Foot and Ankle Center Blog

Posts for: March, 2015

"Bull Durham" is one of my all-time favorite romantic comedies. It’s an intelligent comedy that makes me laugh every time I watch it. The movie centers around a love triangle that develops during a minor league baseball season between the team’s intelligent, sophisticated and sexy mascot, Annie, (played by Susan Sarandon), an up-and-coming rookie pitcher named Nuke LaLoosh (played by Tim Robbins) and an embittered former major league catcher named Crash Davis (played by Kevin Costner) who is demoted to the minors to teach Nuke how to make it into the bigs.
 

I’m sure those of you have seen the movie recall Crash’s famous “I believe in the soul" speech, or the “I never told him to stay out of your bed” speech; however, I wonder how many of you remember Crash’s speech in the team locker room when he counseled Nuke about toenail fungus? Yes, toenail fungus! As Crash held up a pair of Nuke’s filthy, infected flip flops, he said ...
 
“Your shower shoes have fungus on them. You’ll never make it to the bigs with fungus on your shower shoes. Think classy, you’ll be classy. If you win 20 in the show, you can let the fungus grow back and the press’ll think you’re colorful. Until you win 20 in the show, however, it means you are a slob.”
 
Except for the last sentence, that quote is music to a podiatrist’s ears. By no means is anyone a slob who has toenail fungus, but anyone who has it faces an uphill battle to get rid of it. It’s a battle because fungus is everywhere in our environment. You can contract it walking barefoot at the pool, in a locker room or a shower stall. It can be in the carpet at a hotel room or on the floor in an airport as you walk through inspection. You can get it when you get a nail salon pedicure if the environment, supplies and instruments are not sanitized. It can even be lurking in your home or in your shoes.
 
I’m sure everyone 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. Many of the common advertisements you see on TV or in magazines are misleading. Efficacy rates are not always accurate, risks are sometimes understated and treatment costs can be higher than you think.
 
Until recently, getting rid of toenail fungus was nearly impossible. New developments in laser technology have changed this, and lasers are now considered to be the gold standard treatment for toenail fungus.
 
Some of the leading manufacturers of lasers for toenail fungus are Cutera, Pinpointe, Q-Clear and Aerolase. The lasers all function in a similar manner but vary in intensity, spot size and treatment protocol. Average treatment times range from 10 minutes to an hour. One to four treatments are required depending on the type of laser that is used and the severity of the infection. Excellent results have been achieved by podiatrists throughout the country. Improvement is seen in more than 70 to 75 percent of the patients with a cure rate of 60 to 65 percent. A clear nail begins to emerge in three to four months. It takes nine to 12 months for a totally new nail to emerge.
 
There are also other products that are often used in conjunction with laser treatments for added protection. These include the Keriflex Nail Restoration System and Sterishoe Ultraviolet Shoe Sanitizer.
The Keriflex Nail Restoration is a new advancement that allows the client to have natural looking cosmetic nails immediately following the first laser treatment. A series of treatments are applied to the existing nails until the new nail growth has completely cleared. The Sterishoe Ultraviolet Shoe Sanitizer is also a relatively new advancement that is used as added protection to kill bacteria associated with Athletes Foot and fungus. Each insert also includes a fan to dry the inside of the shoe dry during non-use.
 
Helpful tips
If you are interested in seeking laser treatment, here are some helpful tips to guide your decisions:
 
* Select a practitioner who is an expert in foot care and provide you with a comprehensive blueprint to manage your condition and a realistic time frame.
* Confirm that the laser has been FDA approved for the treatment of Onychomycosis, not one that is used for off self-use.
* Review the manufacturer’s website to view before and after photographs.
* Locate a laser operator close to your residence.
* Select a practitioner with expertise in podiatric care and laser therapy.
* Confirm that the practitioner provides a full assessment, confirmation of Onychomycosis, and nail preparation prior to laser treatment.
* Ask your practitioner if they can provide the necessary supplies for care or a list of suppliers.
* Inquire about the number of treatments, intervals between treatments and if annual maintenance treatments are available.

Every New Year, we start out with a clean slate. It’s a time when most of us make a resolution to either stop doing something, or to start something new. The more common resolutions (like getting more exercise and losing weight, dropping bad habits, and saving cash) are super; but I would like to add a new one to the mix and encourage everyone to get healthier feet in 2015, especially women!

On a whole, women are more susceptible to foot problems than men. This is due to improper footwear and physical differences such as the structure of the foot, strength and laxity of the muscles and ligaments, shape and length of the arch, width of the forefoot, size of toes, and hormones that allow muscles in the feet to relax and expand. Pregnancy is also not kind to a woman’s feet. Consequently, women are far more susceptible to ankle sprains, bunions, hammertoes, neuromas, plantar fasciitis, and Achilles tendon pain.

Unfortunately, if problems are not addressed appropriately, conservative treatments become less effective, quality of life declines, and surgery becomes the only option. Here are some simple resolutions to help women achieve healthier feet and a better quality of life.

Resolution 1: Start moving but start smart

Physical activity contributes to your health and can provide benefits to your feet. Select activities that you enjoy and get your feet moving. Don’t rush into fitness. Start smart to avoid injuries like shin splints and plantar fasciitis (heel pain). A steady, gradual program is more beneficial in the long run than an intense program that puts undue stress on your feet. Avoid running on uneven surfaces and terrain; and incorporate cross training into your fitness program to reduce stress on your feet.

Resolution 2: Wear the proper footwear

Choose the right footwear for all occasions this year. Pitch the old sneakers or athletic shoes that have been lying around in your closet or gym locker. Ask your podiatrist for some tips to select a shoe that is designed for your fitness activity and foot type.

Whenever possible, leave the stilettos in the closet. At least try to wear them less or scale down the heel height. There is nothing beautiful about painful feet and shoe wear that leads to ankle sprains, bunions, hammertoes, plantar fasciitis, ingrown toenails, and neuromas that may lead to surgery. Make a healthier choice of shoes this year.

Resolution 3: Say goodbye to ugly toenails

If you are tired of having to deal with the embarrassment of toenail fungus winter is the perfect time for laser treatment. By the time summer arrives, you should be able to wear open-toe shoes again with full confidence. Lasers are the state of the art treatment for toenail fungus and restoring the natural beauty of your nails. Treatments are quick, relatively pain free, affordable, and effective.

Resolution 4: End heel pain now

If you are tired of having an aching or stabbing pain in your heel and trying to avoid cortisone injections in your feet, ask your physician or podiatrist about treatment options. New cutting edge laser treatments are now available to treat plantar fasciitis and end heel pain. Treatments are pain free and an effective alternative to anti-inflammatory and pain medications.

Resolution 5: Support your feet with custom orthotics

Custom orthotics are made from cast impressions of your feet and fabricated into inserts for your shoes. Orthotics provides support for your arches and distributes weight bearing loads more uniformly. They are especially helpful for people with foot deformities, athletes, pregnant moms, and seniors who are experiencing greater changes in their feet.

Resolution 6: Don’t let hammertoes cramp your style

If you are you are tired of muddling through life with severe pain caused by hammertoes and forced to stop doing physical activities you once they once loved, it might be time for hammertoe correction.

There is no single surgical procedure that is best for everyone but your foot and ankle surgeon will be able to tell you the best options. New innovative orthopedic products and surgical techniques are available to minimize downtime and recovery. Stop the embarrassment of wearing open-toe shoes and feel confident about the appearance of your feet.

Resolution 7: Stop bunion discomfort and pain

If you are experiencing severe pain and discomfort because of a bunion that is interfering with your daily activities, it’s time to explore surgical options. If your anxiety has caused you to avoid surgery, you may be doing yourself more harm than good. An altered gait (walking) pattern can contribute to other mechanical problems in your feet and put unwanted stress on your ankles, knees, hips, and spine.

Resolution 8: Healthy feet in 2015


On New Year’s Eve, we all start out with a clean slate. It’s a time when most of us make a resolution to either stop doing something, or to start something new. The most common resolutions (like getting more exercise and losing weight, dropping bad habits and saving cash) are super, but I would like to add a new one to the mix and encourage everyone to get healthier feet in 2015 — especially women!
On a whole, women are more susceptible to foot problems than men. This is due to improper footwear and physical differences such as the structure of the foot, strength and laxity of the muscles and ligaments, shape and length of the arch, width of the forefoot, size of toes and hormones that allow muscles in the feet to relax and expand. Pregnancy is also not kind to a woman’s feet. Consequently, women are far more susceptible to ankle sprains, bunions, hammertoes, neuromas, plantar fasciitis and Achilles tendon pain.
Unfortunately, if problems are not addressed appropriately, conservative treatments become less effective, quality of life declines and surgery becomes the only option. Here are some simple resolutions to help women achieve healthier feet and a better quality of life.
 
Resolution 1: Start moving, but start smart!
Physical activity contributes to your health and can provide benefits to your feet. Select activities that you enjoy and get your feet moving. Don’t rush into fitness. Start smart to avoid injuries like shin splints and plantar fasciitis (heel pain). A steady, gradual program is more beneficial in the long run than an intense program that puts undue stress on your feet. Avoid running on uneven surfaces and terrain, and incorporate cross training into your fitness program to reduce stress on your feet.
 
Resolution 2: Wear the proper footwear!
Choose the right footwear for all occasions this year. Pitch the old sneakers or athletic shoes that have been lying around in your closet or gym locker. Ask your podiatrist for some tips to select a shoe that is designed for your fitness activity and foot type.
Whenever possible, leave the stilettos in the closet. At least try to wear them less or scale down the heel height. There is nothing beautiful about painful feet and shoe wear that leads to ankle sprains, bunions, hammertoes, plantar fasciitis, ingrown toenails and neuromas that may lead to surgery. Make a healthier choice of shoes this year.
 
Resolution 3: Say goodbye to ugly toenails!
If you are tired of having to deal with the embarrassment of toenail fungus, winter is the perfect time for laser treatment. By the time summer arrives, you should be able to wear open-toe shoes again with full confidence. Lasers are the state of the art treatment for toenail fungus and restoring the natural beauty of your nails. Treatments are quick, relatively pain free, affordable and effective.
 
Resolution 4: End heel pain now!
If you are tired of having an aching or stabbing pain in your heel and trying to avoid cortisone injections in your feet, ask your physician or podiatrist about treatment options. New cutting edge laser treatments are now available to treat plantar fasciitis and end heel pain. Treatments are pain free and an effective alternative to anti-inflammatory and pain medications.
 
Resolution 5: Support your feet with custom orthotics!
Custom orthotics are made from cast impressions of your feet and fabricated into inserts for your shoes. Orthotics provides support for your arches and distributes weight bearing loads more uniformly. They are especially helpful for people with foot deformities, athletes, pregnant moms and seniors who are experiencing greater changes in their feet.
 
Resolution 6: Don’t let hammertoes cramp your style!
If you are you are tired of muddling through life with severe pain caused by hammertoes and forced to stop doing physical activities you once they once loved, it might be time for hammertoe correction.
There is no single surgical procedure that is best for everyone, but your foot and ankle surgeon will be able to tell you the best options. New innovative orthopedic products and surgical techniques are available to minimize downtime and recovery. Stop the embarrassment of wearing open-toe shoes and feel confident about the appearance of your feet.
 
Resolution 7: Stop bunion discomfort and pain!
If you are experiencing severe pain and discomfort because of a bunion that is interfering with your daily activities, it’s time to explore surgical options. If your anxiety has caused you to avoid surgery, you may be doing yourself more harm than good. An altered gait (walking) pattern can contribute to other mechanical problems in your feet and put unwanted stress on your ankles, knees, hips and spine.
 
Resolution 8: Healthy feet in 2015!
Your feet deserve the very best in 2015!

 
Many patients try a variety of conservative treatments to tolerate their bunions and to avoid surgery as long as possible. Unfortunately, when conservative care stops working and severe pain and swelling begin to interfere with daily activities, they find themselves at a cross road. This is when the realization sinks in that the time has come to consider bunion surgery. Many of them are at a point where they want surgery sooner than later but they are still confused and anxious. Many even avoid surgery because misconceptions guide their decision. Here are the common questions that I discuss with my patients that hopefully will help you decide if you are ready for bunion surgery.
 
When Is Surgery Needed?
When the pain of a bunion interferes with daily activity, it is time to discuss surgical options with your podiatrist or orthopaedic physician. Both of you can decide if surgery is necessary and what procedures are best suited for you. The overall goals of surgery are to relieve pain, to remove the bunion and keep it from returning, and to correct the alignment and mechanics of the foot.
 
Are There Different Surgical Procedures?
A bunion is more complicated than a bump on the side of the big toe. The type of procedure performed depends on the severity of the bunion and a combination of factors such as age, activity level, health, and condition of bones, muscles, tendons, and ligaments in the foot. Various procedures are used to correct mild, moderate, severe, and arthritic bunions or big toe joints. Your surgeon will select the best procedure for your condition.
 
What Are The Risks?
The vast majority of patients do not experience complications from surgery; however, it is a good idea to review all the pros and cons of surgery with your surgeon a well as the consequences of delaying or not having surgery. Possible complications may include a recurrence of the bunion, continued pain, an overcorrection of the problem, nerve damage, stiffness, swelling, numbness, infection, length of time for healing and recovery, restricted motion and flexibility in the toe joint, and arthritis.
 
Will The Bunion Come Back?
Recurrence is possible but not likely if the correct procedure is tailored to resolve the severity of your bunion; and if proper shoes are worn following surgery.
 
Will I Have Unsightly Scars?
Your surgeon may be able to minimize the incision by using alternate surgical approaches and closure techniques. Laser technology is also available to reduce scars post-operatively. The majority of patients are satisfied with their outcome.
 
What Can I Expect After Surgery?
The length of the recovery period varies depending on the procedure performed. It is important to comply with instructions for dressing care, bearing weight, swelling and shoe wear, exercises and therapy, and medications. Most activities may be resumed within six to eight weeks, but it may take six months for full recovery. Most patients experience a significant reduction of pain and improved alignment of the big toe. Patients will have driving restrictions if the right foot is repaired. Patients will have shoe restrictions for life to reduce the chances of a recurrence.
 
What Are The Keys To Success?
Selecting the right surgeon is critical to ensure a good outcome. When selecting a surgeon, ask about his/her medical school education, accredited residency training, board certifications, areas of practice specialization, and experience in performing bunion surgery. Ask your surgeon to explain all the pros and cons of the surgery and to disclose all of the potential problems and realistic expectations. Remember, not all surgeons are created equal so be careful in choosing the right physician. Choose a surgeon you can trust. Be wary of a surgeon who makes assertions that his/her procedures are superior, minimally invasive, and virtually pain free. Other red herrings become apparent when a surgeon guarantees a bunion will never return, patients never need crutches, or that your bunion is going to get worse if you do not have surgery as soon as possible. Credible surgeons will give you realistic expectations and possible complications.

Do you have bunions?
Bunions are a common foot deformity. Unfortunately, there are misconceptions about them and many people suffer unnecessarily from a painful bunion for years before seeking treatment.
 
What is a bunion?
Bunions are normally described as a “bump” on the side of the big toe but a bunion is more than that. The bump that is seen on the side of the foot is actually a reflection of changes in the bony framework in the front portion of the foot. A bunion causes the big toe to swing toward the second toe and the bone behind the big toe (1st metatarsal) moves inward causing a bump on the inside of the foot. Consequently, this movement throws the bones out of alignment resulting in the formation of a bump. A bunion is a progressive disorder that appears over years and continues to become increasingly prominent. Usually the symptoms of bunions appear at later stages.
 
What causes a bunion?
Most bunions are caused by an inherited, faulty mechanical structure of the foot. The bunion itself is not inherited, but certain foot types that are inherited make a person more likely to develop a bunion. Although it is a common misconception that tight fitting shoes actually cause bunions, they can contribute to the deformity getting progressively worse. Consequently, you may experience symptoms sooner; and the larger the bunion gets, the more it hurts to walk.
 
Symptoms
Most often symptoms occur when wearing shoes that crowd the toes with a tight toe box, or in high heels that provide a small area for load bearing. Women’s shoes often are too small and squeeze the toes together. High heels shoes especially alter the biomechanics of the foot. That is why ninety percent of bunions happen to women. Spending long periods of time on your feet can also aggravate the symptoms of bunions. General symptoms at the site of the bunion may include pain or soreness, inflammation and redness, a burning sensation, and possibly some numbness. Other conditions that may occur include sores between the toes, ingrown toenails, calluses on the big toe, and restricted motion of the toe.
 
Diagnosis
The diagnosis of bunions is very apparent because you can see the prominence at the base of the big toe or side of the foot; however, to fully evaluate your condition, a clinical exam with X-rays is required to determine the degree of the deformity, and to assess the changes that have occurred.
Not all cases are alike and some bunions progress more rapidly than others. Once your podiatrist evaluates your particular case, a treatment plan can be developed that is suited to your needs.
 
Treatment
  • Accommodative Padding - Pads placed over the area of the bunion may help decrease pain. Pads can be obtained from your podiatrist
  • Activity Modifications- Activities that cause your bunion pain, including standing for long periods of time, should be limited.
  • Medications- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help to relieve pain and inflamation.
  • Icing- Applying an ice pack several times a day will help reduce inflammation and pain.
  • Injection Therapy- Injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located in a joint) sometimes seen with bunions; however, injections are rarely used as a treatment.
  • Custom Orthotic Devices- Custom orthotic devices may be provided by your podiatrist to provide additional support and to improve mobility. Orthotics will not correct the deformity but will help retard its progression.
 
When is surgery needed?
When the pain of a bunion interferes with daily activity, it is time to discuss surgical options with your podiatrist. Both of you can decide if surgery is necessary and what procedures are best suited for you.
Recent advances in surgical techniques have led to a very high success rate and there are a variety of surgical procedures that are performed to treat bunions. These procedures are designed to do several things including the removal of the bump, correcting changes in the bone structure of the foot, as well as correcting soft tissue changes that may have occurred.
 
There are a number of ways to perform bunion surgery; and the best procedure for one person may not be the best for another. In selecting the procedure or combination of procedures for your particular case, the podiatrist will take into consideration the extent of your deformity based on the X-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary depending on the procedure or procedures performed.