What is a Podiatrist?

A podiatrist, also called a doctor of podiatric medicine, is a specialist who provides medical diagnosis and treatment of orthopedic foot, ankle problems, such as bunions, heel pain, spurs, hammertoes, neuromas, ingrown toenails and complex wounds . A podiatrist also renders care of sprains, fractures, infections, and injuries of the foot, ankle and heel. A Podiatrist completes 11 years of education and training from college, medical school to residency training. Podiatrists are required to take state and national exams, as well as be licensed by the state in which they practice. Podiatrists that are board certified have demonstrated the highest level of certification and are required to renew there board status every 10 years.

According to the American Podiatric Medical Association, there are an estimated 15,000 practicing podiatrists in the United States. Podiatrists are in demand more than ever today because of high quality of graduate training, expertise in lower extremity disease and the rapidly growing population rapidly. In addition, according to the association, foot and ankle disorders are among the most widespread and neglected health problems affecting people in this country.

Typically, podiatrists:

• Provide medical and surgical services in an office, surgery center and hospital in an out patient and in patient setting.
• Consult with patients and other physicians on management and prevention of foot, ankle leg problems.
• Diagnose and treat acute and chronic foot and leg disorders.
• Perform surgeries to correct or remedy such problems as bunions, neuromas, fractures, hammertoes, bone and soft tissue infections, ruptured Achilles, and other ligaments and tendons.
• Prescribe therapies and perform diagnostic procedures such as X-ray, ultrasound and lab tests.
• Prescribe or fits patients with orthopedic inserts called orthotics that correct walking patterns.

Treat conditions such as: bone disorders, bunions, corns, calluses, cysts, heel spurs, infections, ingrown nails, and plantar fasciitis.

Diabetes and Your Feet

Diabetes is a lifelong chronic disease that is caused by high levels of sugar in the blood.  Diabetes can affect virtually all systems in the body and can be a major source of heart disease, kidney disease, digestive disease, and lower extremity problems.  It can decrease your body's ability to fight off infections, which is especially harmful in your feet. When diabetes is not properly controlled, damage can occur to the organs and impairment of the immune system is also likely to occur.

With damage to your nervous system, you may not be able to feel your feet properly. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired, which can lead to an abnormal pressure on the skin, bones, and joints of the foot during walking and other activities. This can even lead to the breakdown of the skin of the foot, which often causes sores to develop. If you have diabetes, it is important to prevent foot problems before they occur, recognize problems early, and seek the right treatment when a problem does happen.

Diabetic Complications and Your Feet

When it comes to your feet, there are several risk factors that can increase your chances of developing foot problems and diabetic infections in the legs and feet. First of all, poorly fitting shoes are one of the biggest culprits of diabetic foot complications. If you have red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new proper fitted shoes must be obtained immediately. Additionally, if you have common foot abnormalities such as flat feet, bunions, or hammertoes, prescription shoes or orthotics from your podiatrist may be necessary to further protect your feet from other damage.

People who have long-standing or poorly controlled diabetes are also at risk for having damage to the nerves in their feet, which is known in the medical community as peripheral neuropathy. If you have nerve damage, you may not be able to feel your feet normally and you may also be unable to sense the position of your feet and toes while walking and balancing, which can cause even more harm to your feet.

Normal nerves allow people to sense if their shoes are too tight or if their shoes are rubbing on the feet too much. With diabetes, you may not be able to properly sense minor injuries, such as cuts, scrapes and blisters-all signs of abnormal wear, tear, and foot strain.

The following can also compromise the health of your feet:

• Poor circulation
• Trauma to the foot
• Infections
• Smoking

Diabetes can be extremely dangerous to your feet, so take precautions now. You can avoid serious problems such as losing a toe, foot, or leg by following proper prevention techniques offered by your podiatrist. Remember, prevention is the key to saving your feet and eliminating pain.

Chronic Lateral Ankle Pain

Chronic lateral ankle pain is recurring or chronic pain on the outside part of the ankle that often develops after an injury such as a sprained ankle.

Signs and symptoms include:

• Ankle instability.
• Difficulty walking on uneven ground or in high heels.
• Pain, sometimes intense, on the outer side of the ankle.
• Repeated ankle sprains.
• Stiffness.
• Swelling.
• Tenderness.

Although ankle sprains are the most common cause of chronic lateral ankle pain, other causes may include:

• A fracture in one of the bones that make up the ankle joint.
• Arthritis of the ankle joint.
• Inflammation of the joint lining.
• Injury to the nerves that pass through the ankle. In this case, the nerves become stretched, torn, injured by a direct blow, or pinched under pressure.
• Scar tissue in the ankle after a sprain. The scar tissue takes up space in the joint, putting pressure on the ligaments.
• Torn or inflamed tendon.

Treatments for chronic lateral ankle pain include:

• Over the counter or prescription anti-inflammatory medications to reduce pain and swelling. Note: Please consult your physician before taking any medications.
• Physical therapy, including tilt-board exercises that focus on strengthening the muscles, restoring range of motion, and increasing your perception of joint position.
• Ankle braces or other supports.
• Steroid injection.
• Immobilization to allow the bone to heal (in cases of fractures).
• Arthroscopic repair of the joint injury with ligament repair.
• Surgical repair of injured tendons, ligaments and ankle bones.

Shin Splints

Shin splints refer to pain on either side of the leg bone that is caused by muscle or tendon inflammation. The problem is usually related to a collapsing arch, but may be caused by a muscle imbalance between opposing muscle groups in the leg.

Proper stretching before and after exercise and sports, corrective shoes, or orthotics (corrective shoe inserts) can help prevent shin splints.

Sports Injuries

Many sports are hard on the feet because of quick repetitive movements, constricting footwear, and/or increased exposure to injury or trauma. Following is a brief overview of some of the most common injuries that result from particular sports.

Martial Arts and Kick Boxing
Injuries commonly seen as a result of martial arts and kick boxing include plantar fasciitis, Achilles tendonitis, sesamoiditis, and ankle sprains. Stretching is recommended to help prevent injury: specifically, a minimum of 15 minutes of stretching before performing any kicking or punching.

Aerobics
Impact forces from aerobics can reach up to six times the force of gravity, which is transmitted to each of the 26 bones in the foot. That is why proper shoes are crucial to successful, injury-free aerobics. Shoes should provide sufficient cushioning and shock absorption to compensate for pressure on the foot many times greater than found in walking. They must also have good medial-lateral stability.

Team Sports
Activities such as football, baseball, basketball, soccer, field hockey, and lacrosse often lead to ankle injuries as a result of play on artificial surfaces, improper footwear, and/or inadequate stretching.

Flat Feet

Flat feet are a common condition of the foot structure. In infants and toddlers, prior to walking, the longitudinal arch is not developed, and flat feet are normal. Most feet are flexible and an arch appears when children begin standing on their toes. The arch continues to develop throughout childhood, and by adulthood most people have developed normal arches.

Flat feet are generally associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape).

Many people with flat feet do not experience pain or other problems. When pain in the foot, ankle, or lower leg does occur, especially in children, the feet should be evaluated.

Painful progressive flatfoot, otherwise known as tibialis posterior tendonitis or adult-acquired flatfoot, refers to inflammation of the tendon of the tibialis posterior. This condition arises when the tendon becomes inflamed, stretched, or torn. Left untreated, it may lead to severe disability and chronic pain. People are predisposed to tibialis posterior tendonitis if they have flat feet or an abnormal attachment of the tendon to the bones in the midfoot.

Nonsteroidal anti-inflammatory medications, icing, physical therapy, supportive taping, bracing, and orthotics are common treatments for painful progressive flatfoot. Note: Please consult your physician before taking any medications. In some cases, a surgery may need to be performed to repair a torn or damaged tendon and restore normal function. In the most severe cases, surgery on the midfoot bones may be necessary to treat the associated flatfoot condition.

Hammertoes

Hammertoe is a deformity of the second, third, or fourth toes. In this condition, the toe is bent at the middle joint, causing it to resemble a hammer. Left untreated, hammertoes can become inflexible and require surgery. People with hammertoe may have corns or calluses on the top of the middle joint of the toe or on the tip of the toe. They may also feel pain in their toes or feet and have difficulty finding comfortable shoes.

Causes of hammertoe include improperly fitting shoes and muscle imbalance.

Treatment for the condition typically involves wearing shoes with soft, roomy toe boxes and toe exercises to stretch and strengthen the muscles. Commercially available straps, cushions, or non-medicated corn pads may also relieve symptoms.

In severe cases, hammertoe surgery may be recommended to correct the deformity.

Plantar Fasciitis (heel spur)

Plantar fasciitis is the term commonly used to refer to heel and arch pain traced to an inflammation on the bottom of the foot. More specifically, plantar fasciitis is an inflammation of the connective tissue, called plantar fascia that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Overpronation is the most common cause of plantar fasciitis. As the foot rolls inward excessively when walking, it flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Over time, this causes inflammation.

Also known as heel spur syndrome, the condition is often successfully treated with conservative measures, such as the use of anti-inflammatory medications, ice packs, stretching exercises, orthotic devices, and physical therapy.

Note: Please consult your physician before taking any medications. In persistent cases, Extracorporeal Shock Wave Treatment (ESWT) may be used to treat the heel pain.

Smelly Feet and Foot Odor

The feet and hands contain more sweat glands than any other part of the body, with roughly 3,000 glands per square inch. Smelly feet are not only embarrassing, but can be physically uncomfortable as well.

Feet smell for two reasons: 1) shoe wear, and 2) sweating of the feet. The interaction between the perspiration and the bacteria that thrive in shoes and socks generates the odor. Therefore, any attempt to reduce foot odor has to address both sweating and footwear.

Smelly feet or excessive sweating can also be caused by an inherited condition, called hyperhidrosis, which primarily affects men. Stress, some medications, fluid intake, and hormonal changes also can increase the amount of perspiration our bodies produce.

In general, smelly feet can be controlled with a few preventive measures:

• Always wear socks with closed shoes.
• Avoid wearing nylon socks or plastic shoes. Instead, wear shoes made of leather, canvas, mesh, or other materials that let your feet breathe.
• Bathe feet daily in lukewarm water, using a mild soap. Dry thoroughly.
• Change socks and shoes at least once a day.
• Check for fungal infections between toes and on the bottoms of your feet. If any redness or dry, patchy skin is observed, get treatment right away.
• Don't wear the same pair of shoes two days in a row. If you frequently wear athletic shoes, alternate pairs so that the shoes can dry out. Give your shoes at least 24 hours to air out between wearings; if the odor doesn't go away, discard the shoes.
• Dust your feet frequently with a non-medicated baby powder or foot powder. Applying antibacterial ointment also may help.
• Practice good foot hygiene to keep bacteria levels at a minimum.
• Wear thick, soft socks to help draw moisture away from the feet. Cotton and other absorbent materials are best.

Treating Foot Odor
The best home remedy for foot odor is to soak feet in strong black tea for 30 minutes a day for a week. The acid in the tea kills the bacteria and closes the pores, keeping your feet dry longer. Use two tea bags per pint of water. Boil for 15 minutes, then add two quarts of cool water. Soak your feet in the cool solution. Alternately, you can soak your feet in a solution of one part vinegar and two parts water.

Persistent foot odor can indicate a low-grade infection or a severe case of hereditary sweating. In these cases, a prescription ointment may be required to treat the problem.

Treating Excessive Sweating
A form of electrolysis, called iontophoresis, has been shown to reduce excessive sweating of the feet. However, it is more difficult to administer. In the worst cases of hyperhidrosis, a surgeon can cut the nerve that controls sweating. Recent advances in technology have made this surgery much safer, but may increase sweating in other areas of the body.

Neuroma

A neuroma is an enlarged, benign growth of nerves, most commonly between the third and fourth toes. Neuromas are caused by tissue rubbing against and irritating the nerves. Pressure from poorly fitting shoes or an abnormal bone structure can also lead to this condition. Symptoms may include sensations of thickness, burning, numbness, tingling, or pain in the ball of the foot.  Treatments generally include wearing corrective shoes or orthotics and/or receiving cortisone injections. In severe cases, surgical removal of the growth may be necessary.

Morton's neuroma is a thickening of tissues around the nerve that leads to the toes. Morton's neuroma usually develops between the third and fourth toes in response to irritation, such as that caused by wearing high-heeled or narrow shoes, or from trauma. Symptoms may include a burning pain that radiates from the ball of the foot to the toes or numbness in the toes. Conservative treatments usually resolve the pain or progressions of the condition, and range from wearing roomier, lower-heeled footwear or using orthotics to reduce the pressure on the nerve, to injections of corticosteroid medication to reduce swelling and inflammation.

Blisters

Most blisters on the feet are caused by friction and do not require medical attention. New skin will form underneath the affected area and the fluid built up in the blister is simply absorbed back into the tissue. You can soothe ordinary blisters with Vitamin E ointment or an aloe-based cream.

Do not puncture a blister unless it is large, painful, or likely to be further irritated. If you have to pop a blister, use a sterilized needle or razor blade. Wash the area thoroughly, then make a small hole and gently squeeze out the clear fluid. Apply a dab of hydrogen peroxide to help protect against infection. Do not remove the skin over a broken blister. The new skin underneath needs this protective cover. Cover the area with a bandage and mild compression.

If the fluid is white or yellow, the blister is infected and needs medical attention.

Preventing Blisters

You can prevent blisters by breaking in new shoes gradually, and putting petroleum jelly or an adhesive bandage on areas that take the rub—before the blister happens.  Wear socks that have heels instead of tube socks (they bunch up and cause blisters). Acrylic and other synthetic-fiber socks are good choices. Be sure to wash and dry your feet daily to prevent bacterial infections, such as Athlete's Foot.

Athlete's Foot

A chronic infection caused by various types of fungus, Athlete's foot is often spread in places where people go barefoot such as public showers or swimming pools. The condition ranges from mild scaling and itching to painful inflammation and blisters. It usually starts between the toes or on the arch and may spread to the bottom and sides of the foot.

General Treatments

Depending on the type of infection you have, various kinds of medication may be used in treating your fungal problem. Successful treatment usually involves a combination of medication and self-care.

If your condition is not serious, over-the-counter and prescription powders, lotions, or ointments can often help treat scaling, itching, and inflammation. Consult us before taking any medication. Foot soaks may help dry excessive perspiration, but you should contact our office first. If your Athlete's foot does not improve, we may prescribe stronger medication.

Fungal Nails

Since fungal nails are usually more resistant and more difficult to treat than Athlete's foot, topical or oral antifungal medications may be prescribed. Permanent nail removal is another possible form of treatment for fungal nails.

After a fungal nail infection has cleared up, you can take steps to prevent the infection from coming back.

Keeping the fungus under control will help prevent a fungal infection of the skin from reinfecting the nail. Before bed, thoroughly wash and dry your feet, and apply a non-prescription anti-fungal cream to the entire foot from the ankle down. Use the cream every night, then gradually apply it less often. Keep your feet dry. Dry feet are less likely to become infected. Apply powder to your dry feet after you take a shower or bath.

Other tips:

• Don't share nail clippers or nail files with others.
• Don't share shoes or socks with others.
• Try not to injure your nail, such as by cutting it too short (trauma to the nail may lead to infections).
• Wear dry cotton socks, and change them two or three times a day if necessary.
• Wear dry shoes that allow air to circulate around your feet (tight, enclosed, moist shoes contribute to fungal toenail infections).
• Wear shower sandals or shower shoes when you are at a public pool or shower.

Prevention

Follow basic foot care guidelines and you more than likely can head off most common foot fungus problems.

Orthotics

Orthotics, also known as orthoses, refers to any device inserted into a shoe, ranging from felt pads to custom-made shoe inserts that correct an abnormal or irregular, walking pattern. Sometimes called arch supports, orthotics allow people to stand, walk, and run more efficiently and comfortably. While over-the-counter orthotics are available and may help people with mild symptoms, they normally cannot correct the wide range of symptoms that prescription foot orthoses can since they are not custom made to fit an individual's unique foot structure.

Orthotic devices come in many shapes, sizes, and materials and fall into three main categories: those designed to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.

Rigid Orthotics
Rigid orthotic devices are designed to control function and are used primarily for walking or dress shoes. They are often composed of a firm material, such as plastic or carbon fiber. Rigid orthotics are made from a mold after a podiatrist takes a plaster cast or other kind of image of the foot. Rigid orthotics control motion in the two major foot joints that lie directly below the ankle joint and may improve or eliminate strains, aches, and pains in the legs, thighs, and lower back.

Soft Orthotics
Soft orthotics are generally used to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. They are usually effective for diabetic, arthritic, and deformed feet. Soft orthotics are typically made up of soft, cushioned materials so that they can be worn against the sole of the foot, extending from the heel past the ball of the foot, including the toes. Like rigid orthotics, soft orthotics are also made from a mold after a podiatrist takes a plaster cast or other kind of image of the foot.

Semi-Rigid Orthotics
Semi-rigid orthotics provide foot balance for walking or participating in sports. The typical semi-rigid orthotic is made up of layers of soft material, reinforced with more rigid materials. Semi-rigid orthotics are often prescribed for children to treat flatfoot and in-toeing or out-toeing disorders. These orthotics are also used to help athletes mitigate pain while they train and compete.

MRI

Magnetic resonance imaging (MRI) is sophisticated diagnostic equipment used to diagnose an array of health problems or conditions, including:

• Arthritis.
• Fractures.
• Infections.
• Injuries of the tendons, ligaments, or cartilage.
• Tumors.

MRIs use no radiation like conventional X-rays or CT scans. They employ large magnet and radio waves to produce three-dimensional images. MRIs are very good at portraying soft tissues and bones in your feet and ankles.

People with the following conditions may not be good candidates for a MRI:

• Conditions that requires a heart pacemaker.
• Artificial heart valves.
• Electronic inner ear implants.
• Electronic stimulators.
• Implanted pumps.
• Metal fragments in eyes.
• Surgical clips in the head (particularly aneurysm clips).

Individuals with dental fillings or bridges, a replacement hip or knee, or tubal ligation clips are generally safe to have a MRI.

In most cases, a full exam of the foot and ankle via MRI lasts between 60 and 90 minutes.

Extracorporeal Shock Wave Therapy

Extracorporeal Shock Wave Therapy (ESWT) is used to treat chronic heel pain (plantar fasciitis). "Extracorporeal" means "outside of the body." During this noninvasive procedure, sonic waves are directed at the area of pain using a device similar to that currently used in nonsurgical treatment of kidney stones.

Extracorporeal Shock Wave Therapy is prescribed for patients who have experienced plantar fasciitis for an extended period of time -- six months or more -- and have not benefited from other conservative treatments. The brief procedure lasts about 30 minutes and is performed under local anesthesia and/or "twilight" anesthesia. Strong sound waves are directed at and penetrate the heel area to stimulate a healing response by the body. ESWT is performed on an outpatient basis. Although there are no bandages, someone will need to drive the patient home.

People who are not candidates for ESWT include pregnant women and individuals with neurological foot disease, vascular foot disease, pacemakers, or people taking medications that interfere with blood clotting (such as Coumadin).

This therapy is a safe and effective alternative treatment for heel pain and only requires a short recovery time. Clinical studies show a 70 percent success rate for treatment of plantar fasciitis using Extracorporeal Shock Wave Therapy.

Basketball And Your Feet

With all its running, twisting, turning, and jumping, basketball is one of the hardest games on feet. Different movements put all the areas of the foot at risk. That is why proper conditioning, stretching, and well-fitted shoes are critical to a healthy enjoyment of the sport.

Ankle sprain is a particularly common injury in basketball. But the repeated shock and pressures on the foot can also lead to inflammations, including Achilles tendonitis, plantar fasciitis, and sesamoiditis.

Basketball Shoes

Foot and ankle stability, shock absorption, and traction are the most important qualities for basketball shoes. If you are susceptible to ankle injuries, consider a high-top or three-quarter shoe that provides added support to key foot structures during play. Look for shoes that offer the following:

• A wide toe box with plenty of room for your toes to move around. Not enough room can lead to blisters, corns, and calluses.
• Lightweight, breathable material for uppers; generally, leather is recommended.
• Dense, abrasion-resistant soles that are low to the ground for better traction and support.
• A well-cushioned midsole for a shock-absorbing layer. An EVA or EVA-compressed layer is lightweight but not as durable or stable. A polyurethane layer has greater stability, but it is often heavier, too.
• Bend in the forefoot of the shoe, which is at the ball of the foot near the toes. Be sure there is less bend in the arch where you need the added support to keep the foot stable.
• A firm heel counter that fits snugly.
• Laces as the form of closure give you the ability to adjust for the support you need throughout the foot.

When buying basketball shoes, be sure to take the socks you plan to wear with them to ensure a proper fit. Have your feet measured standing up and fit the shoes to your larger foot. Walk around, turn, twist, and jump in each pair on a hard surface to see how your foot feels during each of these movements. Most importantly, make your choice based on comfort.