the running season for many fitness enthusiasts who have been cooped up for the long, hard winter. This time of year, complaints from shin splints soar. Shin splints are usually exercise induced by over training or improper training. Repeated stress on the tibia (shinbone) and connective tissues results in soreness, pain and inflammation. Shin splints can be a real nightmare for runners and cause a great deal of pain and discomfort. They can also be a nightmare for other athletes as well as the coaches and trainers who try to keep them in the game.

Runners are more likely to get shin splints as they shift their workouts from the treadmill to the road, or when they begin to train for a race. Indoor exercises on the treadmill, stair master, elliptical machine or stationary cycle are excellent for cardiovascular conditioning; however, they do not expose the legs and feet to the same impacts that occur on outdoor terrain. Many runners ramp up spring workouts too soon and find that they are more prone to get shin splints. It’s critical to allow your body to gradually adjust to the outdoor terrain. The general rule of thumb is not to exceed your distance and workout duration by more than 5 to 10 percent a week.

It’s difficult to diagnose shin splints because the pain can mimic other problems such as growth plate inflammation, partial muscle tears or tendonitis. Also, the origin of the pain can come from muscle imbalance, varying leg lengths, spine problems, nerve or artery entrapment syndrome or compartment syndrome.

Most people think there is only one kind of shin splints, but this is a misconception. There are actually three types of shin splints: Medial Tibial Stress Syndrome (MTSS), stress fractures and compartment syndrome. The latter of the two may be very serious if left untreated.

The Medial Tibial Stress Syndrome (MTSS) is the most common form of shin splints. It involves the inflammation of tissue surrounding the bone lining of the tibia (shinbone) where several leg muscles originate. Often, there are micro-tears in the tissue attached to the tibia. MTSS can occur in the posterior (lower outside) or anterior (lower inside) portion of the leg.

Posterior shin splints are the most common and account for approximately 75 percent of the cases. This is usually attributed to over-pronation (excessive flattening of the foot) as it becomes load bearing to the ground.

Anterior shin sprints are typically present in both legs and especially common among runners at the onset of the season when they are exposed to uneven terrain. They are also present among athletes who play on hard surfaces, sports that require excessive starts and stops and activities that involve jumping.

Micro-tears and inflammation in the soft tissue attached to the tibia are usually present. Moderate pain is present at the beginning of exercise and tends to dissipate until the exercise is over. It may also become noticeable after waking up in the morning.

The more advanced forms of shin splints are more difficult to diagnose. They can be related to a stress fracture or compartment syndrome.

Stress fractures are incomplete breaks in the bone that are usually caused by excessive stress on the bone. The bone micro-fractures develop when there is not ample time for recovery.

The most common stress fractures are located in the tibia. Athletes who engage in high-intensity training are at increased risk. This includes runners who average more than 25 miles per week, participants in track and field, soccer, dance, tennis and basketball.

Females are also at higher risk than males. Females are three times more likely to have shin splints evolve into stress fractures. Smokers and consumers of alcohol (10 drinks per week) are also more at risk.

Stress fractures usually cause severe pain and even nausea in some cases. This condition is diagnosed with X-rays and bone scans. Walking is restricted to a CAM walker, icing, anti-inflammatory medications, massage therapy, laser therapy, different shoe wear and protective shin guards. Pain usually improves when the fracture is immobilized.

Recovery varies but is usually around two to six weeks with proper rest, icing, immobilization, compression, elevation and laser treatment. Return to activity must be gradual.

Compartment syndrome is the most serious type of shin splints. It is more likely to develop as a result of an injury if you are taking anticoagulants. This condition occurs when pressure increases in a confined space.

There are a few compartments within the lower leg, but the most common one is found in the anterior (front) fascial compartment in the lower leg muscle below the knee. During exercise, the muscle can swell. This condition is common among long distance runners and hill runners. Pain is quite severe with movement and persists when resting.

In fact, it seems to be much greater than the injury itself. Pain tends to increase over time and causes a burning sensation and tightness around the area. If left untreated, it can have a damaging effect on the blood supply to the muscles in the affected compartment resulting in necrosis (death of the muscle). Other complications include permanent nerve damage, scarring resulting from surgery, infection, kidney failure, loss of limb and, in rare cases, death.

It is critical that the condition be diagnosed quickly to relieve the pressure and to help facilitate recovery of the muscle. The prognosis for this condition depends on how quickly it is diagnosed and treated. Time is of the essence.

When my friends ask me why my wife and I run, we usually tell them, ”because it makes us feel like winners, regardless of how fast we go or how much ground we cover.” That’s the truth! Most people get into running to lose weight and to stay healthy. Before long, running becomes a part of your lifestyle. Speed or distance does not matter that much as long as I get the feeling and satisfaction of accomplishment with each run that I do. So each and every run, I feel like a winner. You can too, but you have to be smart about it.

Also, be patient. Results will come in time if you are persistent. In the next article, I will give you some tips on how to battle shin splints and get your feet ready for the exercise

 


By John M. Sigle DPM, FACFAS
May 19, 2014
Category: Uncategorized
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Many of my patients ask me how they got toenail fungus and I tell them “there’s a fungus among us!” By that I mean it’s everywhere in our environment. Common sources of infection include swimming pools, public showers, gyms, and nail spas; however, you can even get from traveling barefoot at a hotel, and sharing nail clippers, nail files, or nail polish. It’s not only found in public places, it can be lurking in your home too. When a patient with toenail fungus tells me they walk around the house in bare feet, I tell them, “no shoes, no socks, no way!” Toenail fungus is very contagious and they can put their significant other, or family members, at risk if the proper precautions are not taken. Who wants that? Once the little yellow fungus monsters (Dermatophytes) invade the nail bed, they want to stay for life! In the majority of cases, toenail fungus is rarely cured; it’s managed.

Anyone who has this condition wishes there was a fast remedy, but there is no quick fix with conventional remedies like over-the-counter topical creams, prescription lacquers, or oral medications. Each of these remedies is a long, tedious process that works less than half the time. Buyers beware because many ads are misleading. Efficacy rates are not always accurate, risks are sometimes understated, and treatment costs can be high.

Laser technology has helped millions of people pitch their glasses. Now, breakthrough laser treatments for toenail fungus are allowing people to pitch their socks for open-toe shoes and sandals, and to go barefoot without embarrassment. Treatment is not a cure for everyone but podiatrists across the country are having outstanding success.

There are a variety of lasers on the market to treat toenail fungus. Some are FDA approved, others are not. They function in a similar manner but have different energy strengths, pulse durations, spot sizes, and treatment parameters. Tiny pulses of laser energy are applied to the toenail and surrounding tissue to eradicate the fungus. Treatments are relatively pain-free. Patients feel a mild pinch as the toenail heats up with a warm sensation that dissipates within seconds when the laser is applied to the next toe. Pain injections are not administered and, in the majority of cases, medications are not necessary or prescribed. Consequently, there are no risks or side effects. Other therapies are sometimes used in conjunction with laser treatment such as topical fungal creams, vitamins, nail soaking products, and ultraviolet shoe sterilizers. Depending on the type of laser used, the numbers of treatments range from one to three and treatment times vary between 15 to 60 minutes. Treatment intervals are usually scheduled four to eight weeks apart. Patients are able to return to work or resume normal activity immediately following treatment, and can continue to have pedicures afterward. Patients must be compliant while the new nail clears and often apply antifungal cream for a year.

Follow-up care or maintenance is sometimes required depending on the severity of the condition. Treatments are shown to be between 60 to 80 percent effective. The new nail begins to clear within three months but can take as long as one year to become fully visible.


A young woman recently told me there are actually “I Hate Feet Groups” on Facebook.

I realize this is hard to believe, but most people have the perfect body image of themselves that begins at their head and extends down to their toes. More than three-quarters of my female patients are embarrassed by unsightly toenails, and my male patients share the same concern. I am constantly receiving apologies from patients who have toenail infections from Onychomycosis (toenail fungus), irregular shaped nails due to trauma, toenails that are malformed (spoon shaped, brittle, splitting or horizontal nails) or nails that are discolored.

These conditions not only present physical problems but often cause psychological problems as well. As summer approaches, many people will avoid wearing open-toe shoes, sandals and flip-flops. Some will even stop participating in social and recreational events, or hide their feet because they are self-conscious and embarrassed about the way their toenails look. Distress can be quite extreme, and their quality of life can diminish. Regardless of age or gender, no one enjoys having infected or unsightly toenails.

The good news is that podiatrists now have the ability to create attractive nails for women and men. Podiatry Today recognized the KeryFlex Nail Restoration System as one of the top 10 innovations in podiatry. This system is used to repair toenails damaged by fungus, injuries and malformations.

The KeryFlex system restores damaged toenails to their natural appearance. It is recognized as an immediate cosmetic improvement to compliment laser fungal treatments. It looks and feels natural and is available in a number of hues to match the color of the nail bed. The

KeryFlex nail is durable and unaffected by acetone, nail polishes or detergents. Also, it does not stick or irritate the skin. Treatments can be given on a regular basis, just like getting a pedicure. When used in conjunction with toenail fungus treatments, the time interval between treatments is six to 10 weeks. KeryFlex applications are stopped when the new nails clear.

The KeryFlex nail restoration system uses polymer resins and special activators that bond to the damaged portion of the toenail to create a durable, yet flexible nail when exposed to a certain frequency of ultraviolet light. It is designed to flex with the movement of the toes and reduces further trauma to the nail bed.

It is a non-porous material and does not allow moisture to permeate or get in between the nail and prosthetic nail. The KeryFlex material also has an anti-fungal agent to retard the growth of fungal infections.

The procedure is fairly simple and takes about 15 to 25 minutes. Treatment is offered to both women and men, and clients are thrilled because they can instantly have healthy looking nails. They’re able to resume normal activities, get a pedicure or apply nail polish.

Treatment is a real confidence booster.

KeryFlex is exclusively available to podiatrists. Treatment is done by a podiatrist and trained technician in a sanitary medical setting to prohibit cross contamination. All instruments are sterilized in a medical ultraclave. Also, nail application materials are exclusively used by only one client.

Consult with your podiatrist to see if you are a good candidate for this treatment.

KeryFlex is not ideal for clients who have in-grown toenails, symptomatic peripheral vascular disease or diabetic neuropathy, arterial insufficiency or suspicious pigmented lesions on their natural nail.

The Foot & Ankle Center of Illinois/Illinois Laser Center is the first podiatry clinic in Springfield and Decatur to offer KeryFlex treatments. To learn more about this new innovation, visit www.myfootandanklecenter.com or call Dr. John Sigle at (217) 670-2160 to schedule an appointment.