Keep Your Feet Feeling Young

There was an article in the July 23 edition of the Wall Street Journal about Cankles, which is a word used to describe thick or fatty ankles. It is a combination of calf and ankle and is not usually used in a flattering way.

It seems that now that all other areas of the body have been firmed and sculpted, the ankles are getting their due. The article states that Gold’s Gym declared July to be “Cankles Awareness Month” with workouts devoted to the ankle. Even with their Cankles-busting workout, though, it may not show much improvement.

For those who just don’t want to give up on those perfect-looking ankles, plastic surgeons are advertising liposuction for ankles to remove the fatty deposits. The concern is that there can be trauma to the surrounding vessels and tendons that squeeze through the ankle to enter the foot. There are also people who are finding temporary relief by applying Preparation H hemorrhoid cream to their ankles.

Your ankles are meant to be functional. In many cases the heftier ankles are due to the formation of the achilles tendon lower than usual, so what you see is the muscle belly. In those cases, toning your ankles may even make them seem larger! Before you do anything to affect your ankles, or any other part of your body, be sure to discuss it with your physician. Also take a long look objectively and see if it is really something that you need to do. In most cases, it’s just not worth it.

Many runners have been surprised to take off their socks after a run to notice that one or more of their toenails is turning black and blue.  Many times the bruised toenails can look much worse than they are, but there is actually a simple explanation for this condition.

If a runner does not wear shoes that fit them properly then their feet are able to slide in their shoes.  This can occur if running shoes and too big because the foot will slide around in the shoe and bang up against the front edge.  This can also occur if shoes are too small because the toes begin to jam up against the front of the shoe.  This is why it is so important to get shoes that fit properly in order to prevent the toes front hitting the front of the shoe to hard.

If the nails are turning black and blue from the toes hitting up against the front edge while running don’t be alarmed.  The color change is from micro lesions under the nail from where tiny capillaries have broken.   If you notice this discoloration the best way to get rid of this is to stop running in the same shoes that caused this condition.

Most of the time the discoloration does not cause much discomfort, however, the nail can become infected if it is not kept clean so make sure you wash around the nail to prevent  infection from occurring.  Sometimes if there is enough bleeding under the nail pressure can build which will cause discomfort.  If the nail starts to become painful, then you will want to go to get evaluated by a podiatrist.  The pain either signifies infection or pressure build up from bleeding under the nail, both of which can be easily treated by a podiatrist.

A bruised nail does not automatically mean that you will lose the toenail.  If there is substantial bleeding beneath the nail and a podiatrist relieves that pressure quickly, then the nail can reattach to the nail bed.   Otherwise, the prolonged trauma from the pressure can cause the nail to detach and a new nail to begin forming and growing.   If that occurs, the original, damaged nail will simply fall off when the new nail has progressed.   As long as the nail comes off with no pain or bleeding, there should be no concern.

Bruised nails are a common sign of running shoes not fitting properly.  If this occurs, get new running shoes.   Your best bet is to visit a specialty running store, which has staff trained to properly assess your needs to recommend the right shoe for you and to ensure that shoe fits properly.   If you have any pain with the injured toenail, be sure to get in to visit your podiatrist.

I have written before how impressed I often am with specialty running stores. Tonight I have the opportunity to visit the Luke’s Locker location in Katy, TX, a suburb of Houston, for a reception sponsored by Asics. It was a very informative evening and I had the opportunity to visit with Sarah Balboa, the shoe manager at the store.

In speaking with Sarah, it is clear that she is passionate to stay on top of the features of every shoe she stocks in the store. She is committed to provide her clients with the best fitting and most functional shoe for that person and their particular foot type and mechanics. She takes the time to watch the customer walk without shoes so she can recommend the appropriate shoe, while taking into consideration what activity the person will do as well as if an orthotic is being worn and, if so, what type.

As a podiatrist, this is crucial for me to know. I treat serious athletes and I need to know that I am sending them to a store where the staff will take the time to devote to them to ensure they function at the highest level. As I’ve said before in a previous post: Running Stores Know Runners. I have lots to stay abreast of and, try as I might, there are so many changes in running shoes. Some companies update and change as often as three times a year!

So while it’s easier sometimes to pull a shoe off a shelf at Academy or Sports Authority, and even easier to order online, there is no substitute for going to a store like Luke’s Locker where the staff is well trained and their mission is to provide you with the equipment you need to keep you running at peak performance.

This just in…

Yao Ming has decided that the best way for him to repair his broken navicular bone in his left foot is to have surgery. The plan is to use a bone graft to fix the fracture and surgically lower his arch to reduce the stress on his foot. This will keep him out for the entirety of next season with the Houston Rockets.

This is probably, in truth, the best option for Yao. Most elite athletes are treated with surgery because it provides the most stable, quickest, an most complete repair. Yao’s fracture is different because the navicular manages a large amount of the transfer of weight from the ankle to the foot. It is an irregular bone with irregular joints so it’s repair can be unpredictable.

Based on his treatment thus far, it seems that Yao is doing his best to heal completely and, hopefully, make it back to the basketball court. I hope he will end up in a good pair of biomechanically sound orthotics afterward to best balance his feet to prevent future injury. I wish him a complete and speedy recovery.

As parents, we always want the best for our children. Did you know that most of our kids are wearing shoes that are too small? Don’t feel too bad, it happens to us all (yes, even your friendly neighborhood Houston podiatrist).

We are conditioned to our own adult feet, which are no longer growing. We wear our shoes until they die, and often well past their demise. We buy shoes out of desire, but not necessity. Kids are different.

The feet of children are rapidly growing and developing and need room to do so. But don’t give them too much room. The old days of buying shoes with “room to grow” were just our parents trying to stretch the usage of the shoes. Don’t do that! Kids need shoes that fit them properly, just like you do.

What do you look for when you are buying shoes for children? First of all – keep shoes off of your infant! Babies who are not yet walking should be barefoot or wearing socks or soft booties…nothing more. Oh, and I don’t care if they are so cute or match the outfit. Keep them off! Babies need to explore their feet for proper development and feel what it is like to stand and balance barefoot. They need that natural feedback, so let them have it.

I’ll relent a bit once the kid starts walking. The shoe, however, needs to be flexible. If you push up under the toe area while holding the shoe, the shoe should flex upwards with minimal resistance. Toddlers’ feet also do not need any arch support, so don’t look for shoes that have it.

This changes between ages 3 and 4 when you may notice some in-toeing, out-toeing, toe walking, or excessive stumbling. Children this age don’t have the ability to compensate for biomechanical forces and issues like adults do. Their pediatrician may tell you that the child will grow out of it. Even so, what most commonly happens is that kids just develop the ability to compensate for those biomechanical forces and the mechanics lead to problems down the road. Identifying issues early and putting a child into a custom foot support, called an orthotic, when needed will allow the kid to develop around a more mechanically correct position. Because of this, the correction that an orthotic device provides to a child may become permanent.

Also at this age, kids start wearing shoes that are more familiar in appearance you your adult shoes. Many athletic shoe companies will make sizes for children. You should also buy a shoe according to the activity, just like you do for adults. For instance a running shoe for kids who enjoy running (not playing, I’m talking about running). The rule of thumb is to have about a half-inch between the longest toe and the end of the shoe.

Your child’s feet are crucial to their happiness. Kids are built to go nonstop – bundles of energy to run, jump, play, and climb. If you see your kid sitting out during a game, or refusing to walk when you are out shopping, don’t chalk it up to laziness. First check to see if the shoes are too small. If they’re not, consider taking the child to a podiatrist to see if there is anything more you can do to get your child active once again.

There are many dedicated female runners who become pregnant and are faced with the decision of taking the next 9 months off from running or continuing to run while pregnant. There are varying opinions out there about how much exercise a woman should or should not do during pregnancy. This can be confusing for a woman who is looking for a clear cut answer. The reason for the ambiguity is that there is no absolute “yes or no” answer to if a women should continue to run during pregnancy. The answer depends on the health, level of running a women usually does, and difficulty of pregnancy of the women.

One thing that most experts on this subject agree on is that women should stay active during their pregnancy as long as they do not overexert themselves. If you are a long distance runner, then you are going to need to tone down your training schedule because any stress or strain you put on yourself will also be put on your child. It is also important to remember to never let yourself become overheated because when you overheat so does you baby. If you live in a hot climate, such as Houston, then you are going to have to consider moving indoors for your runs. Runners do love, and even depend on, their routine. Pregnancy, however, requires some of your routines to change.

There are also many side effects of pregnancy that may limit a woman from running certain speeds, distances, or even running at all. During the first trimester, women commonly feel morning nausea which may prevent those who are used to running in the morning from continuing their morning running routine. During the second and third trimesters, the feet also can become swollen which can prevent women from running. Women should not attempt to run away the swelling in their feet because this may overwork the heart as it attempts to pump the excess fluid against gravity while also keeping up with the stress of running.

Running is a very important part of many women’s lives. It is important for pregnant women to know the facts about running while pregnant in order to keep their body and their baby’s body safe. It is also important to communicate with your doctor and podiatrist about running during pregnancy so that they are well informed of your physical activity during pregnancy so they can best inform you of any side effects you may experience.

Shin splints is one of the most common injuries that connects runners all over the world. Also known as medial tibial stress syndrome this aliment can be very painful and irritating to deal with as a runner. Here are some facts you need to know about shin splints to educate yourself about what they are and how you can help to alleviate them.

What are Shin Splints?
Shin splints are an irritation on the front of your lower leg that manifests as pain, swelling and soreness. The pain is caused by muscles pulling on the shin bone called the tibia. This happens due to overworking and overloading the muscles and bone (tibia) load of the lower extremity.

What causes Shin Splints?
Shin splints are caused by physical activities such as running. Certain motions can make an athlete more prone to getting shin splints. These motions are: running on uneven surfaces, not wearing the proper running shoes, running on hilly surfaces, and frequently stopping and starting during activity. The contour of your feet can also affect the probability of acquiring shin splints. People with flat feet have a much greater chance of getting shin splints because it causes the muscles on the shin to pull harder on it.

How do I heal Shin Splints?
The best way to heal shin splints is to rest from the activity that caused them to appear. This treatment is not always feasible (or desirable) so there are some other things that can be done to lessen there severity. These include icing the area for 15 minutes 5 times a day, getting new running shoes that properly support your feet, and taking over the counter medication that also has a anti-inflammatory agent to reduce swelling. Providing support with an appropriate insole or custom orthotic can also provide the biomechanical support and control needed to reduce the pull of the muscles and prevent the pain from returning.

Shin splints are a very common obstacle that many athletes have to overcome. Just because you have shin splints does not mean you need to stop a sport or activity that you love. If the information above does not help to alleviate the pain then you may want to consult your podiatrist for further treatment.

A sprained ankle is one of the most common injuries of the lower extremity, with approximately 8 million people spraining an ankle each year. Also known as twisting or turning the ankle, it can happen as a result of playing sports, running on uneven surfaces, or just walking along. The foot turns in on the leg, which can lead to a stumble, trip, or fall.

There are some interesting statistics that show that people who sprain their ankles will injure them again in the same way up to 80% of the time. Why does one injury put someone at such major risk of repeating the injury?

Studies have shown that many people who have a tendency of spraining their ankle have poor balance. This can be demonstrated by standing upright (have something close to hold on to) and standing on one foot. The more wobbly you feel, the better the chances are that you will sprain an ankle, often repeatedly. This can be remedied by some simple exercises to increase the strength of the muscles. Again, stand on one leg and try not to wobble. Hold that position for one minute and repeat on the other leg.

Why does balance training help someone from repeatedly turning their ankle? As an ankle is sprained, the supporting ligaments are injured. They do heal, but in a stretched position. There are receptors in the ligament that are damaged also, which provides feedback to the brain about the position of the joint. This feedback becomes faulty with persistent injury and the balance suffers as a result.

While ankle supports and braces are helpful to provide stability to the weakened joint, pursuing a regimen of exercise to increase the balance is particularly helpful. This can be as simple as standing on one foot and balancing when you are brushing your teeth every day. If you want a greater challenge and result, there are a number of balance boards and mats available.

I had the opportunity to attend my friends’ children’s high school graduation this week. The school is a small private school in Houston, TX with a graduating class of 17. It was an inspiring ceremony and I wish my best to all graduates this commencement season.

Of the female graduates, almost all of them were wearing the highest heels I have seen. It hurt me to watch as they walked across the stage to receive their diploma. People ask me what i think of such shoes. My answer is “They’re great for business!” At some point these young ladies will have foot issues and I’ll be there to treat them.

The most common injury that comes from wearing high heels is a Morton’s Neuroma. This is an inflammation of the nerve that travels between the metatarsal bones and provides significant pain in the forefoot.

Treatment for a Morton’s Neuroma can include anti-inflammatory medication, cortisone injections, custom orthotics, and nerve sclerosing injections. A recent study appearing in the Journal of the American Podiatric Medical Association also showed the effectiveness of shockwave therapy (ESWT)on neuromas, previously used only on heel pain. There is also surgery to remove the painful nerve, of course as a last resort.

Wearing high heels occasionally is unlikely to provide problems. Habitual use, however, can cause significant trouble. Moms…be sure to tell your daughters…they won’t listen to us dads!

The videos just got up on the website, so I can’t call this one a sneak preview.

This video discusses the use of a custom orthotic to control the biomechanics of the lower extremity. When we deal with the multitude of foot and ankle injuries, mechanics plays some role. From heel pain, to neuromas, to chronic ankle sprains, controlling the mechanics with an orthotic is the best long-term investment to keep those injuries from reoccurring. To learn more about the use of orthotics, visit our website.

[youtube]http://www.youtube.com/watch?v=dfv8jqtDxnU[/youtube]

I’d like to introduce everyone to my 8 year old son Ariel. Ariel has been wearing orthotics since he was four and is incredibly diligent about making sure he transfers them from shoe to shoe. Today, however, he forgot and found his feet to be aching. Of course, when we were walking home he said…Dad, should you blog about me forgetting to wear my orthotics? I thought we’d do one better and make a short video withfoot him telling everyone in his own words.

[youtube]http://www.youtube.com/watch?v=UCFV8tlRNTg[/youtube]

A blister is a small pocket of fluid contained in the outer layers of the skin. A blister is caused by irritation of the skin from excessive rubbing, burning, freezing, chemicals toxic to the skin, or infection. It can contain blood, serum, or pus within it. If you are athlete you are probably very familiar with blisters. They commonly appear at places that get repeated irritation. The location of blisters depends on the activity you are doing. If you are a golfer, weight lifter or baseball player the most common places to get blisters are on your hands, a skier or snowboarder on your shins or lower legs, and a runner or walker on your feet.

Once people realize that they have a blister the most common issue is not knowing what to do. Do I pop the blister or do I leave it alone? Some people say don’t pop a blister because it can get infected and it will just get worse. Other people say pop a blister as soon as it forms otherwise it will keep getting bigger. I can see why there is confusion as to pop or not pop a blister because there is a little truth in both of these statements. As far as what a trained health care professional will tell you, such as a podiatrist, it is better to pop the blister, but doing it in a clean and sterile manner. If you need to drain a blister because you are going to continue the type of activity that caused the blister, follow the following guidelines to do it safely

1) Gather the following supplies: washcloth, soap, sterile needle, gauze, antibacterial ointment, Band-Aid

2) Clean the area over and around the blister with a washcloth, soap and water.

3) Carefully hold the sterile needle in your dominant hand and gauze on your non-dominant hand. Puncture the blister on the side then immediately apply pressure over the blister with a gauze pad until you have drained all the liquid from the blister. Be sure to leave the “roof “ of the blister intact.

4) Properly dispose of the needle and gauze pad.

5) Apply a thin layer of topical antibacterial ointment to the area where the blister was located.

6) Put a Band-Aid over the area to help prevent infection.

7) Figure out what caused the blister to form and find a way to stop the irritation from continuing. This will prevent additional blisters from forming.

Blisters are common occurrences, especially in active people. Most blisters are easy to treat but if you feel uncomfortable treating it on your own, or think that your blister may be infected, contact your local podiatrist for a professional opinion.

I just got my newest video for my website back from the editor and thought you’d like a sneak preview. It’ll be on my website shortly, but I got it up on YouTube so you can take a look now.

[youtube]http://www.youtube.com/watch?v=GDEFXmIN5Og[/youtube]

We all have those things we come across and say “I should have thought of that!” A few years ago, when in the exhibit hall for the Houston Livestock Show and Rodeo, I had such a moment.

Among all the tractors, ranch supplies, hot sauces, and other vendors you’d expect, I came across a guy selling insoles. The product was much more supportive than one you would find in a pharmacy but a far cry from a custom orthotic. Plus, knowing his audience, he had some that would fit into western boots.

As with most conventions and exhibit halls, there is a ton of walking on hard concrete floors. Surely the number of attendees with foot pain increases as the day wears on, and there the vendor is to provide instant relief at a premium price…Genius!

As you head off to such a conference, go prepared with either some good insoles, such as Powerstep or Superfeet. If you are already experiencing foot pain, see your podiatrist for relief before you go and do all of that walking.