Keep Your Feet Feeling Young

There was a comment on my blog asking me about my profession and what I do. I’m going to open that up to what podiatrists do in general and how caring for an often neglected body part saves lives. I’m further spurred on to write this by the irresponsible remarks by Rep. John Shadegg (R-AZ) made on Neil Cavuto’s Fox News Channel Program. He lumped Podiatry in with aromatherapy and acupuncture, calling them an “esoteric demand that most people don’t have or don’t need.” I won’t place judgements on the other slighted professions, but I do have strong feelings about Podiatry.

Most people are fortunate to be born with two feet. Unlike shoes, which wear out after a period of time, these feet must last a lifetime. The average person takes thousands of steps each day and walk the circumference of the Earth twice over their lifetime. Your car needs routine maintenance every few thousand miles. Shouldn’t the same be true of your feet.

When something goes wrong with your feet, who is there to fix them? Family practice physicians and internists often prescribe medication. Many orthopedists look to correct the problem with surgery. Podiatrists look for the root of the problem…the underlying biomechanical deficiency…and treat the cause of the issue, not just the effect.

I can talk all day about what we do…people coming into our offices in miserable pain and leaving feeling relieved that there is a solution. The Podiatric profession is responsible for technological improvements in surgical technique, biomechanical correction, such as orthotics and bracing, that have benefited many. Talk to someone who had foot surgery 25 years ago and another who had one recently and you’ll find two very different experiences.

The greatest contribution, in my opinion, is the contribution of Podiatry to the care of diabetics. We just can’t quantify how many feet and legs have been saved by the direct and indirect influence of a podiatrist. While many are quick to amputate a toe, foot, or leg that is deemed unsaveable, the podiatrist will do everything possible to save the limb. New wound dressings are constantly coming to market, one better than the next, which podiatrists have helped develop. New wound healing therapies are developed with the research by podiatrists. New products are developed to help keep the diabetic foot healthy so these wound dressings and therapies are never needed.

These developments do not just benefit the podiatric profession. I’m proud to have colleagues like Dr. David Armstrong, Dr. Larry Harkless, Dr. Jon Steinberg, and so many others who travel around the country and world educating physicians of all types about the latest techniques and research to save diabetic limbs. Not to mention the thousands who are walking on two feet due to their research, teaching, and development.

So, Congressman, I’m happy you have two healthy feet. I’m glad you’ve never awoken with a sharp, stabbing pain in your heel. I’m thrilled that you’ve never known the fear of losing a limb or the elation of knowing that you’ve “only” needed two toes amputated, but still have a foot to walk on. But just know, that when you do need a podiatrist, you’ll be pleased that this “esoteric demand that most people don’t have or don’t need” is here to help you.

Sneaking right under the wire…before the month is over…our August newsletter is available online.   If you subscribe, you should have it in your inbox shortly.  If not, visit http://su.pr/1yG3ZU to download it and previous issues.  You can subscribe by emailing news@tanglewoodfootspecialists.com

This month, we highlight a new treatment for damaged and fungal toenails called KERYflex.  We are among the first in Houston to offer this innovative treatment for nail restoration.  The result is a healthy looking nail that can be shaped and polished  .  I’ll post more about it soon!

President Barack Obama has received some significant criticism in the last couple of weeks for some comments he made related to his health care plan. He suggested that doctors stand to make $30,000 for an amputation. This number is not even close, as it consists of the entire hospital stay. According to an article by the Associated Press, the surgeon’s fee is a small fraction…often less than $1,000. But President Obama is correct in assuming that we need a better focus on preventative diabetic foot care.

By far, the most cost effective way to treat diabetic foot complications is to prevent them entirely. Believe it or not, once a complication occurs, such as a foot ulcer, the costs increase exponentially. Once an ulcer forms, it can cost up to $8,000 to treat…$17,000 if it becomes infected! Spending a significantly lower cost to prevent an ulcer from occurring is most certainly ideal!

How can we prevent a diabetic foot complications from forming?  First, every person with diabetes should form an association with a podiatrist for routine foot checkups.  These checks will help to monitor circulation down the legs and into the foot, nerve sensation, and assess risk factors for formation of ulcers and wounds.

Since wounds primarily form in areas of pressure, managing that pressure is incredibly important.  Even Medicare has recognized the value in shoes with insoles that will prevent those pressures from causing problems and cover a pair of shoes and several pair of insoles each year.  The insoles are made of a soft material that redistributes the weight and alleviates areas of pressure.  We, as do many podiatrists, carry lines of diabetic footwear.  Those who do not will refer you somewhere that does.

You can’t rely on the podiatrist alone to keep you healthy.  I always recommend that my patients with diabetes perform a quick foot check each evening before bedtime.  What they look for is anything that wasn’t there the day before:  redness, bleeding, pus, etc.  For those who cannot pick their feet up to see the bottom, a wonderful mirrored scale is available called the CheckPoint scale.  Its mirrored surface allows you to easily view the bottom of the foot for daily inspection.  This way if you notice a problem, you will know it is no more than 24 hours old.

Experts say that diabetics need the right care to keep their limbs.  I couldn’t agree more with that statement.  There will always be factors that put diabetics at greater risk of developing foot problems, being vigilant in controlling your blood sugar while watching for the smallest sign of a problem, will tip the scale in your favor.

A bunion is a common foot deformity that presents as a bump on the inside of your great toe joint. Especially in warmer climates, such as Houston, where people tend to wear open shoes year-round, people with bunions become concerned about the appearance. When they put on a closed shoe, the pressure on the bunion can cause a sharp, stabbing pain.

Most people think a bunion is a growth of bone on the side of the foot, but in most cases this is incorrect. A bunion is formed by the rotation of the first metatarsal bone which is caused by mechanical forces. This bone shifts over and causes the great toe to move over towards the second toe. This can even cause the great toe to push up the second digit, forming a hammertoe.

The worse and more painful the bunion becomes can require surgery. This often involves the bone being surgically fractured, repositioned, and repaired using a tiny screw. Needless to say, the recovery is involved, since the bone must heal. The good news is that bunions do not form overnight and steps can be taken to prevent their progression once they are noticed.

A bunion typically does not form because of bad or tight shoes, although they can contribute to them. The potential for developing a bunion is hereditary. If a parent or grandparent has a bunion, it puts you at greater risk for developing one yourself. This is because you inherit the mechanics that causes a bunion to form. So when you notice a bump on the side of your foot beginning to form, see a big callus on the side of your great toe, or start seeing your great toe drifting towards your second toe, that is the time to take action.

An orthotic is a custom insole or shoe insert that works to correct the mechanics that causes a bunion to form. By addressing the forces that cause a bunion deformity, an orthotic helps to neutralize them and redistribute them across the foot. The orthotic essentially fools your foot into functioning more efficiently and stops the bunion deformity from progressing.

To have an orthotic made properly, a podiatrist should perform a biomechanical examination to learn what forces are coming into your foot from the lower back, hips, knee, and ankle. A gait analysis is often performed to see how the foot functions when walking. Ultimately a mold of the foot is taken with plaster or fiberglass while holding the foot in a stable, neutral position. It is from this mold that the orthotic is fabricated.

The orthotic will do much more than prevent bunions from progressing! By making your feet, which are your base of support, more stable, it takes the pressure off of the knees, hips and back. In fact, many people who suffer with knee and back pain find that an orthotic removes the pressure and relieves the pain.

Bunions will reach a point where orthotics will no longer help and surgery may be your only option. The sooner you visit with a podiatrist, the more likely you will be to prevent a bunion from becoming worse and, hopefully, will be able to avoid surgery altogether.

Have you ever heard the saying “You are what you eat”?? There is some truth to this statement especially when it comes to runners and other athletes. What you eat can strongly affect the outcome of your daily runs. Not eating enough can leave you lacking energy and feeling fatigued early in the run. There are a couple of things to keep in mind about how much and what to eat before a run.

If you run in the morning, make sure you eat something before your run because the food you digested from the night before is mostly gone by the morning and won’t provide with you with the energy you need to sustain you through your workout. If you are not a big breakfast person then consider eating something that is easily digestible and over 200 calories about 30 minutes to an hour before your morning run.

Men and women runners both need to make sure they are getting enough calcium in their diets, but this is especially true for women. When you run you put stress on your bones which cause them to need to remodel. If there is not enough calcium in your body then stress fractures may form. Some foods that are great options to make sure you get an adequate amount of calcium in your diet are dairy products like milk, yogurt, and cheeses. Although taking a calcium supplement may be a good option for some, the best way to get calcium is from food.  This is because you also require Vitamin D to absorb calcium into your body. Calcium and vitamin D tend to be found in many of the same dairy products.

The types of food you eat also will affect your running performance. In our society, there is a negative stigma against carbohydrates. For runners, however, carbohydrates should be your best friend. When you exercise your body creates fuel by breaking down the food that you eat. Carbohydrates are the most readily accessible food group to be broken down to use as fuel. After carbohydrates, the next most important food group to make sure you get enough of if you are a runner is protein. Running puts a lot of strain on your muscles and causes micro tearing in the muscles to stimulate muscle growth. Protein is needed to repair the micro damage to muscles in order to allow muscles to grow.

Of course, it is important to stay hydrated.  Especially in warm climates, such as Houston, the body cannot function properly if you do not consume enough water.  Be sure to drink throughout the day and during your run.  If your urine is not pale in color, you are not drinking enough fluids.

All runners need to pay special attention to what they eat. Having a healthy and balanced diet that is tailored to running can really help boost the performance and energy of a runner.

Former, and possibly future, Olympian Paula Radcliffe won the New York Half Marathon on Sunday. This is her first race since the New York Marathon in November and also her first after recovering from bunion surgery. She will assess her progress in the next few days to see if she will pursue the World Championships Marathon in Berlin.

This is great news. One of the most common concerns my patients have when considering bunion surgery is whether or not they will be able to return to running, triathlons, or any other athletic activities. I’m pleased that I’ll be able to point to Ms. Radcliffe as someone who recovered from bunion surgery and rehabilitated several other injuries and has been able to return to a world-class level.

One treatment that is likely helping her at this point is a custom orthotic. An orthotic is a custom insole that supports and stabilizes the lower extremity. It balances the mechanics to remove the forces that deform the foot and cause a bunion. An orthotic allows the foot to work at it’s most efficient and prevents a recurrence of the bunion. I hope that Paula’s doctors have her in a custom orthotic so she can continue to pursue her goals.

I had the opportunity to be invited to Foot Solutions here in Houston to spend the afternoon in residence for a “Doctor’s Day.” I had the opportunity to meet some of their clients who had questions about the best treatment for their feet. Some of my patients came too, to get my opinion on what was the best shoes for them.

Foot Solutions is a national franchise that specializes in quality shoes that supports the foot properly to allow for optimal function. Their shoes range from fashion, to sandals, to therapeutic, to more specialized shoes, such as MBT and Chung Shi. Much of what they provide is complimentary to what I strive to do for my patients at the office. Some of their products diverge from my philosophy, such as their idea of what constitutes a proper custom orthotic.

One of the most exciting new lines of shoes that I was introduced to is a line of handcrafted, custom-ordered, shoes for men from Tauer & Johnson. These shoes offer a large number of different styles and the customer’s choice of leather and sole. The quality is truly extraordinary and very comfortable. Recently, shoe companies have been providing men with fewer choices and the quality is not what it used to be. This now offers men a choice of shoe to suit them and offers a perfect fit.

I will love to return to spend time at the store. It is important for podiatrists to have a shoe store that knows how to properly fit and recommend a shoe. It’s equally important for the store to have a podiatrist to refer to when a shoe alone will not solve the issue.

It’s a familiar sign, especially on fast food restaurant doors: “No Shirt, No Shoes, No Service (No Kidding).” Well in a Burger King in Sunset Hills, MO they certainly weren’t kidding! A mother was threatened with the police being called because she did had no shoes on her 6 month old baby. At six months old, of course, the baby is certainly not walking and likely not crawling. Even if she was, I suspect that her mom wouldn’t have her crawling around the dirty floors of the restaurant.

I hope that everyone reading this already realizes how ridiculous this is! The reason shoes are required in restaurants is not because of a health code, but rather to limit the establishment’s liability in case something is stepped on. Certainly shoes are dirtier than bare feet! And flip flops are permissible, so the exposure of a foot can’t be the issue.

The baby’s mom is absolutely correct. She stated in the St. Louis Fox Station’s report, that the baby didn’t even own shoes. At six month’s old, I should hope not! Baby’s at that age developmentally need access to their feet. Plus, as the baby is learning to stand, cruise, and walk, she will need the sensitivity of the soles of her feet to provide feedback to learn how to balance. At most, the baby can wear socks or very soft booties.

Once her baby starts to walk unassisted, shoes can then be used. When they are, however, they must still have a very flexible sole to allow for proper function of the foot. So, to answer a very common question, there is no age at which a child should start wearing shoes. It all depends on the baby, when she starts to walk, and the developmental milestones. Even if they are the cutest shoes, and they match the outfit perfectly, keep them off the baby. She’ll have plenty of time for shoes once she’s walking.

I have been a fan of the Houston Texans since the team started. I’ve been at almost every home game and love watching them. I don’t get nearly as frustrated as some others by past seasons. You see, I grew up a fan of the New York Jets. Yes, the Jets are the team that passed up Dan Marino for Kenny O’Brien. If that’s not frustrating, I don’t know what is.

Being a Jets fan all these years, I’ve learned a few things. One of those things is never predict that this year will be THE year…at least not publicly. I wish my Texans learned the same thing. All reports from the team, unofficially, and certainly the press have been hyping this team as our first playoff team. Even before the first snap of preseason!

Well, Tuesday’s workout saw two injuries of starters that can have a significant impact on the team. Center Chris Myers suffered a high ankle sprain on a play that Coach Gary Kubiak called sloppy. This will keep him out indefinitely, but he hopefully can return during the season. It all depends on the extent of he injury and how quickly he is able to rehabilitate. Starting Cornerback Jacques Reeves fractured his fibula in a collision with Andre Davis during another play that also sounds pretty sloppy. He’ll be out six to eight weeks.

Fortunately both players will not need surgery, but it is a major hit to the Texans expectations for their season. No one wants to see them healthy more than I do…I’m ready for a winning season and I’ll be there watching and cheering them on.

There are many people out there who cringe at the thought of having to run and, let’s face it, they do so for a good reason, running is a hard sport. I’ve seen track and cross-country teams in Houston wearing t-shirts that say “Our sport is your sports punishment.” Although many people train their bodies to be able to endure the physical requirements it takes to run, it can be quite intimidating to a new runner.

One of the most popular reasons that people start to run is to lose weight. Running is one of the best physical activities you can do to shed a couple of extra pounds in a short period of time. If you are using running as a tool to lose weight, here are some pointers to help you reach your weight lose goal in the most healthy and satisfying way:

1) You are what you eat
One of the most common misconceptions about weight loss is that you can simply lose weight by working out and not changing your diet. This is not true. The best way to lose weight is a combination of diet and exercise.

2) Don’t start off too fast
When people start their weight loss workout routines they tend to be excited and driven in the beginning and are at risk for doing too much too fast. This causes people to tire out, give up, or get injured. Try and write out a workout routine that you can realistically follow without pushing yourself to exhaustion.

3) Make sure you have the right equipment for your workout
When starting to run for the first time it is important to get a new pair of shoes that will give your feet the support they need. Also make sure you get some quality socks that will be able to absorb the sweat from your new workout schedule. There are many other gadgets runners use such as camelbacks, utility belts, absorbent clothing, and sweat bands. The best way to figure out what you will need for your runs is to visit a specialty running store. The employees are often runners themselves and can offer good advice.

Running is a great way to help shed a couple of extra pounds. In order for running to be affective a person must also change their diet, make a realistic workout routine, and have the right equipment that will help them avoid injury.

I usually only write about local Houston sports stories, but I found this one particularly upsetting and tragic. A star defensive end from USC and first round draft pick, Kenechi Udeze had to retire from the Minnesota Vikings due to unrelenting foot pain caused by peripheral neuropathy from chemotherapy. Udeze was diagnosed with acute lymphoblastic leukemia in 2008 and missed the entire season, although determined to return to football.

One side effect to some forms of chemotherapy is peripheral neuropathy. This can result in a numbness or persistent pain in the feet or hands. Chemotherapy, although effective in eliminating rogue cancer cells, is also detrimental to many healthy cells as well. Several years ago, when musician Melissa Etheridge was fighting breast cancer, she was noticing numbness in her fingertips. As she was unwilling to sacrifice her ability to play the guitar she sought alternate ways to treat the cancer. Thankfully she was successful in beating the cancer.

Peripheral neuropathy is most commonly associated with diabetes, however it is a common effect of a number of illnesses, medications, and treatments. Unfortunately it is caused by a number of different factors, so one treatment will not be successful in all cases. In fact, there are many cases of peripheral neuropathy that cannot be treated effectively at all.

To date, the only treatment that I have found that is successful in limiting peripheral neuropathy pain caused by chemotherapy is Neuremedy. It is a medical food with a bioactive form of vitamin B1 that helps to nourish the nerves. It is available in the offices of many podiatrists as well as online. Neuremedy does not interact with any other medication and has no side effects.

I wish Kenechi Udeze the best in his continued fight against cancer and hope that he ultimately finds a way to limit his pain and return to the football field where he belongs.

An orthotic is a vital piece of equipment for those who wear them. They provide support and comfort when running and playing sports. They also help people get through their day outside of sports and exercise.

One of the biggest misconceptions is that orthotics should only be used for exercise and athletics. This couldn’t be further from the truth! The function of an orthotic is to provide support to the foot to allow the lower extremity to work more efficiently. For that reason, wearing them only for exercise puts you at a disadvantage.

Muscles have memory and enjoy consistency. If you only wear an orthotic for exercise, that only accounts for 10% of your day…maybe even less! Think about it this way: Let’s say you could only use your car 10% of the time, but you had to walk the rest. You’d be pretty tired, right? So think about your feet and legs only being allowed to work at peak performance for that same short time.

To make it easier to wear an orthotic throughout the day, they can be made to fit an athletic shoe, dress shoe, women’s high heels, western boots…anything where the heel is closed in. For those who enjoy a more open shoe, some sandals, such as Bite, can accommodate an orthotic. Other sandals, such as Birkenstock and Naot, can be custom made with an orthotic built in.

There are many factors that determine the useful lifetime of an orthotic. The first is the material the orthotic is made from. In my Houston podiatry practice, the orthoses we fabricate are made a firm plastic material. Because this material is durable and wears very little, the orthotic generally lasts about four to five years. Softer materials, such as cork, leather, and foams, will deform with time and has a much shorter lifespan of one to three years, depending on how it is constructed.

Another factor is your activity level. A marathon runner is harder on their feet than a “weekend warrior.” The foot is dynamic and must change with every step and manage forces. So the foot changes with time and those who are more active notice quicker and more dramatic change. This will require a change in orthotics sooner, simply because of a change in mechanics.

Finally, there are other issues that will cause an orthotic to be replaced. A major joint replacement, such as a knee or hip, will alter the mechanics of the lower extremity significantly enough to warrant a new orthotic. Generally, I wait six months for the joint to “settle in” until I move forward with evaluating for a new orthotic. Many women see changes in their feet and mechanics during and after their first pregnancy. This will occasionally require a reevaluation for new orthotics.

And let’s not forget about our household pets. If your puppy chews up your orthotic – we’ll need to replace them then too!