Dr. Fahim Discusses Remedies for Heel Pain

In a new video, Dr. Ramy Fahim, a foot and ankle surgeon with Ankle & Foot Care Centers in Warren, Ohio, talks about heel pain and remedies for the condition.

Most cases of plantar fasciitis, commonly called heel pain, can be treated successfully without surgery, Dr. Fahim points out.

Over-Use, Improper Stretching Can Spark Tendinitis

smeskoTendinitis is the inflammation of a tendon, a thick cord of tissue that connects muscle to bone. Achilles tendinitis, or an inflammation of the Achilles tendon, is one of the most common causes of foot or ankle pain.

Other types of foot/ankle tendinitis include posterior tibial tendinitis and peroneal tendinitis.

Tendinitis can result from an injury or over-use, says Dr. Mark S. Smesko, a podiatric physician and surgeon with Ankle & Foot Care Centers in Youngstown, Ohio.

Improper stretching prior to exertion or incorrect form during physical activity can also contribute to the development of tendinitis, Dr. Smesko said.

Some people, including those with “flat feet,” tight tendons or arthritis, are particularly prone to tendinitis.

“Pain is the most common symptom of tendinitis,” Dr. Smesko said. “The pain of tendinitis is most noticeable when you try to move that part of your body. The involved tendon may swell.”

Home Care

Rest and ice can ease the pain of tendinitis, Dr. Smesko said. He recommends staying off a painful foot or ankle as much as possible and applying ice for up to 15 minutes at a time, three to four times a day.

When to Visit a Podiatrist

“If ice and rest don’t eliminate the pain, or if the pain persists beyond a week, it’s a good idea to see a podiatrist,” Dr. Smesko said. “Don’t put that off. Tendinitis can become a chronic problem, and it’s much more difficult to treat a chronic problem than an acute injury.”

Diagnosis and Treatment

A podiatrist seeing a patient with possible tendinitis will ask a patient questions about the pain and his or her general health and likely perform a complete physical examination of the feet and ankles, he said.

The doctor may order X-rays or an MRI to rule out any other problems that often cause pain, like a fracture or torn tendon.

Treatment will focus on relieving the pain and preventing further injury.

“A podiatrist may create shoe inserts or a soft cast to effectively immobilize the affected area,” Dr. Smesko said. “It could take a couple of weeks for a tendon to heal. Medication could be involved as well.”

Prevention

Custom orthotics can help control the motion of feet and decrease the chance of a patient re-developing tendinitis. A podiatrist may also recommend certain stretches or exercises to increase the tendon’s elasticity and strengthen the muscles attached to the tendon.

“Gradually increasing your activity level with an appropriate training schedule can also help prevent tendinitis,” Dr. Smesko said. “For example, it’s better to build up to a 5K run instead of simply tackling the whole course the first day.”

Easy Measures to Discourage Athlete’s Foot

podolskySevere cases of athlete’s foot, officially known as tinea pedis, can require advanced treatment.

But many cases of the common condition can be prevented with some very easy measures, says Dr. David Podolsky, a podiatric physician and surgeon with Ankle & Foot Care Centers in Youngstown, Ohio.

Keep your feet dry

Athlete’s foot fungus tends to thrive in a dark, warm, moist environment, and that’s often exactly what we have inside our shoes, Dr. Podolsky said.

“It’s important to hand-dry feet completely with a towel after bathing and/or swimming,” he said. “Only a little bit of moisture is needed to retain athlete’s foot fungus.”

Wear the right socks

Light-colored and/or polyester socks are preferred over dark-colored or nylon socks, Dr. Podolsky added.

Nylon socks don’t breathe well, so moisture tends to stay on our feet instead of being wicked away, he said.

“Likewise, dark stocks tend to sustain heat than reflect it,” he said. “That adds to the potential for the foot fungus to grow.”

Try absorbent foot powder

Absorbent foot powder used in the shoes on a weekly or twice weekly basis will also help to wick moisture away from the feet and socks, Dr. Podolsky said.

Initial use of an over-the-counter athlete’s foot cream or spray, applied directly to the affected areas on a daily basis, may also be helpful.

If signs of athlete’s foot persist for two weeks, a visit to a podiatrist would be a good idea.

Simple Steps Help People with Diabetes Keep Feet Healthy

debiec

When people with diabetes watch their feet carefully, they can prevent some of the most severe risks of diabetes, including lower-limb amputations, says Dr. Robert Debiec, a podiatric physician with Ankle & Foot Care Centers.

People ages 20 and older who are living with diabetes account for about 60 percent of non-traumatic lower-limb amputations, according to the Centers for Disease Control and Prevention’s 2014 National Diabetes Statistics Report.

“The CDC says diabetes-related foot and lower-leg amputations have decreased by 65 percent since 1996,” Dr. Debiec points out. “Still, many more amputations can be prevented by closer attention to the health of one’s feet.”

People with diabetes may be less aware of cuts or wounds on their feet due to the nerve damage related to their disease, Dr. Debiec says.

Dr. Debiec and the American Podiatric Medical Association offer this advice to help people with diabetes protect their foot health:

  • Inspect your feet daily. Check the entire foot and all 10 toes for cuts, bruises, sores, or changes to the toenails, such as thickening or discoloration. Treat wounds immediately and see your podiatrist if a problem persists or infection is apparent.
  • Exercise by walking. This can help you maintain a healthy weight and improve circulation. Be sure to wear athletic shoes appropriate for the type of exercise you’re doing.
  • Wear shoes that fit. When you buy new shoes, have them properly measured and fitted. Foot size and shape can change over time, and ill-fitting shoes are a leading cause of foot pain and lesions. Certain types of shoes, socks, and custom orthotics are available for people with diabetes, and they may be covered under Medicare (learn more here).
  • Keep your feet covered. Never go barefoot, even at home. The risk of cuts and infection is too great.
  • Rely on a professional. See a licensed podiatrist to remove calluses, corns, or warts — don’t tackle them yourself, and don’t ask an unlicensed nonprofessional to do it. Over-the-counter products can burn your skin and injure your foot. Podiatrists are specially trained to address all aspects of foot health for people with diabetes.
  • Get checkups twice a year. An exam by your podiatrist is the best way to ensure your feet stay healthy.

“For people with diabetes, taking charge of your own foot health can help you avoid foot-related complications like amputation,” Dr. Debiec says. “Working with your podiatrist will help you safeguard your foot health.”

For a free booklet on diabetic neuropathy, visit this page.

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2 Easy Steps Can Discourage Wounds, Save Feet

gronerAs a wound care specialist, Dr. Thomas Groner sees dozens of debilitating foot wounds every week and knows that many of them could have been prevented by one of two very easy actions.

“First, it’s very important to look carefully at your feet and let your foot doctor know if you notice anything unusual,” said Dr. Groner, clinical director of the podiatric residency program at the Alliance Community Hospital Wound Care Center.

“Second, it’s important to wear shoes that fit right,” he said.

Although those seem like simple preventive measures, they are often overlooked.

In many cases, that’s because diabetes can blunt the feeling in one’s feet. If a person suffering from such numbness doesn’t physically look closely at his or her feet, warning signs may be missed and poorly fitting shoes could rapidly turn a small wound into a dangerous one.

In other cases, patients may feel the pain of a new wound but conclude it’s too minor to justify a doctor’s appointment, then grow complacent as the wound gets worse.

“There are people who have lost their legs, and it could have been prevented,” Dr. Groner said.

These conditions -- (from top) a heel ulcer, a neurotropic ulcer and dry gangrene -- can often be prevented but can also lead to amputation. (Images courtesy of American Podiatrict Medical Association.)
These conditions — (from top) a heel ulcer, a neurotrophic ulcer and dry gangrene — can often be prevented but can also lead to amputation. (Images courtesy of American Podiatric Medical Association.)

“It’s not uncommon for someone who has lost feeling to wear loose-fitting shoes and get a blister,” he said. “If they don’t notice, that blister can turn into a wound before they see it.

“For people with diabetes, the risk of not feeling a wound is complicated by the greater likelihood that they might step on a sharp object and develop a serious infection without realizing it.”

The APMA has published some compelling statistics about the dangers of wounds. A landmark study in the 1980s found that some 85 percent of amputations in people with diabetes are preceded by a foot ulcer. Other research suggests that more than 80 percent of diabetic lower extremity amputations are preventable (read more here).

Dr. Groner has some suggestions for those who may have lost feeling in their feet:

  • Ask a caretaker or relative to regularly check your feet for you, especially the bottoms of feet where forerunners to serious wounds often start and may go unnoticed for days or weeks.
  • Look into custom-fitted diabetic shoes, which are often covered by insurance. They’re wider and deeper and have a custom insert that’s molded specifically to the patient’s foot. Some insurance plans cover new diabetic shoes every year.

“Since it’s been established that wounds so frequently lead to amputations, I tell my patients that it is important to prevent wounds as opposed to treating them after they occur,” Dr. Groner said.

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Skin Cancer is Risk to All, No Matter the Skin Color

williamsBy Dr. Kwame Williams

Many African-Americans and other people with dark skin believe they face lower risk for skin cancer than light-colored people.

And while that is true, complacency surrounding that fact often leads to late detection of cancer among patients with dark skin, which means their cases are often more deadly. Moreover, many may not be aware that one form of cancer – acral lentiginous melanoma, or ALM, which often occurs in the feet – is more common among darker people.

According to the American Cancer Society, melanoma, a serious cancer that starts in the skin’s pigment cells, has become more common in the United States each year for at least 30 years. The lifetime risk of getting melanoma is about 1 in 40 for whites, and only about 1 in 1,000 for blacks and 1 in 200 for Hispanics.

However, the ACS also reports that the survival rate for melanoma is much lower among blacks – just 73 percent, vs. 91 percent among whites. Doctors say that could be because cases among African-Americans get detected later, when chances for survival are lower.

Deadly ALM

People with darker skin are more likely to be afflicted with ALM, a rare and aggressive cancer that is often found on the soles of the feet, palms of the hands and beneath toenails and fingernails. These are areas that many people ignore.

We don’t hear much about ALM, but it caused the 1981 death of Musician Bob Marley at age 36. The melanoma that started beneath his toenail was originally thought to be a bruise from playing soccer.

ABCS of melanoma

The bottom line is this: No matter what color your skin is, you need to regularly look for, keep an eye on and ask your podiatrist about unusual moles, bumps or patches on your feet.

Here are what podiatrists call the “ABCs of melanoma.”

  • Asymmetry – When a lesion is divided in half and the sides don’t match.
  • Borders – Borders look scalloped, uneven or ragged.
  • Color – There may be more than one color. These colors may have an uneven distribution.
  • Diameter – The lesion is wider than a pencil eraser (greater than 6 mm).

To detect 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 scaly areas.

Preventing skin cancer on the feet and ankles is similar to doing so with any other body part. Limit sun exposure and be sure to apply sunscreen when you’re outdoors and your feet and ankles are exposed.

Further reading

For more information on skin cancer in the feet, visit this article on the American Podiatric Medical Association website.

For more on ALM, check out this article from the Washington Post.

 

Heel Pain Can Strike Us All – Even President Obama

Sometimes, life can be a pain in the … heel. Just ask President Barack Obama.

Recently, the commander-in-chief underwent a routine physical examination and was given a clean bill of health, except in one area – his feet. His doctor diagnosed him as having symptoms consistent with plantar fasciitis, which causes pain when standing or walking.

Common foot complaint

“This is the biggest complaint we get from the patients we see,” said Dr. Johnny Alayon, a podiatric physician with Ankle & Foot Care Centers. “This is common among people over 30, but sometimes it will happen with younger people who are very active.”

Plantar fasciitis occurs when the ligament (plantar fascia) connecting the heel to the toe, supporting the foot’s arch, becomes strained or irritated. This tissue can become inflamed for many reasons, most commonly from irritation by placing too much stress (such as excess running and jumping) on the bottom of the foot.

“You feel this heel pain when you try to get out of bed in the morning and you feel like an old man,” said Dr. Alayon, who has been a practicing podiatrist for more than 13 years. “You get up and stretch it out and then the pain goes away. But then, maybe a month later, it happens again. Maybe then the pain is so bad that nothing you do stops it from hurting.”

Overuse injury

Plantar fasciitis is referred to as an “overuse injury” and commonly affects athletes who try to do too much or who do not stretch properly before starting their activities. The injury is most common with athletes participating in basketball, soccer and baseball.

For President Obama, too much basketball might be the culprit. It’s well known that he plays regularly, and the repetitive jumping and movement could be taking their toll. Jumping increases the bodyweight force that the foot has to absorb by several times.

“We see these types of injuries in athletes, as well as in “weekend warriors,” who don’t stretch or think they are 16 again and try to do the things they used to do,” said Dr. Alayon. “Some of this pain can be prevented before treatment is needed.”

Prevention tips

Dr. Alayon suggests these tips for preventing plantar fasciitis and other types of heel pain:

– Stretch. We aren’t always encouraged to stretch before and after our activities. But to avoid injury, you need to stretch regularly – even before you get out of bed in the morning.

– Evaluate your feet. It’s natural for your foot to change as you age. When it does, your ligaments do, too. Every five to seven years, your foot could change – become flatter, wider or longer. You need to evaluate these changes and make sure you have the right footwear for your activity.

– Choose proper footwear. If you are very active, you need to evaluate your footwear often. How old are your shoes? If you’re a runner, the soles of your shoes are only supportive enough for 500 miles. They might still look good, but they won’t support you like they need to. Generally speaking, for an active person, you should change your shoes about every six months.
Non-athletes develop the condition as well, with approximately 10 percent suffering from the condition at some point in life. General causes for plantar fasciitis include obesity, flat feet, repetitive trauma, tight Achilles tendon and/or poor shoe choice.

Treatment options

Fortunately, plantar fasciitis responds favorably with simple treatments such as rest, ice, physical therapy, anti-inflammatory medication, proper shoe choices, night splints, orthotics and/or cortisone injections. Plantar fasciitis surgery is reserved for people who don’t get better despite treatment.

“Almost 100 percent of the time, we can treat this conservatively, without surgery,” explained Dr. Alayon. “The biggest thing is that if the pain is becoming progressively worse or won’t go away even after stretching and evaluating your shoes, you need to see a podiatrist. There might be other more serious reasons for your pain and we need to figure that out.”

To schedule an appointment at an office near you, visit www.ankleandfootcare.com/locations.html. To receive free information about heel pain, visit www.ankleandfootcare.com/heel-pain-booklet.html.

Go for the Gold When It Comes to Winter Sports Safety

By Dr. Craig Beaudis

Some of us will spend hours watching the best amateur athletes from around the world compete for gold during the 2014 Winter Olympics in the next few weeks.

These athletes are highly-trained and talented in events like skiing, ice skating, speed skating, bobsledding and hockey. Sometimes, they make success look so attainable that they inspire us to lace up our ice skates or jump on our sleds in a quest to duplicate their feats.

But while participating in winter sports can be good for the body and mind, as with any physical activity, it requires some planning and caution to avoid injury.

“Common winter sports injuries include sprains, strains, fractures and dislocations in the foot and ankle,” said Dr. Beaudis, a podiatric physician with Ankle & Foot Care Centers. “Many of these injuries can be prevented if precautions are made. A fun day on the slopes or rink can easily end with a trip to the hospital unless safety is a priority.”

Dr. Beaudis and the group of podiatrists at Ankle & Foot Care Centers, the region’s largest podiatric care provider, with physicians and surgeons serving patients at 20 local offices, offers these safety tips when participating in winter sports:

Participate with a partner. If possible, skiers, snowboarders and sledders should stay with a partner and within sight of each other. Also, make sure someone who is not participating is aware of your plans and probable whereabouts before heading outdoors.

Check the weather for snow and ice conditions prior to heading outdoors. Pay attention to warnings about upcoming storms and severe drops in temperature. Make adjustments for icy conditions, deep snow powder, wet snow and adverse weather conditions.

Know and abide by all rules of the sport in which you are participating. Take a lesson from a qualified instructor, especially in sports like skiing and snowboarding. Learning how to fall correctly and safely can reduce the risk of injury.

Dress for the occasion. Wear several layers of light, loose and water- and wind-resistant clothing for warmth and protection. Layering allows you to accommodate your body’s constantly changing temperature. Wear proper footwear that provides warmth and dryness, as well as ample ankle support.

Also wear appropriate protective gear, including goggles, helmets, gloves and padding and check that all equipment is kept in good working order.

Warm up thoroughly before playing and exercising. Cold muscles, tendons and ligaments are vulnerable to injury. It’s important to warm up by taking it easy on the first few runs.

Drink plenty of water before, during and after activities.

Always carry a cell phone in case of an emergency.

Seek shelter and medical attention immediately if you, or anyone with you, is experiencing hypothermia or frostbite. Make sure everyone is aware of proper procedures for getting help, if injuries occur.

If you were to experience a cold weather related injury, visit your physician ASAP or go to your closest emergency room for immediate treatment to avoid any long-term consequences.

For more information about foot and ankle care or to schedule an appointment, call Ankle & Foot Care Centers at 888-881-8805.

Don’t Leave Your Feet Out in the Cold This Winter

By Dr. Craig Beaudis

The winter months can be some of the most enjoyable of the year. Think blankets of snow, a cup of hot coffee, sitting by a warm fireplace reading a good book and spending time with family and friends during the holidays.

Although the season brings plenty of cheer and a break from outside chores, for diabetics, it also provides elements that make caring for their feet more challenging. Decreased circulation, dry skin and spending time exposed to cold and wet conditions put diabetic feet at a higher risk for developing an infection or serious foot condition.

“It’s the time of year when diabetics should pamper their feet and keep them as comfortable as possible,” explained Dr. Craig Beaudis, a podiatric physician at Ankle & Foot Care Centers. “The best gift you can give your feet this year is taking time to treat them right.”

Dr. Beaudis and the rest of the expert podiatrists at Ankle & Foot Care Centers offer these tips for taking care of your feet during the colder months:

BE SHOE SIZE WISE

Don’t settle for shoes and socks that are a half-size too big or small. Winter shoes, like boots, are more restrictive than summer footwear, but your toes need room to breathe. Make sure your toes aren’t cramped and that you don’t tie your shoes too tight. If you can’t find the right shoes in the store, check out diabetic footwear that is specially made to keep your foot cushioned and protected.

DAILY FOOT CHECK

Get a shower. Check. Brush your teeth. Check. Look at your feet. Check.

The most important few minutes of your day could be those spent looking at your feet. Diabetics should check their feet every day, searching for cuts, blisters, irritation, fungus or any other abnormalities. Don’t just check the tops, either – don’t forget the side, back and bottom of your foot. If you can’t get a good look at all the areas of the foot, we recommend having a family member or friend take a look, so nothing gets missed.

Give your toenails some attention, too, noting any discoloration or thickening. If you have difficulty noticing if things are changing, keep a photo log of your foot checks.

If you have neuropathy, these daily foot checks are vital. But, all diabetic feet run the risk of problems if not treated early. You are the first line of defense in preventing serious issues – if you see something questionable, call one the foot and ankle specialists at Ankle & Foot Care Centers.

LATHER UP

Dry skin is one of the unwanted effects of the cold, dry winter air. Just like chapped lips and cracked hands need help, so do your dry feet. It’s important to keep your feet dry, clean and moisturized during the winter. Find a nice lotion to apply to the top and bottom of your feet. But don’t get it between your toes – that could increase the risk of foot fungus. If moisturizer does get between your toes, make sure to thoroughly rub it in so no lotion is visible.

Creams you’d find at the drug store would do the trick, but if you have diabetic neuropathy, you should ask a podiatrist about a diabetic foot care cream that may help even more.

KEEP ‘EM COVERED

Going barefoot is a bad idea. Not only should diabetics keep their feet warm in the winter, they need to protect them. House shoes or slippers are recommended and comfortable. Diabetic slippers for men and women offer protection and support and can accommodate custom orthotics.

If you don’t have slippers, at least wear socks. Diabetic socks encourage healthy circulation and keep feet dry and fungus-free. Cotton or acrylic socks (not nylon) prevent irritation and reduce moisture. Remember: Never use heating pads or hot water to keep feet warm. Put on a pair of socks or slippers, instead.

The American Diabetic Association recommends at least one diabetic foot exam per year for anyone not already seeing a podiatrist regularly. For more information on diabetic foot care or to schedule a foot check, call 888-881-8805.