Quick Tips for Your Diabetic Feet!

Foot problems increase if you suffer from diabetes. Diabetics must constantly monitor their feet or face severe consequences, including amputation. Here's some basic advice for taking care of your feet:

• Always keep your feet warm.
• Don't get your feet wet in snow or rain.
• Don't smoke or sit cross-legged. Both decrease blood supply to your feet.
• Don't soak your feet.
• Don't use antiseptic solutions, drug store medications, or sharp instruments on your feet.
• Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, contact our office.
• Use quality lotion to keep the skin of your feet soft and moist, but don't put any lotion between your toes.
• Wash your feet every day with mild soap and warm water.
• Wear loose socks to bed.
• Try to wear seamless socks to avoid seems rubbing your feet.
• When drying your feet, pat each foot with a towel.
• Buy shoes that are comfortable without a "breaking in" period.
• Do not go barefoot.
• Check your feet daily for any cuts, bruises, wounds, or other injuries.

Can Smoking Cigarettes Cause Foot Pain?

By Dr. Adam Thomas

The answer is to this topic is yes, indirectly. Smoking is well known as a contributing factor to health issues. With respect to the feet and lower extremities, years of smoking can not only lead to the more common issues of breathing complications such as emphysema, COPD and lung cancer, but it can lead to cardiovascular issues and artery disease. The effects of years of smoking can lead to narrowing of the arteries due to the chemicals causing constriction of the arteries repeatedly. If this is combined in an individual more prone to high cholesterol, this can be a very bad mix. The arteries, therefore, can become blocked with plaques. The complications of this most people are aware of is the fact that it can lead to heart disease, CAD (Coronary Artery Disease) and eventually open heart bypass surgery. 

What is less known is the fact that the blockages don’t just happen in one area such as the heart but all through the circulatory system. If the first areas becoming blocked are in the lower extremities, the first signs and symptoms may not be chest pain but rather pain in the legs or the feet. When it starts, it may manifest with simple cramping upon walking a certain distance before having to rest (claudication). This is due to the reduced blood flow getting to the feet and legs as the demand for oxygen goes up with exercise or walking. As the disease progresses, the distance an individual can walk shortens until the pain happens with both walking and resting (rest pain). Theses pains in the legs and feet can be signs of PAD or Peripheral Arterial Disease. 

Peripheral Arterial Disease

Often times in the podiatrist office, the early signs of this disease can be caught and treated before progression. Simple testing can be performed in office and if detected, appropriate referrals can be made to a specialist who treats this disease. Newer technologies are available with minimal invasive techniques to help improve blood flow to the legs and feet which will in turn reduce the pain, improve quality of life, and reduce the chances of amputation which can be a devastating end result of this disease.   

Barefoot Running: The Big Debate

Barefoot running is running without shoes or running in shoes that have very thin soles. This type of running is also known as minimalist running or natural running. There is a big debate in the foot community about whether barefoot running or going barefoot at all is better than wearing shoes.

Against Barefoot Running

Those against barefoot running aren’t sure that this activity is better for you. Podiatrists on this side of the argument claim that running on softer surfaces like natural mud trails and grass provides cushioning similar to shoes. They also argue that most runners run on concrete, which is an unforgiving surface.

Pain is also a major topic that comes up in this argument. It is believed that running without shoes or the support of regular running shoes can cause common foot and ankle ailments. Podiatrists express that when you place additional strain on your Achilles tendon, the result is pain and Achilles tendonitis. Podiatrists also argue that barefoot running is the cause of plantar fasciitis and that running without arch support will most likely lead to pain in the plantar fascia. They do not recommend that people run without proper fitting shoes, especially if you have low or flat arches.

For Barefoot Running

Advocates for barefoot running are on the other side of the coin. Some claim that running shoes are a part of big business and that biased businesses fund their own research to yield results that suggest it is better to run with shoes. By doing this, people continue to believe that they need expensive running shoes with all of the “necessary features.” People then go out and buy the running shoes and businesses continue to make a profit.

Other barefoot runners do not necessarily believe it is all a conspiracy. They simply argue that there are some populations all over the world that suffer from less foot problems and the only difference is that those other populations do not wear shoes. Barefoot runners claim that shoes do not offer support and that they actually weaken the muscles in your feet and ankles. This is because shoes prevent you from learning how to truly use those muscles. Shoes can also cause you to walk with an improper gait for years, which could eventually throw your body’s alignment out of whack.

Barefoot runners believe that shoes do not offer support, but they do believe that shoes offer protection from harmful objects like rocks, glass, nails, twigs, unfavorable weather, hot or cold surfaces, etc. This is the one true benefit of shoes, which is why some runners don’t run barefoot and opt for those minimalist running shoes like the Vibram FiveFingers.

Vibram FiveFingers (Minimalist Running Shoes)

Below are other reasons why some believe barefoot running is better for you and your feet:

• Barefoot runners have lighter footfall. In other words, they tend to strike the ground with the middle or front of their feet instead of their heel. This type of running puts less pressure on your joints and reduces impact injuries.
• Barefoot runners are able to run faster. Without the weight of shoes, they can increase their speed.
• Barefoot runners save money by not purchasing expensive running shoes.
• Running barefoot allows you to feel the ground. Being able to feel the terrain allows you to change your gait so that you can improve the way you run and improve your balance.
• Runners who run in shoes get the same injuries like plantar fasciitis anyway.
• This is how we were designed to run. If we are born without shoes, it must mean that our bodies and feet are capable of adapting to walking and running on the earth barefoot.

                       Heel Strike vs. Forefoot Strike

Barefoot runners believe that if you suffer from any pain like plantar fasciitis or Achilles tendonitis, it is because you made the switch to barefoot running too quickly. They suggest that you start walking around barefoot slowly on a soft surface like grass or dirt. Gradually work your way up to running on the soft surface. It helps you learn how to feel your feet so you do not strike the ground with too much force. You have to gradually train your body to make the switch. This means strengthening your feet, ankles, and calves before attempting that 10 mile run.

If you think about it, this is what you should do with any new physical activity. If you are just starting to lift weights, you don’t try to lift 300 lbs over your head on the first day. You could injury yourself. It is the same way with barefoot running. Since you will start to use more of your foot muscles that have been ignored while wearing comfy shoes, you don’t want to over work them or stress them. If you decide that barefoot running is right foot you, take it slow!

Caution:

Some people are not suited for barefoot running. If you have diabetes or live in a littered area, it is best to not to go barefoot as you could easily injury your feet.

X-rays Examined!

An X-ray is a form of electromagnetic energy. Podiatrists use this energy to make an image of your foot showing the soft tissues, tarsal bones, metatarsal bones, and phalanges. They order X-rays of the foot to be taken from different views: the front, side, and one at an angle.

The way an X-ray works is a film is put behind the part of your body having the X-ray. The X-ray machine shoots out X-ray particles that pass through your body and onto the film. The more X-rays that pass through and hit the film, the darker that part of the X-ray will be. Dense parts of your body, like bones, show up white on the film because they block out the X-ray particles. 

You might have heard that X-rays are harmful, but don’t worry. Doctors and radiologists take precautions to help keep you safe. The problem with X-rays is that they are a form of ionizing radiation, which means that when an X-ray hits an atom, it can knock electrons off the atom creating an ion (electrically charged atom). The charge of an ion can break DNA chains, which could result in death of the broken chain and cause various diseases. The DNA chain could also result in a mutation and cancerous cells. To prevent these complications, only the minimum amount of radiation required to get the best results is used by trained radiologists. Also, a lead apron or lead shield is used to protect certain parts of your body. X-rays are safe when used with care.

X-ray technology is an important tool that your podiatrist may use to help with the diagnostic process. It lets doctors see straight through your human tissue to examine any broken bones, detect arthritis or osteoporosis, and even identify unexplained pains without having to perform surgery to peek around. It can also help find the cause of tenderness, swelling, and deformities in addition to detecting cysts and tumors. They are also useful after surgery to make sure that you are healing correctly.

Is It Safe to Have Pedicures?

By Dr. Belinda Dotter

"Is it safe to have pedicures?"

Yes! As long as you consider the following things:

1. Look around the pedicure area:  Is is clean?  Are dirty tools lying around?  When in doubt, change salons.
    
2. Bacteria and other organisms (such as fungus) can enter your skin through any broken skin, so any scratches, bruises, scabs, wounds or abrasions should not touch the foot spa water. Or if you're unsure, better to postpone the pedicure until the skin has healed.
    
3. Do not do the following 24 hours before the pedicure:  use hair removal cream, wax, or shave legs.
    
4. Find out how the salon cleans and disinfects the foot spas, how they are maintained between customers. The foot bath and instruments should be cleaned and disinfected after each customer. 
    
5. Ask to see the disinfectant. Salons should use an EPA-registered hospital grade disinfectant.  If there is a label on the container stating "Hospital", "Medical", or "Health Care", then that product may be used as a disinfectant on surfaces in these environments.  You want the salon to use this type.  You may be labeled as a picky customer, but better picky than a foot infection.
    
6. Pay attention to how much time is spent between customers on cleaning the foot spa/bath.  Most hospital grade disinfectants need 10 minutes to fully work.  If the cleaner is used then rinsed within 3 minutes then that foot spa is not considered disinfected.
    
7. Do not use the foot spa if you are not sure it is disinfected and safe to use. Do not risk your health. You should report any problems to your state cosmetological board if necessary.

12 Year Old Almost Dies From Foot Blister

Macenzie Campbell, 12, almost died from a blister after wearing shoes without socks.

Macenzie Campbell was rushed to Royal Bolton Hospital when a blister on his foot became infected because he wore shoes without socks. His mother thought that the infection was a wart and applied a treatment but the next day, his foot had swollen and a red rash spread all over his body. After the rash started turning black, his body went into shock, his organs started to fail and his body began to shut down. Macenzie is now recovering at home, after doctors operated on his foot to remove the infected tissue and kept him in the hospital for a week. According to the doctors, he was six hours away from death.

A blister is the result of friction or rubbing on the skin. It forms when the outer layer of skin separates from the inner layers causing fluid to build up in between them. A blister could also be filled with pus if it is infected. Typically, a blister develops if the skin is wet or moist and is continually rubbed in the same location, and they are most common on the feet and hands. If you are suffering from a blister, you might wonder, “When is it okay to drain it?”

Do not drain it if...
If the blister is small and not too painful, keep it clean and leave it intact. Do not try to drain it because the skin acts as a barrier to keep bacteria out and lowers the risk of infection. Also, the fluid within the blister keeps the underlying skin clean and promotes healing. Cover the blister with a bandage or gauze pad and it should heal on its own. If you are diabetic, do not attempt to puncture or drain your blister and please see a podiatrist.

Drain it if...
If the blister is large, painful and prevents you from your daily activities, you may want to try to drain it. First, make sure your hands are clean and clean the blister thoroughly. Wipe the blister with rubbing alcohol, and use the rubbing alcohol to sterilize a sharp needle. Puncture the blister near the edge not the middle because you want to try to avoid disturbing the unbroken skin over a blister. Let the fluid drain and when it is done, apply an antibiotic ointment and cover the blister with a bandage.

Don’t forget to look for signs of an infection: pus drainage, redness or warmth around a blister, an increase in pain, red streaks in skin, and fever. If a blister becomes infected, one of the risks include secondary impetigo, a contagious bacterial infection. Another risk is cellulitis, a serious skin infection that may affect tissues under your skin and spread into your bloodstream. In the case of Macenzie Campbell, he suffered from Sepsis, a life-threatening bacterial infection in the blood stream.

To prevent blisters, minimize the friction and keep your feet dry by wearing fresh socks. You should also wear proper fitting shoes.

Marvin Jones of the Bengals Out with Foot Injury

Marvin Jones # 82

Third-year wide receiver for the Cincinnati Bengals, Marvin Jones, sustained a left foot injury during Saturday's practice at the Paul Brown Stadium. Coincidentally, Jones suffered what is called a "Jones Fracture." These fractures can be tiny stress fractures or an acute and sudden break in the foot. Jones fractures are caused by repetitive stress, overuse of the foot, or trauma.

Jones had surgery over the weekend and it consisted of having a pin placed in the fifth metatarsal bone. It is likely that he will miss the rest of preseason and the first month of the 2014 NFL season (first three games). The Bengals hope that he will be able to return after the bye week for the game against the New England Patriots, scheduled Oct. 5 at 8:30 pm.

Walk Your Feet!

Walking is a very inexpensive way to stay healthy and help keep your feet in shape. This is an activity suitable for all ages that can happen any time, year round and practically everywhere. It is also a great way for people to start getting the recommended amount of exercise, especially if they are unused to physical activity, pregnant, or overweight.

Most of us are familiar with the benefits of exercise; it helps control weight, cholesterol, and blood sugar levels. More specifically, walking is an aerobic exercise that delivers oxygen rich blood to your muscles. It is a healthy activity that will improve your cardiovascular fitness and lower your blood pressure as well as your risk for heart disease, stroke, and diabetes. Walking on trails and natural ground also prevents older adults from falling because they will be more use to the unevenness of the ground, which helps to improve their balance. Additionally, walking is a low-impact exercise that will be easy on your joints.

Did you know that a brisk walk can burn up to 100 calories per mile? You should try briskly walking for 30 minutes a day. If you have been inactive and are just beginning, start off slow and walk at least 5 to 10 minutes around the block. Work your way up to the “30 minute brisk walk” goal. It is okay to take it easy until you feel comfortable walking faster for longer periods of time, as any exercise is better than none.

After you start habitually walking, you should notice that you feel better overall. This is because your body will release endorphins that help relieve stress, anxiety, and decrease depression. Walking also gives you a chance to clear your mind and keep it sharp— some even consider it a type of meditation. Walking daily helps boost your mood, helps you get a good night’s sleep, keeps your muscles strong, and helps you live happier longer. 

Before you start, be sure to wear proper fitting walking shoes to help prevent bunions, blisters, or calluses. Your shoes should be comfortable and offer enough support for you feet. Also, don’t forget to wear socks. Now get out there and enjoy the fresh air! :)

Tips for the Dancing Toes!

Do you love to use your feet to express yourself? Are you a dancer?  Do you dance barefoot? If you answered yes to any of these questions, you may be at risk for feet issues. This is a typical problem for dancers, and if you don’t take time to monitor what’s going on with your toes, very painful injuries can result. A few of these common injuries can be found below:

• Calluses- toughened areas of the skin which have become relatively thick and hard in response to repeated friction, pressure, or other irritation.
• Blisters- small pockets of fluid within the upper layers of the skin, typically caused by forceful rubbing (friction), burning, freezing, chemical exposure or infection.
• Bunions- deformities often erroneously described as an enlargement of bone or tissue around the joint at the head of the big toe.
• Cracks and Splits- sensitive skin on the bottom of the feet and heels becomes too dry, it can split open, leaving painful cracks called fissures on your heels.
• Athlete's Foot- a fungal infection that usually begins between the toes. It occurs most commonly in people whose feet have become very sweaty while confined within tight-fitting shoes.

Dancing can be a beautiful thing, as long as your feet feel beautiful too. You want to be able to do what you love and keep your feet healthy. Below you will find some tips for healthy toes. Be sure to take proper care of your toes before and after dancing.

Do you want your feet to look like this...

                                                                                               ...or this?

Here are some tips for healthy toes:

• Make sure to stretch and exercise your toes regularly. This may seem strange, but this will ensure your toes are feeling healthy and it can prevent injuries. A typical toe stretch consists of grabbing your foot by placing a hand on each side and using your fingers to bend your toes down.
• Proper preventative care starts with soaping feet daily and drying them well, especially between the toes. This is to keep them clean and free of fungus. It's important to dry the feet well, or they will become overly soft and could lead to athlete's foot or skin cracks (athlete's foot is known to start between the toes).
• Don't ignore foot pain. Symptoms that increase or do not resolve within a reasonable period of time need to be evaluated by your podiatrist.

Remember, you can enjoy dancing barefoot. It's a great way to exercise and do what you're passionate about. However, you need to take the correct preventative steps to avoiding the serious issues that can come along with neglecting to pamper your feet. Visit our website to see our tips and treatments.

Community Foot Specialists - Podiatrists/Foot & Ankle Surgeons Serving Dayton and Springfield, Ohio Call today to schedule your appointment! (937) 426-9500

The Right Shoe for You

By Dr. Bridget Brondon

Just like all feet are different shapes and sizes, shoes are all different shapes and sizes as well.  No two brands measure the same way, for example Adidas shoes generally run bigger than Nike and Puma shoes run small and narrow.  Even within a certain brand of shoes, different styles can fit differently.  

       Different Sized Feet

Try and have your foot measured either by someone who knows how to do it at the store, or if you see a foot doctor, you can ask them to measure it also.  This will at least give you a starting point regarding size and width of your foot.  Keep in mind, however, that you may need to go up or down a half-size or more depending on the brand and style of the shoe.  

The only way to know exactly what your size is for a specific shoe is to try on the shoes in the store.  Also, when trying on shoes, try on BOTH the right and left shoes. Most people have one foot that is slightly larger than the other and this can make a difference in the overall comfort of the pair of shoes.  When in doubt, go with the size for the larger foot, not the smaller foot. That way you are less likely to get rubbing or irritation from a shoe that is too small.  If there is a significant difference in the size of your feet, you may need to get a different size for each.  Not all companies offer this, but New Balance is one option that does.  

The shape of our feet can also determine which shoes are better for our feet than others.  Frequently in the office, I will hold up a shoe to a patient’s foot and half of the foot will be hanging over the side!  If your foot does not fit within the lines of your shoe, it is likely causing increased pressure on your foot from squeezing into it.  If you have a wider foot, look for a shoe with a rounded or square forefoot area (the part from the ball of the foot forward).  If you have a narrower foot, look for a shoe that has straps or laces to help hold it on your foot better.  Also, if you have some type of deformity of the foot, such as a bunion or hammertoes, make sure that the shoe you select can accommodate the deformity without adding extra pressure to the area.

The fabric of the shoe can also make a big difference.  Tighter fabrics with less give to them, such as new leather or plastic, can cause irritation if they are rubbing on prominent areas of the foot.  Softer fabrics can be more flexible which may not be good if you need more support.

Keep in mind, our shoe size and shape frequently change with time due to gravity and standing/walking on our feet over the years.  Don’t worry so much about the number on the shoe box.  Most people won’t be able to guess the size of your feet just by looking at them so it shouldn’t be a big deal if you have to go up from an 8 to a 9.  Comfort and preventing problems should be more important than the number.

Plantar What?

Plantar Fasciitis (pronounced "PLAN-ter fash-ee-EYE-tus"), one of the most common causes of heel pain, presents itself when there is an issue with the long band of tissue that runs across the bottom of the foot. This long band is called the plantar fascia, and it creates the arch of the foot by connecting the heel bone to the toes.

If your plantar fascia is irritated or inflamed, a likely result is heel pain often described as a stabbing feeling in the foot. Most patients agree that the pain is triggered after long periods of rest. For example, they might feel pain in their foot when they take their first steps out of bed or after sitting or lying down for a while. Other patients, such as athletes, feel pain after prolonged periods of activity or exercise (but not during).

Along with plantar fasciitis, many patients suffer from heel spurs, a bony projection in the heel.  A common misconception is that heel spurs cause plantar fasciitis, but most heel spurs cause no symptoms and many go undetected for years.

The following are risk factors for developing plantar fasciitis:

• Being overweight/ obese
• Age (between ages of 40 and 60)
• Tight calf muscles
• Faulty foot mechanics such as high arches or flat feet
• Impact activity from running or other sports
• New or increased activity
• Occupations that require you to spend long hours on feet

Some simple treatments that you can do from the comfort of your home include rolling a frozen water bottle underneath your foot and stretching your calf muscles multiple times a day. You could also do a towel stretch by using a towel to pull the top part of your foot back towards you while sitting down.

If you suffer from a more severe case of heel pain, come see us. Some of our treatments include taking an oral anti-inflammatory, cortisone injections, shoe orthotics, and night splints. Call our office to schedule an appointment today.

Barefoot Beach Activities

If you are up for new fitness challenges this summer, try an athletic activity such as beach soccer, beach volleyball, or barefoot beach running. There are numerous benefits to these intensive sand workouts. One important benefit to note is that beach activities are easier on your joints because the sand absorbs most of the impact every time your feet hit the ground. You should also keep in mind that the sand is a surface that is constantly changing under your feet. For this reason, running (or jumping for that matter) on the beach works the muscles differently than running on hard surfaces. For example, the ankles need to make constant adjustments with each stride in order to preserve balance. Other muscles such as the lower back, hips, core abdominals, and calves are used more because they too need to compensate to maintain balance.

Barefoot running also strengthens foot muscles by allowing your feet to move through their natural range of motion. Another benefit is that athletic beach activities burn more calories than running on hard surfaces because you have to expend more energy pulling your legs out of the sand. For instance, you use more energy to lift your knees higher than you would if you were working out on a hard surface. One of the best benefits of physical activity on the beach is the Zen feeling you can experience. You do not have to inhale any fumes or exhaust from passing cars, you get a chance to smell fresh water, hear the waves, see the beautiful ocean, and feel the spray of the ocean breeze. An added bonus is that sand is a great exfoliator so it’s like getting a natural pedicure.

If you are interested in athletic beach activities, follow these tips:

• Take it easy. You may need to keep the length of your activity shorter than usual since you will use more energy on the sand. You don’t want to overexert yourself. 
• Do not expect to move at your normal pace. The sand is a more difficult terrain to master, and it will surely slow you down.
• Ease into barefoot running. If you plan on barefoot beach running, run at low tide and closer to the shore where the sand is more compact to avoid injuries. Also, you want to slowly build strength in your feet and ankles. You don’t want to start off doing too much too frequently since your feet and lower leg muscles are accustomed to support from shoes.
• Shorten your stride. Take smaller, quicker steps instead of forcing your feet into the sand. Staying light on your feet will help you from sinking.
• Stay hydrated. 
• Protect your skin. Being at the beach means you will be in direct sunlight. Apply sunscreen.
• Keep an eye out for sandcastles and beach holes!
• Don’t forget to stretch. Take the time to thoroughly stretch to keep your muscles loose and flexible.

Now get out there and have fun!

Bouts of Gout

By Dr. Bridget Brondon

Gout is quickly becoming a problem we see more and more of in our office.  We all probably know someone with gout, or if we’re really lucky, we have it ourselves (not!).  There have even been dinosaur bones discovered with gout in them, so humans are not alone!  But what is gout and how big of a problem is it?

 Gout is a form of arthritis, which is why it affects the joints of our feet.  It occurs when there is an excess of uric acid in our bodies.  This can happen one of two ways: we can either produce too much uric acid or we don’t get rid of it fast enough.  Most people fall into the group that does not get rid of the uric acid fast enough.  This can be due to your regular metabolism, but there are other things that can decrease the uric acid excretion, such as certain medications (aspirin and water pills especially), alcohol intake, and certain foods, especially red meat and high fructose corn syrup.  Kidney problems can also cause this because they are the filtration system that cleans out the uric acid from the body. Dehydration can also bring on a gout attack.

When uric acid builds up in our bodies, it ends up circulating through our bloodstream and one of its favorite places to get stuck in is the joints of our feet, most commonly in the big toe joint.  Other areas of the feet often affected are the middle/arch area of the foot, where lots of very small joints are present, and in our smaller toes, but gout can occur in any joint of the body.  Other body parts that can be affected are the hands, fingers, and ankles.  

 The uric acid particles form crystals within the joint, under a microscope, look very similar to sewing needles.  The inflammation from these crystals is what causes the pain.  Other symptoms include redness at the joint, swelling, warmth in the area, and A LOT of pain.  Without any treatment, in time, these crystals would naturally get broken down and absorbed into the body, but who wants to suffer through all that pain when there are medications that can help?

So, how do you know if you have gout?  The symptoms above are a very good first indication.  An aspiration of the joint can also be done where some fluid from the joint is removed with a needle and sent to the lab to look for crystals in the fluid.  Your doctor can also run a blood test to determine your uric acid levels to check if it is high.  It is important to note, however, that during the first few days of an attack, very often your uric acid level in your blood is often normal, because a lot of the uric acid has made its way to the joint and is no longer in the blood stream.  Bloodwork is usually done a month or two after an attack to determine what the baseline uric acid level in your body is when you are not undergoing an attack.  If it is naturally high, you may need long term therapy to lower it.

 The most common medications that are used for treatment for an acute gout attack (when the joint is super red, swollen, warm and painful) are anti-inflammatory medications and colchicine (brand name Colcrys).  Anti-inflammatories, such as Indomethacin, Aleve, Advil, Ibuprofen, Motrin, or a Medrol dose pack (steroid pack) can help to decrease the inflammation present made by the crystals and help reduce the swelling and pain.  Colchicine works to stop the inflammation from being created in the first place.  Sometimes, these two medications are prescribed at the same time to work together to get rid of the inflammation.

 It is possible to have only one gout attack in your lifetime, but it is far more likely that they may come and go throughout your life if your uric acid is not properly managed long term.  This is done with medication taken daily to help with the excretion of uric acid from the blood on a daily basis, so the levels do not rise high enough to cause a gout attack.  There are primarily 2 medications that do this: Allopurinol and Febuxostat (brand name Uloric).  Allopurinol is generally the first medication tried.  The dosage of this medication can be tweaked to fit your needs.  This medication does not work for everyone though and flares can continue to occur, or sometimes a patient can have a reaction to the drug.  Febuxostat is an alternative option in these cases.  It is also a safer drug for those patients with kidney problems.

Although gout may be a problem that only bothers you every once in a while at the beginning, it is important to seek long term treatment if you are prone to gout attacks.  The longer uric acid remains at a high level in your body, the more lasting damage you can have to your joints, even if you aren’t having any pain at the time.  Just like with osteoarthritis, even when you aren’t having symptoms, the damage to your joints is still occurring.  The same thing is true for gouty arthritis.  Over time, it also begins to take less to trigger a flare-up so they can happen more easily and more frequently.  With time, the uric acid crystals within the joint eat away at the cartilage which can cause problems with motion and inflammation in the future as well.  The crystals can over time deposit themselves permanently in the joints as well, which can cause stiff joints, bumps, and irritation.

So, what can you do to prevent a gout?  Well, once you have it, you have it.  But you can prevent attacks primarily by watching what you eat.  You can still eat all of your favorite foods, but moderation is the key.  Drink plenty of water to keep yourself hydrated and help flush your kidneys.  If you do get an attack, see your doctor right away. We want to help you start feeling better faster!

Mowing the Lawn Barefoot?

Many people admit to mowing their lawns barefoot.  The feel of fresh cut grass is all too tempting… but don’t do it!

Please keep in mind that a lawn mower is a machine that uses a rotating blade at high speeds to cut grass. You should not mow your lawn barefoot or while wearing flip flops, sandals, or other open-toed shoes. The mower can cause flying debris, and wearing shoes helps you avoid stepping on hidden objects like twigs, rocks, mulch, broken glass, etc.

Wearing appropriate shoes also prevents your feet from turning green (caused by the chlorophyll in the grass).  Plus, if you have diabetes, going barefoot is generally a big no-no. Walking barefoot leaves you open to any number of injuries and if you suffer from neuropathy, you may not be able to feel that you are injured.

According to the US Consumer Product Safety Commission, thousands of people are injured by lawn mowers every year. Types of injuries include cuts, burns, other infection-prone lacerations, broken bones (fractures), severed tendons, and amputations. Minor injuries and superficial wounds require immediate treatment, so flush wounds with water and apply antibiotics to prevent infections. For more serious injuries, surgical intervention is usually required.

Still, many people make the decision to mow the lawn barefoot after weighing the risks: their age, slope of the lawn, type of mower they will use (riding mower vs. push mower), mowing pattern, height of the grass, etc. Nonetheless, it is best to take safety precautions to avoid any serious injury.

• The American Podiatric Medical Association suggests that you always wear hard-top shoes when operating a lawn mower.
• Before you start mowing, remove objects like toys and yard tools off of the lawn.
• Do not remove safety devices such as guards or shields from your lawn mower.
• Try to use the “grass catcher” or “clip bag” that usually comes as an attachment to help prevent projectiles from causing harm.
• Make sure you have firm footing at all times. Pay attention to the change in slope and terrain.
• Do not mow the lawn if it is wet. This helps prevent slipping on the grass.
• Do not use your feet to remove debris in lawnmowers. Use a stick or broom handle instead.
• Never touch the lawn mower blade with your hands or feet, even if the engine is off. The second you free a jammed blade, it could start to spin and cause an injury.
• Do not let children ride on a lawn mower — not even on the lap of a parent. A majority of injuries happen to children, and many doctors see foot injuries related to children who were riding as “passengers.” Typically, children fall off of the mower and get run over, resulting in serious injury/ amputation.
• Do not mow while heavily medicated, intoxicated, sick, or overly tired.
• Be sure you know how to stop the mower at a moment’s notice.
• If you have to walk backwards, be careful to avoid running over your toes (yes, it does happen).
• Continue to maintain your lawn mower to ensure that it is working correctly.

**Remember** If you like the feel of fresh cut grass you can always walk around your lawn barefoot after you finish mowing it. To cut a long story short, don’t mow the lawn barefoot. Take care of your feet because they don’t grow back!

Wearing Flip Flops All Summer, Yea or Nay?

Dr. Belinda Dotter

Flip flops and sandals are increasingly the shoes of choice during the summer. The crop of new styles and funky designs have made them very common and popular.  But are they good or bad for our feet?

Flip flops can give us basic protection when out by the poolside, for example, protecting our feet from the hot floor.  They can also prevent athlete's foot or plantar warts while in public places like showers, pool areas, and locker rooms.  However, flip flop use during extensive walking is not so great because they offer no arch support, heel cushioning, or shock absorption.  We can suffer foot pain due to lack of arch support, tendinitis, and even sprained ankles if we trip. Also, don’t wear the same pair of flip flops year after year. If they are worn out, make sure you throw them out.

Many of us start out relieved at being able to come home or get to the weekend so we can ditch our work shoes and put on some comfortable flip flops, only to want to throw them away after several hours of activity.  So, wear them in moderation.  Short periods of time is acceptable, just don't overdo it!

So Basic It’s Simple!

Dr. Bridget Brondon

Our feet are an area of the body that is commonly overlooked until something goes wrong.  They are hard to reach, take a lot of wear and tear through the years, and are body parts that many people deem to be “gross.”  As a doctor’s office, we most commonly see patients who are actively having a problem or concern with their feet.  We love seeing our patients and helping you feel better, but what can all people do to reduce the risk of needing to visit the foot doctor?  How best can you prevent problems from occurring in the first place?

Here are some basic foot maintenance tips to keep you in tip-top shape:

1. Wash your feet daily- Dirt, oil, dead skin, bacteria, fungus, sweat, etc. are all naturally found on all skin of the body, but because of where they are located, sometimes these can be in even greater amounts on the feet.  Cleaning with soap can help scrub the bad stuff away.  Don’t forget to clean in between the toes too.  This is a place especially susceptible to infections because of the friction created from your toes rubbing together.
    
2. Dry feet well after washing- Excess moisture on your skin can cause it to break down and infections can occur.  Once again, in between the toes is very important as well.
    
3. Check your feet every day- The faster you notice a problem and take steps to fix it, the sooner and probably better it can be fixed.  Same goes for your feet.  The sooner you notice if something is wrong (like bruising, swelling, redness, cuts, sores, scrapes, etc.), the sooner you can start to treat the problem.  If you can’t reach your feet or see the bottoms, try using a mirror or have someone else look for you.
    
4. Apply lotion- As we get older, our skin has less moisture in it naturally and can dry out easier, especially in colder, drier weather.  Others naturally have dry skin.  If you notice dry skin on your feet, applying lotion every day can help.  Do not apply in between your toes, as that can cause too much wetness from the lotion.  Thicker creams/lotions always provide greater moisture, but any lotion is better than none!
    
5. Soak your feet- For mild aches and pains, this can be a very easy remedy.  A warm-water bath with epsom salt can feel very nice.  Remember to check the temperature of the water before putting your feet in, as you can burn them if the water is too hot.  Also make sure that you apply lotion afterwards.  Warm water and the salt can dry out your feet as well.
    
6. Supportive shoes- As often as possible, try to wear good supportive shoes with adequate cushion.  This will help to support your joints, ligaments, and tendons so they do not become strained.

As always, if you notice a problem with your feet that isn’t getting better, call our office to schedule an appointment.  We want to help you keep those feet feeling great and keep you comfortably walking on your way!

Got Cold Feet?

Dr. Adam Thomas

Getting “cold feet” is not just an expression for chickening out or getting nervous and changing your mind. You can literally get cold feet if you have poor circulation. Circulation is the flow of blood throughout your body. Poor circulation occurs when the blood flow becomes restricted and is often indicative of a more serious problem.

Signs and Symptoms include:

• Cold feet and toes (despite the weather)
• Red, purple, or blue toes
• Cold hands and fingers
• Feeling tired / Lack of energy
• Swelling and water retention – most noticeable in the feet
• Feeling numb in the extremities
• Loss of hair on feet or legs
• Cramps in legs
• A feeling of pins and needles
• Sometimes headaches
• Shortness of breath
• Blotches and blemishes in skin
• Lumps in blood vessels or varicose veins
• Wounds that heal slowly

Risk Factors:

• High Cholesterol
• Diabetes
• Smoking
• Lack of Exercise
• Poor Diet
• Sitting or standing in one place for long periods of time

Another cause could be Peripheral Arterial Disease (PAD). In this disease, plaque builds up in the arteries that carry blood to other parts of your body. The plaque can harden over a period of time, causing the arteries to narrow and reduce the amount of blood flow, especially to the legs. PAD is a very serious disease that could lead to gangrene, the death of tissue, which could result in amputation of the extremity.

Treatment options for poor circulation include lifestyle changes. For instance, you could change your diet by trying herbs (like ginger), eating foods with more fiber, or drinking more water. You should also try moving more: stretching, doing yoga, swimming, or going on gentle walks – nothing too demanding to start if you have poor circulation. It is a good idea to quit smoking since it produces carbon monoxide, a gas that displaces oxygen in the blood and destroys the lining cells in blood vessels, allowing plaque to stick to blood vessel walls. A lot of the tips mentioned above could also lower your cholesterol.

Other suggestions are to use relaxation techniques to reduce stress, wear socks to keep your feet warm, avoid long periods of immobility, and try to elevate your legs. Please visit your local doctor to make sure that there aren't more serious concerns related to your poor circulation.

Stop the Itch!

Dr. Belinda Dotter

With warmer weather being here, we are more active and more exposed to this pesky fungal skin infection. If you notice a scaly rash that itches, stings, or burns, you probably have athlete’s foot. Athlete's foot, officially known as tinea pedis, is a fungal infection that usually starts between the toes. It is very common for this infection to affect people with sweaty feet, especially if they wear shoes that fit too tight. Most people affected by Athlete’s Foot maintain that itching worsens after the removal of shoes and socks. Be careful because this infection can spread— especially if you scratch the infected parts of your feet.

Athlete’s foot can extend to other parts of your body, including:

• Your hand. A similar infection may develop on your hands if you continue to scratch or pick at the itchy parts of your feet.
• Your nails. Athlete’s foot can spread to your toenails because of the fungi. This is a problem because your toenails can be more resistant to treatment.
• Your groin. Athlete’s foot can travel from the feet to the groin via your hands or a towel. The same fungus that causes Athlete’s foot can also cause Jock itch.

Athlete’s foot does not just spread by body parts. It can also spread other ways:

• Sharing. If you share clothes, socks, shoes, rugs, mats, towels, or bed linens with someone who has the infection, chances of you getting Athlete’s foot increase.
• Walking barefoot. Public areas like swimming pools, locker rooms, saunas and communal baths/ showers are more susceptible to the fungi associated with Athlete’s foot. This is because fungi like to thrive in warm, moist places.

Try these tips to prevent Athlete’s foot or to help ease the symptoms if you already have the infection:

1. Keep your feet dry. Also, be sure to keep the areas between your toes dry since this is where Athlete’s foot usually begins.
2. Do not share shoes.
3. Wear well-ventilated shoes. Avoid shoes made out of rubber or vinyl since these synthetic materials do not allow for air to move.
4. Do not wear the same pair of shoes every day. Alternating shoes allows them to dry out while they are not being worn.
5. Change socks regularly, especially if your feet sweat often.
6. Protect your feet in public places by wearing shower shoes or waterproof sandals.
7. Use antifungal powder on your feet daily if you have Athlete’s foot.

Some types of athlete’s foot can lead to blisters or ulcers. Another type called Moccasin, causes scaling and dryness on the soles of the feet. Sometimes it is mistaken as eczema or very dry skin. Since there are different varieties of Athlete’s foot and this infection is highly contagious, see your local podiatrist if you have a rash on your foot that doesn't improve within a few weeks after self-treatment. If you have diabetes, please visit your podiatrist sooner as there are a number of foot-related complications associated with diabetes.

High Heels and You

Dr. Belinda Dotter

It's spring and time to wear gorgeous high heeled sandals. Here’s some information and tips to keep your foot in tip top shape when wearing them!
Studies have shown that high heeled shoes create excess pressure on the plantar surface, or sole of the foot, which can lead to metatarsalgia (ball of the foot pain), excess stress on foot joints, and painful calluses. The higher the heel is, the more probability that muscular imbalances are occurring while walking in the shoes — causing certain leg and foot muscles to work too hard. These imbalances can lead to problems such as knee pain, heel pain (plantar fasciitis), and hammer toes.

Common Mistakes:

1. Incorrect Size:  You may be surprised to learn that your shoe size has changed over the years. A change in foot size can often be attributed to hormonal changes and natural changes in soft tissue that occur with aging. The next time you shop for shoes, be sure to measure your feet for both length and width. Be aware that the right size shoe may not always be a good fit, so it helps to try on a few different styles until you find the most comfortable fit. Shoe sizes can vary to almost 1 size depending on the manufacturer!
    
2. Extreme Height: One of the most common problems with high heels is pain under the ball of the foot. A higher heel means more stress on the ball of the foot, ankle, and knee, which increases as the height goes up.  
   Try these to minimize pain and possible injury: 
   
   -  Prefer to wear a platform shoe, this adds height without the extreme slope and pressure on the ball of the foot. 
   -  Wear a chunky heel instead of stilettos.
   -  Find a heeled shoe where the heel is positioned more toward the back of the shoe, which is more stable than a heel positioned more toward the center of the shoe.
    
3. Not Enough Coverage:  Shoes with very little to no straps on the top of the shoe.  This will allow too much motion on an already unsteady, elevated heel. You can bet that long periods of walking in these shoes will leave you with tired, sore feet and put you at risk for an ankle sprain. Your best bet is to choose styles that fit the shape of your foot well, offering adequate material to hold your foot in the shoe — a good example is a high-heeled boot or a shoe with straps across the toe area, arch, and ankle.
    
4. Pointy Toed Shoes:  Seeing the way the toes are squeezed into these pointy-toed shoes are painful to observe. Besides the toes being pushed into a cramped space, there is an issue with the shoe's toe material not covering enough of the toes. This forces the toes to work harder at maintaining stability, possibly contributing to toe contractures, such as hammer toes. A better choice is a shoe that has more material across the toes and more of a rounded toe box. Another toe problem that can be aggravated by high-heeled shoes is a bunion deformity.

Sock It to Me!

Dr. Bridget Brondon

Socks are helpful clothing items that provide extra cushion to the feet when walking and standing.  They also help absorb moisture from the feet and prevent friction when the feet are in shoes.  In today’s world, socks have become quite a fashion statement as well.  Dress socks, sports socks, tube socks, more socks (that was my best Dr. Seuss impression!), between the bright colors, crazy patterns, and fancy fabrics, the number of sock choices can be overwhelming!  So how do you go about choosing the type of sock that is right for you?

The good news is that for most people, the type of sock that you wear does not have as much effect on the feet as do the type of shoe.   Of course, wearing any socks at all is better than none.  It is also important to change your socks every day to help prevent infection and odor.  However, there are a few medical conditions that may require a sock of a certain type:

Diabetics with neuropathy or circulation problems:  
It is important for this group to find a sock that will not be too constricting and are made out of a soft material.  Another thing that can be helpful is a seamless sock as seams within the fabric can cause irritation to the skin.  Many stores sell “diabetic socks” which can give you a head start on knowing what fabrics to look for, but unlike diabetic shoes, these are not as well-regulated and so you may not get any more for your money that just a regular sock.

Sweaty feet: 
As the weather grows warmer, it is often inevitable that our bodies will try to cool us off more by producing more sweat.  Because our feet are “trapped” in shoes, this is often an area of high sweat production.  The answer is NOT to stop wearing socks.  That can actually create more problems.  If you have sweaty feet, a moisture-wicking sock is important to help draw the moisture away from the skin and prevent irritation, infection, etc.

Swollen and/or achy feet: 
Socks with compression can help to reduce the amount of swelling within the legs, ankles, and feet.  Gravity tends to pull fluid down throughout the day while we are standing and sitting with our feet down, causing a heavy or aching feeling.  Compression socks or stockings do not allow extra fluid to remain in the lower parts of the legs and help push the fluid back up towards the heart to re-circulate through your body.  The amount of compression within the socks can vary depending on how much fluid is in the legs.  Even using light compression can help to prevent fluid from collecting in the legs and feet.  Though they may not complete resolve the swelling that tighter compression would, every little bit can help!

Highly active people or people who stand a lot: 
The more time you spend on your feet, the more pressure you put on the joints, muscles, tendons, and ligaments.  Socks with good cushion are the best choice for these individuals.  There are also socks that have some mild compression within the arch area that can help support your feet.  While the fabric isn’t strong enough to take the place of support you get from a well-made shoe or a shoe insert/ orthotic, once again, every little bit can help!