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:


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.


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.


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.


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.

Running Can Be Fun and Injury-Free

Running doesn’t always have to feel like a punishment for doing something wrong – it can be a fun and healthy experience. But in order for running to provide health benefits without causing lower extremity injuries, you must follow proper technique.

Runners commonly battle foot and ankle injuries, as the impact of every step is the equivalent of up to two times a person’s body weight. The top five running injuries are stress fractures, tendonitis, plantar fasciitis, runner’s knee and shin splints.

Former high school and college runner and podiatric physician Dr. Kwame Williams treats patients out of Ankle & Foot Care Centers’ Northside, Liberty and Boardman offices. He offers the following tips for minimizing your injury risk and keeping running fun.

  • Increase your turnover. Focus on taking quick, light steps while keeping your core ‘tighter.’ Pretend you’re stepping on hot coals, or run as if you’re trying not to create a sound. The culmination of these efforts make your stride and cadence most efficient.
  • Mix in intervals. Go to a track, run one lap at your fastest minute per mile pace, walk half or quarter to recover, then do it again. Work your way up to five to five times. If you can’t find a track, run from light post to light post or stop sign to stop sign.
  • Try some hills. Find a steep hill about a football field in length at most and sprint it hard, jog back down, and do it again. At maximum effort, you should only be able to get in about four of these.
  • Rest. Running hard every day makes you slow and it’s no fun. Running is violent to your body –  it’s critical to recover and repair. Without rest, you will never built upon your success.

Remember to warm up. A quick way is to do 30 pushups, 30 sit-ups and one minute of jumping jacks and you’re good to go.

For more information on healthy running or injury treatment, contact Dr. Williams at 330.629.8800.

Hispanics Face Greater Risk of Diabetes

According to recent statistics, Hispanics are increasingly facing foot problems as a result of diabetes. In the latest research linking Hispanics and diabetes, about 12 percent of Hispanics have diabetes, and almost two-thirds of those with diabetes have some sort of foot problem.

With diabetes can come a myriad of foot problems, ranging from ulcers to lower limb amputations. The good news is that foot and ankle specialists, like those at Ankle & Foot Care Centers, can treat these ailments before they become serious.

Dr. Christian Carbonell, a podiatric physician at Ankle & Foot Care, with 18 offices in the Mahoning Valley, presented a free bilingual seminar titled “Diabetes and Your Feet,” about diabetes and Hispanics’ increased risk to getting the disease. The presentation was at the Youngstown Orginizacion Civica y Cultural Hispana Americana, Inc. (OCCHA) facility as part of the practice’s community outreach efforts.

More than 40 attendees there learned how Hispanics are more at risk for diabetes and how it can result in foot ulcers and lower limb amputations.

In addition to explaining the symptoms and treatments for those experiencing foot problems as a result of diabetes, Dr. Carbonell recommended these dos and don’ts for preventing major foot problems.


  • Examine your feet daily
  • Keep the area between the toes dry
  • Moisturize dry skin
  • Wear comfortable shoes
  • Visit a podiatrist regularly


  • Don’t tear at loose skin
  • Don’t soak your feet in hot water
  • Don’t walk barefoot
  • Don’t smoke
  • Don’t use chemical callus removers

If you need further advice on how to care for your feet, the expert staff at Ankle & Foot Care Centers can help. To schedule an appointment at a location near you, call 330-758-6226.

7 Reasons to Mind Your Feet as You Resolve to Exercise More

More than half of Americans annually resolve to exercise more, according to polls, but before you hit the gym be sure to address how a workout can impact your feet.

Podiatric physicians Dr. Craig Beaudis and Dr. Michael Daniels at Ankle & Foot Care Centers, with 18 offices in the Mahoning Valley, recommend heeding the following advice:

  1. Time for new shoes. Athletic shoes that are more than a year old have lost their support and may cause an increase in foot pain or possibly injury. Invest in a new pair of shoes.
  2. If the shoe fits. Be measured by an experienced salesperson or podiatric physician, and purchase shoes based on fit, comfort and its intended use. A running shoe, for instance, will not provide the lateral support needed for tennis or basketball.
  3. About that blister. Blisters are caused by wrinkles in socks, poor-fitting shoes, excessive moisture or deformities. Powder or additional padding can help avoid blisters. Avoid the temptation to pop the blister.
  4. Heel pain can be a warning sign. Don’t ignore persistent pain in the heel, especially if it occurs in the morning or after resting. This may be plantar fasciitis. If stretching before taking your first steps in the morning and after sitting for long periods does not resolve the pain, see a podiatric physician.
  5. Don’t ignore nagging pain. Chronic foot and ankle pain after exercising should be checked out. A podiatric physician can develop a treatment plan that alleviates your pain and improves your exercise regimen.
  6. Diabetics can exercise, too. People with diabetes should have annual foot exams, at minimum; more frequently if you have poor blood flow or loss of sensation. Most diabetics are also eligible for diabetic shoes, which are designed to reduce the incidence of foot ulcers. A podiatric physician can provide proper measurements for therapeutic footwear.
  7. Too much, too soon. Tendinitis may occur by overdoing it too soon. Slowly begin your exercise program, and warm up and stretch appropriately. Treat tendinitis with rest, ice and anti-inflammatories. If it does not resolve, see a podiatric physician.

Injuries to the feet are among the more common reasons why the “exercising more” resolution gets broken. Without healthy feet it’s difficult to maintain the momentum and good habits the well-intentioned set out to achieve. Best wishes for staying true to your resolution, and have a safe and healthy new year.

If you need further advice on how to care for your feet upon starting an exercise program, the expert podiatrists at Ankle & Foot Care Centers can help. To schedule your appointment today at one of 19 locations, visit the website at http://www.ankleandfootcare.com/.

Improper Footwear a Concern to Overall Foot Health

Wearing the wrong size or type of shoe can do tremendous damage to one’s feet. It’s a troubling concern often brought on by stretching the useful life a shoe, wearing a shoe that’s too large or too small, or by using footwear for activities outside their intended purpose.

What can happen? For adults, injuries can range from blisters, corns and callouses to bunions, ulcers, plantar fasciitis and hammertoes. The severity of injuries can be as extreme as amputation, particularly when compounded with existing conditions such as diabetes.

In children, many of the same issues can occur, as well as additional ones such as damage to the growth plate at the back of the heel bone. Made of soft cartilage, the growth plate is more susceptible to injury than mature bone.

For many families on tight budgets, buying and wearing proper footwear is easier said than done. But following some practical advice can help extend the life of shoes and help avoid many of these foot health problems:

  1. Be measured for shoes in the afternoon or evening. This is when your feet are the largest and most swollen, allowing for the most properly sized shoe.
  2. Unlace shoes every time they’re removed.
  3. Hand wash shoes with vinegar and water rather than using a washing machine.
  4. Keep shoes as dry as possible. Leather shoes that get wet wear out faster.
  5. Use baking soda to help remove foot odors.

If you need advice on how to treat heel or foot pain, the expert podiatrists at Ankle & Foot Care Centers can help. To schedule your appointment today at one of 19 locations, visit the website at http://www.ankleandfootcare.com/.

The Dangers of Overuse

Sports injuries to the feet, ankles and legs are commonly caused by overuse—when athletes, whether professional and amateur, put too much strain on their muscles, bones and tendons. This can happen, for instance, when runners add too much mileage too quickly, or when an athlete returns to a sport after an off season with very minimal training.

These injuries of overuse can include pulled muscles, ruptured Achilles tendons, plantar fasciitis and many more. In most cases, though, they are preventable through proper training.

When you begin an exercise regime or other physical activity, it’s important to gradually build up to your desired level of activity. Over time, your feet, ankles and legs can adjust to the demands your activity places upon them, reducing your risk of injury tremendously.

If you need advice on starting a new exercise regime or suffer from an injury of overuse, the expert podiatrists at Ankle & Foot Care Centers can help. To schedule your appointment today at one of 19 locations, visit the website at http://www.ankleandfootcare.com/.