Keep Your Feet Feeling Young

Peripheral Neuropathy is becoming a more-frequently diagnosed condition. In fact, in Houston, TX podiatry practice, I see neuropathy as becoming an overused diagnosis…one that is used when the doctor can’t figure out what is causing a numbness or pain.

Peripheral neuropathy is a common effect of diabetes. The blood sugar can cause the nerves to swell, affecting the nerve fibers within. Also, because diabetics suffer from problems with the microvascular circulation, there is a reduced amount of blood flow to the nerves. Neuropathy is not excusive to diabetes, however. Chemotherapy can cause neuropathy, which often continues after treatment stops. Alcoholism can also cause neuropathy. Unfortunately, there are also many forms of neuropathy that are not able to be attributed to a particular disease.

There are a number of pharmaceuticals that have been used for years to help alleviate the pain and numbness from neuropathy. Neurontin, Lyrica, and Cymbalta are a few of the better known and used medications. These are antidepressant medications that have an effect to moderate nerve pain. Unfortunately, because the medication often provides side effects, people are confronted with the decision of taking the medication and having relief or feeling exhausted and cloudy all day.

Medical foods are specially formulated supplements intended for the dietary management of a disease that has distinctive nutritional needs that cannot be met by normal diet alone. Two medical foods commonly used in podiatry are Neuremedy and Metanx.

Neuremedy is a fat soluble form of Thiamine (Vitamin B1). Thiamine deficiency is well-documented in those who can suffer from neuropathy, such as diabetics and the elderly. Resolving a thiamine deficiency can result in resolving the symptoms of peripheral neuropathy. Neuremedy delivers a bioactive form of thiamine that is readily absorbed and used by the body. I recommend that people try a two month course of Neuremedy to assess how effective it works. Neuremedy is dispensed from the office by many podiatrists and can also be purchased online.

Metanx is another medical food that is indicated for the distinct nutritional requirements of diabetic patients with peripheral neuropathy. Metanx regulates homocysteine and helps the blood vessels to produce a natural vasodilator called nitric oxide. As a result, blood flow increases in the vessels that carry important nutrients and oxygen to the nerves. This has been found to alleviate the symptoms associated with peripheral neuropathy. Metanx is available at all pharmacies by prescription.

When it comes to alleviating neuropathy symptoms, don’t stop at pharmaceuticals that can provide adverse reactions. Ask your podiatrist if a medical food can help to alleviate your pain and numbness.

Yes, that title says what you think it says. I must begin with a warning…this post is not for the faint of heart or stomach! So a friend of mine on Facebook posted this and I just had to write about it. Check out the link to this article about how a man found out he had diabetes. Take your time, read it, and come on back for my comments…I’ll wait.

First of all, the comments I heard were that he had to be PRETTY drunk to not feel his dog chewing off his toe (yuck!). That may be why he passed out, but he didn’t feel it for another reason. What he didn’t know is that he is diabetic…with a blood sugar level of over 500! Blood sugar should be kept at or below 120 for a controlled diabetic. With uncontrolled diabetes comes a syndrome called Peripheral Neuropathy. Neuropathy is a syndrome where the nerves become numb as the small vessels in the foot are affected by the high blood sugar levels. The foot becomes so numb that he wouldn’t feel a splinter, a bump, an infection, or even a dog chewing it off.

So how did chewing his toe off save his life? According to the article, the infection was in the bone. This type of infection could have spread up his leg putting his entire limb in danger. In fact, it could have put him into sepsis which could kill him. By the dog performing the amputation, he removed the infected section and prevented this from happening.

The take home message is this…if you notice a problem in your feet, whether you are diabetic or not, do not wait until your dog operates on you! Although much less newsworthy, you should visit a podiatrist to make sure that you are not putting your life or your limb in jeopardy.

For those who want more on the story, watch the video below (again…it’s pretty gross!)

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Today Oprah Winfrey is dedicating the entire episode to what she is calling the “silent killer”…diabetes. The episode will feature Dr. Mehmet Oz, Dr. Ian Smith, trainer Bob Greene, and chef Art Smith. Diabetes is a topic that can never have too much discussion.

23 million people in the United States have diabetes, almost 8% of the population. There are 1.6 million new cases of diabetes every year. Why is a podiatrist so concerned about this? Not only can diabetes affect your eyes, heart and kidneys, but your feet are at great risk.

60-70% of people with diabetes end up with some form of nerve damage in their feet known as peripheral neuropathy. This causes a numb or painful feeling in the feet and legs and can affect one’s life dramatically. Think about the feeling you get when you hit your “funny bone.” Now think of that in both feet, constantly, 24-7…not too pleasant. Fortunately, we’ve had some success in treating diabetic peripheral neuropathy. In my office, I use a medical food called Neuremedy which is a fat-soluble form of thiamine, often deficient in diabetics. Another treatment is Microvas therapy. This non-invasive treatment helps to stimulate the small blood vessels to bring more oxygen and nutrients to the nerves, effectively reversing peripheral neuropathy.

Diabetes is responsible for 60% of non-traumatic lower extremity amputations. It’s been well documented that once someone has an amputation of part of the foot, there’s a very high chance that the other foot will be amputated within five years. Diabetics lack the ability to heal as well as those without. A simple crack in the skin or ingrown toenail can become a limb threatening injury. Diabetics should not wait to seek attention for anything on their feet, whether a callus or a diabetic wound or ulcer. In our office, a patient who calls with a diabetic concern is treated as a medical emergency.

All diabetics should establish a good relationship with their internist and/or endocrinologist to manage their overall diabetic control. It is also vital for a good relationship with a podiatrist and opthalmologist before there is a problem. An ounce of prevention is truly worth a pound of cure.

I am on an airplane returning to Houston, TX from the Toronto area after a weekend of presenting at the Canadian Federation of Podiatric Medicine practice management conference held in conjunction with the American Academy of Podiatric Practice Management. It was a bit crazy since we were holding the conference only a short 15 miles from downtown Toronto, where the G20 summit was being held and where rioters were tearing up the city.

It was the first full conference of this type brought to the Federation. As presenters, we get energized with the excitement when attendees hear our material for the first time. In fact, sitting in on many of the talks given by my colleagues, I always pick up new ideas even though I have heard this material many times. We all look forward to returning next year.

The most striking thing I learned over the course of the weekend was that I was speaking to a room full of highly educated foot specialists. Of course I was…I’m a podiatrist myself! But these foot specialists are not considered to be podiatrists in the province of Ontario. They are chiropodists.

In the United States, chiropody was the precursor to podiatry with the designation having changed in the late 60′s. Chiropody is also the term used by the British, but the scope there is now similar to what a podiatrist does in the US. Of course in the US, podiatrists manage all ailments of the foot and ankle. We manage and care for our patients’ conditions with both conservative therapy, such as custom orthotics and bracing, and also surgical means.

In Canada, podiatry does exist in all provinces. In Ontario, however, podiatrists are restricted from performing bone surgery. The other strange thing is that no new podiatrists could be licensed to practice in Ontario since 1991. Even a podiatrist trained in the states are now licensed as a chiropodist. This group is now being discriminated against by the podiatrists who remain, numbering less than fifty. Sound ridiculous? It is!

The potential for podiatry and chiropody to unite and become more integrated in the health fabric of the area is great. It is the short-sighted outlook of these podiatrists who can’t see that as their numbers decrease, so will their relevance. When they retire, their practices will have no value. No child can go to school and take over the family business.

Why can’t chiropody and podiatry work together? Both professions can coexist as podiatry. The two, non-surgical and surgical can complement one another in a powerful way, just as ophthalmology and optometry do in the states. The infighting and underhanded methods being used by the podiatrists in Canada are ultimately going to hurt the profession across the country.

I support chiropody and it is time to change their designation to podiatrist. It’s time to stop confusing the public and start working together to strengthen a united profession.

World Cup fever has hit across the world! Even here in Houston, TX, where soccer usually takes a back seat to most other team sports, people are talking about it. It won’t be long until we start hearing vuvuzela blasts around town.

In my Houston podiatry practice in the Galleria area, I have treated many soccer players, from kids running after the ball to collegiate and semi-pro players. There are a few common foot and ankle injuries that are most common to these athletes.

One of the most common situations I see is not an injury from playing soccer at all, but from the shoes. Soccer players notoriously wear their shoes too tight. This causes problems with their toes forming painful corns and calluses, toenails getting bruised from the added pressure, and even ingrown toenails that become painful and infected. Soccer players insist that the shoes need to be tight to allow them to feel the ball. The truth really lies in the culture of the sport and the athletes would be better served with well fitting shoes.

During game play, sprained and broken ankles are common, as they are with most turf sports. Ankle injuries occur because of the starting, stopping and pivoting motions of the foot. When a soccer player makes a sudden pivot, they stand a good chance of being off balance and rolling their ankle. This injury can be prevented by wearing an ankle brace or taping the ankle. Ankle injuries that occur should be cared for immediately. Early immobilization and therapy to restore strength and balance have been proven to allow for the most complete recovery and return to play. Of course an ankle fracture is more serious and required immediate attention.

Turf toe is another common soccer injury. Although more associated with football, it is common whenever the great toe joint can become overextended. This creates a jamming of the joint and severe chronic pain. This can keep a soccer player on the sidelines, but can be controlled. The mechanics must be addressed with a custom orthotics to redistribute the pressure on the great toe joint. A thin carbon steel insole can also support the joint and can reduce the pain significantly in a matter of days.

The World Cup will do doubt trigger an increase in youth and adult involvement in soccer.  An understanding of the possible injuries, prevention, and early detection and treatment will lead to a much more thorough enjoyment of the sport.

I continue to be intrigued by crazy shoes.  There are times I’ll see a woman in a shoe on TV, in a magazine, or even on the street, think they’re crazy, only to have other women tell me they’re “cute.”  Well these heels take the cake, and no one can argue that they are WAY over the top. We certainly won’t be seeing women in these heels walking around the Galleria here in Houston, TX. Even IF they resemble an armadillo.

These 12 inch platform heels designed by Alexander McQueen are so over the top that models refused to wear them, citing them too dangerous to walk in.  I can’t blame them.  First of all, the foot is just not shaped that way.  Second, all I can think about is that this is what a female Herman Munster should be wearing!

But then again, Lady Gaga wore these heels in her video for Bad Romance and seemed to move around fairly well in them, possibly with some trick photography.  Singer Kelis did wear them on the red carpet.  Of course the originals are far too pricey for the average woman, but LF and Jeffrey Campbell have made a similar version for the masses.

What do you think?  Would you give them a try?  Would you let your daughter wear them?  Let me know!

Ingrown toenails are one of the most common conditions that I see in my Houston, TX podiatry office near the Galleria area. I’ll be so bold as to say that all podiatrists see their fair share of them. It is also the most common foot condition that I see in kids. They occur when the toenail is too wide for the nail bed. This alone isn’t usually painful. That happens when the owners of these feet take it upon themselves to dig out the nail that they feel is just in reach. Welcome to the medical specialty of “bathroom surgery.”

Ah, yes…bathroom surgery. No big deal, these operators insist, I’ll just dig out the corner. What? No, my toe always bleed when I trim them. Isn’t that normal. Huh? Doesn’t happen to you? Hmmm…you must be doing something wrong. But what’s the telltale sign of a bathroom surgeon? When their spouse/child/pet steps on their foot and they fall down in tears!

It’s true…when you have an infected ingrown toenail it seems as if a big target is then painted on your foot. Everything WILL hit it! It’s one of Murphy’s most reliable laws. I’d like to offer some compelling reasons to retire from the not-very-lucrative specialty that you have chosen.

Most bathroom surgeons know that their success rate isn’t so good. Your operation may temporarily help the pain, but how long does it stay gone? Not very long! Within a month you’re back at it again? If you had your appendix out and it kept growing back every month and you nnede to have it out again and again (without anesthesia), would you be happy? I think not!

When patients come into the office with an ingrown toenail, I’ll offer a recommendation about what needs to be done. If the toe is infected, our choices are limited. Next, we’ll make sure the toe is good and numb before we proceed with any procedure. The procedure will be painless, but I’ll be honest that the numbing requires an injection which is uncomfortable. Once the toe is numb, the procedure generally takes under 5 minutes with little bleeding. You’ll leave, usually in the same shoes you came in, with a bandage on your toe.

As I’ve mentioned before in my blog, I’m far from a fashion critic, but my attention was called to pop star Lady Gaga. Her costumes are certainly headed for shock value, but when I saw what she wore to Sting’s Rainforest benefit, I was floored! (Actually the shoes shocked me slightly less than her performing onstage with Bruce Springsteen…never thought I’d see THAT!)

As you can see from her colorful outfit (well, kinda black really) topped off by shoes that have NO heel.  She’s forced to walk on her toes with her heel suspended behind.

These shoes (which by the way, she’s been seen in before) can cause stress on her Achilles tendon, causing it to inflame, and even cause heel pain.  Also, because the pressure is forced to the ball of her foot, she also opens herself to possible stress fractures.

That’s just the issues in her feet!  She also can have pain and problems with her knees and back because of her altered gait and weight distribution.  They’re also a major fall waiting to happen!!

I’m pretty sure her shoes are not going to be mainstream, especially here in Houston, but I’d hope that Lady Gaga is careful of how much she wears her extreme footwear before she starts hobbling around the stage rather than dancing.

Perception is everything! I love one patients come into my Houston, Texas, Podiatry clinic with the full diagnosis and treatment plan decided because their internet research. I’ve had corns that were warts, warts that were, warts that were broken bones, broken bones that were sprains and lots of spurs that were foreign object embedded in the foot.

People assume that because they keep a clean house that there are no dangers lurking. Take one patient who came in with a splinter that she couldn’t get out. There was definitely a hole where a splinter could have entered and x-rays showed some soft tissue changes. What did I pull out of her foot? A toothpick! A WHOLE toothpick! She was flabbergasted! Needless to say she was a bit grossed out, but felt much better.

I’ve also pull out many, many thick wiry hairs from the foot. Pet hairs, especially short-haired dogs like black labs, have hairs like wires.  You’d be amazed how often they can get into a bare foot and cause a full, painful foreign body reaction to form. They’re also tough to get out, since they cut and snap easily.  Be careful when you brush your pup!

These are extraordinary examples.  Mostly I’ll find a wood splinter or glass sliver.  Most of the time I can get it out in the office but if it is particularly deep, we’ll need to go to the operating room.

If you step on something, unless it’s easily accessible, you must come in to get it checked.  Sometimes a tetanus shot is necessary and antibiotics may be prescribed.  For diabetics, a foreign body is truly a medical emergency, since it can easily become infected.

It is so easy to write a splinter off as nothing more than a nuisance, but if it gets more painful with time, it is a sound idea to give the office a call.  We’ll get you in immediately!

Bret Michaels has been living a life that is a double-edged sword. He has had a phenomenal music career with Poison, has become a reality show star, and is currently a contestant on Donald Trump’s Celebrity Apprentice. He also is a Type 1 diabetic and suffered a brain hemorrhage last month. Brett is appearing on the Oprah Winfrey Show this week to discuss his latest health crisis, the first appearance he has made since falling ill.

During the Celebrity Apprentice, Michaels won his task as project manager to donate a nice sum of money to the charity he is playing for, appropriately the Juvenile Diabetes Association. He demonstrated how someone living with diabetes can live an exceptional life with the proper control. We also through him the lows when diabetes is put on the back burner and his sugars levels dropped too low.

The most heart-wrenching moment of the season was when he learned that his daughter might be diabetic. Type-1 diabetes can be passed to children. Every parent wants their children to be safe and healthy and the agony that Bret was in, blaming himself for his daughter’s potential illness, was palpable.

As a parent, a fan, and a podiatrist in Houston, TX, I wish a full and speedy recovery to Bret Michaels. I hope he continues to share his experiences to raise awareness of those living with diabetes.

Your feet are your foundation…Your base of support. When your base of support isn’t stable, it causes an effect to your posture. This instability can directly affect your ankles, knees, hips, and back. According to an article published in the Daily Mail this week, flat feet can account for regular, severe headaches.  Even migraines!

In fact, expert say that as much as 25% of migraine headaches are caused by issues with posture.  The weakness in the feet causes the muscles in the lower limbs to contract for longer periods of time.  The signals from the overloaded muscles can overwhelm the brain.  This causes the blood vessels within the brain to become inflamed and sufferers are left with a pounding pain from it.

In my Houston, TX podiatry practice, I see this quite often.  People are referred every day with back pain, hip pain, knee pain, and, yes, even headaches that have no other causes than postural issues.  What I look for in these patients are how their feet are managing pressures.  By taking a weight-bearing x-ray, one taken while standing, I am able to look at the bone structure and how the foot manages while bearing weight.  By watching you walk, I’m looking for the height of the arch, the angle the foot bears weight in, and how the heel rolls with each step.

While there is surgery that can correct a severely flat foot, I recommend it rarely because of the very long recovery.  A more conservative approach involves making a custom orthotic.  An orthotic is a custom insole with addresses the cause of the instability.  When properly made with a comprehensive biomechanical exam, an orthotic provides stability and efficiency to the feet and legs.  This will cause the muscles that are working overtime to be able to calm down to a more normal level.  This would quickly solve any postural conditions that created those painful headaches.

If you’re ever told that “nothing is wrong” when you’re suffering with pain, ask your doctor to watch you walk.  Relief may be just a referral to a podiatrist away.

This Friday, Oprah Winfrey will be hosting her show from Radio City Music Hall, home of the famous Radio City Rockettes, and will be interviewing Christina Aguilera. Although now I live in Houston, TX where I am a foot surgeon and run a podiatry practice, I am originally from New Jersey, right outside of New York City.

When I think of the Rockettes, I remember them high kicking from one number to another, all while wearing VERY high heels. Christina Aguilera also wears high heels on stage, dancing through her entire show. What’s amazing is that many women wear high heels like these all day every day at work. In fact, the average woman wears even higher heels than she would normally when she goes out for the evening, even when she may be dancing.

Wearing high heels too often do have their drawbacks. By having the heel elevated, it causes the foot to forced into an unnatural position leading to a shortening of the Achilles tendon. This tendon shortening can make it difficult, and for some women even impossible, to wear a flat or low heeled shoe…even a tennis shoe. Doing so often causes a pain where the Achilles tendon attaches to the heel bone, known as Achilles tendinitis, and also can cause a pain in the front of the leg, known as shin splints.

There has been a recent trend of young girls wearing high heeled shoes. This is even more devastating. When girls start to wear high heels so young, the shortening of the Achilles tendon is more pronounced and habitual use may even require surgery to correct. No young girls, or even teenagers, should wear high heeled shoes except on very rare occasions.

Finally, when walking for long periods of time shopping, and especially dancing, hi heeled shoes are not your best choice. Don’t get me wrong, I understand the need and desire to wear an attractive shoe. Most important is that you choose a shoe that you can wear throughout the day without pain. If you feel like you can’t wait to get your shoes off at the end of the day, and feel tremendous relief when you do, then you need to put more thought into your shoe choice.

Since the volcano erupted in Iceland last week, there have been major disruptions. Most of them, of course, were directly involving Europe and the everyday effects of having a cloud of ash on top of you. Others were vacationing in Europe, or visiting on business, and can’t catch a flight back home. The airports are opening and the delays are lifting.

I have a patient in my Houston, TX wound clinic who encountered a more substantial effect. I treat many patients with open sores, known as ulcerations, on their feet and legs. Ulcers are commonly found in people with diabetes, but can occur in others as well. In the case of this patient, he is a young, otherwise healthy, man who inherited a rare form of neuropathy, nerve damage affecting the feet which leads to numbness and an increased predisposition to developing ulcers. He has had these wounds for over nine years and has already had one of his toes amputated.

I have become concerned about one particular area of his wound, which is deeper than the rest and very close to bone. To ensure the bone is not infected, I wanted to send him for a specialized bone scan. In this test, blood is drawn from the patient, tagged with a radioactive isotope, and returned to him. This isotope is drawn to high concentrations of white blood cells, indicating infection, and is sensitive to areas of bone that are infected.

Here’s the problem: The isotope comes from Europe and all the hospitals in the area are out of it. Is there another test? Well, we could do an MRI ordinarily, but he has implanted metal pins near that area and interference is likely, which will give a poor result. Other types of bone scans are possible, but not specific for infection. We’re stuck waiting for new product to arrive.

Without minimizing the impact of someone stuck in Europe, my patient is effected in a much more severe way. Without this test, it will be difficult to determine if the bone is infected and the extent of the infection. This will delay surgery, if necessary, and delay full healing of the wound. I will continue to follow up with him regularly to ensure his condition doesn’t worsen and will eagerly await the arrival of the much needed isotope from Europe

Springtime is here in Houston, TX! The wildflowers are out in force and coloring most grassy patches in and around town. It’s definitely one of my favorite times to be living here. I also see the signs in my Houston podiatry practice. It’s the official start of sandal season.

I have written in the past about taking a break from toenail polish during the winter months and I’m happy to report that many of my patients have heeded the warning. But now all bets are off! Try convincing a sandal wearing lady NOT to paint her toenails. Good Luck!

With the season comes some ill-effects from using polish. Most polish has formaldehyde and other chemicals within it. These chemicals will dry and damage your toenails. There are commercial polishes that minimizes these chemicals, but most report them to be inferior. Most nail polish removers contain acetone, again damaging to the toenails. The removers without acetone are not as effective. You can see the results of all these chemicals with the white appearance of the nails’ surface after you remove the polish. This weakens the nail, making it more susceptible to infection.

If you use any topical medication to treat toenail fungus, it cannot penetrate the layer of nail polish to get to the nail. One solution for this is to use a “healthy” polish that also can prevent and treat fungus. Most importantly, if you are concerned about the changing appearance of the toenails, come in to the office to get them healthy again.

Spring has sprung!  The weather is getting warmer, the clothes are getting lighter, and the shoes are becoming…well…lesser.  Here in Houston, TX, sandal season comes early as our spring quickly evolves into our hot, humid summertime.

When the patients in my Houston podiatry practice come in during this time of year, they are more aware of their bunions, hammertoes and other bumps that have been hidden in shoes all winter.  They don’t like them, they don’t look nice, and they want them gone…NOW!  So practically speaking, is springtime the best time to have bunion surgery?

A bunion is when the first metatarsal bone rotates to cause a painful bump on the side of the foot, just below the big toe.  It often aches when you walk and makes it difficult to wear shoes because of the pressure.  Commonly, if you have a bunion, a parent or grandparent likely has or had one too.  Bunions can only be “removed” with surgery.  That surgery usually involves the metatarsal bone being surgically fractured and repositioned.  The bone is secured with a tiny screw.

Recovery after bunion surgery is somewhat involved.  It requires a period of time without walking and then walking with the assistance of crutches.  Stitches stay in for 2-3 weeks and it takes 6-8 weeks for the bone to be completely healed.  So…will your feet look good in sandals?

Bunion surgery is very effective for correcting the appearance of the feet and many feel little discomfort after surgery.  Best results come with great compliance from my patient to help to minimize swelling.  So lets put it this way.  If you had surgery in April, you’d probably ready to wear those strappy sandals after about 2 months…still most of the summer left to enjoy.

A few caveats…first of all, I personally don’t recommend surgery when there is a bunion without pain.  The foot is too important to bear weight and function to play with the structure.   There’s no such thing as cosmetic surgery of the foot.  Furthermore, everyone is different and procedures vary, so visit the office to see what your surgery and recovery would look like.

Happy shoe shopping!

We’re well into March Madness 2010 and the West Virginia Mountaineers have reached the Final Four for the first time since 1959. One of the Mountaineers star players, Guard Truck Bryant, broke his fifth metatarsal two weeks ago, but may see some play time as the tournament comes to a close.

The fifth metatarsal is a common bone injured in basketball. A strong tendon, the peroneus brevis, attaches to the base of the bone. When the ankle twists, which happens often in basketball, the tendon can pull on its attachment to the fifth metatarsal and break the bone. This is a serious injury that requires immobilization and sometimes requires surgery to correct.

Mountaineers’ trainer Randy Meador said how a specialist has constructed a custom orthotic device for Bryant. This orthotic is designed to redistribute pressure away from the injured bone to allow him to bear weight, but still allow the fracture to remain stable. This isn’t a cure-all by any stretch, but we’re talking about championship basketball, not a YMCA pick-up game…there’s a lot at stake!

Ideally the fracture would be allowed to heal.   Meador said that it’s not a “big break” which likely means the fracture is not displaced.  I wouldn’t be surprised if Bryant ends up with surgery to repair the injury after WVA’s season is officially over.  If not, he will likely be in a boot to immobilize him for 6-8 weeks.  Until then, Bryant and his team will do what they can to capitalize on the position they’ve worked so hard to get their team to.  Good luck!

Foot pain is common. At some point most people will experience pain or discomfort in their foot. While much of the time this is due to a direct foot issue, it sometimes can be because of instability elsewhere in the lower extremity. If left untreated, this can lead to pain in the ankles, knees, hips, back, or even your rear end. So my title can be taken literally or figuratively.

A literal “pain in the rear” due to unstable mechanics comes in a condition known as Piriformis Syndrome. The Piriformis muscled lies deep to the gluteal muscles and the sciatic nerve passes right beneath or through it. It functions to move the thigh away from the body’s midline and externally rotates it. Piriformis Syndrome is a condition in which the piriformis muscle irritates the sciatic nerve. This causes a pain deep in the buttocks and can even cause symptoms of Sciatica, a referred pain down the leg. The pain is generally made worse by sitting, squatting, or climbing stairs.

The primary cause of Piriformis Syndrome is biomechanical in nature. Overpronation of the foot can ultimately lead to the formation of this syndrome. It is essential that this be addressed with the use of a custom orthotic to prevent recurrence of the issue. Treatment also involves a stretching regimen and physical therapy. In resistant cases anti-inflammatory medication can be used and a cortisone injection may also help.

Speaking more figuratively, any pain in the foot has the ability to become a pain in the butt! From an ingrown toenail, heel pain, and Achilles tendon pain to something like a simple painful corn, foot pain can make everyday activities painful and laborious. I see it daily in my Houston, TX, podiatry practice – people waiting weeks, months, or even years for their foot pain to go away. There is no reason to wait so long!

The quickest avenue to eliminating the pain in your foot is by visiting your podiatrist. A podiatrist can simply diagnose the cause of your pain and offer solutions to quickly resolve it. Many people I treat are stunned how quickly the pain resolves…all regretting that they waited so long! Most find that the difficult part of solving their foot pain taking charge and scheduling the appointment.

Who would have thought that a foot doctor could treat the pain in your foot that’s become a pain in your ass? Both at the same time!

I am an unapologetic fan of the Grateful Dead – a Deadhead. I saw them many times before the passing of Jerry Garcia and have seen their many reincarnations and offshoots over the years. Unfortunately, the band rarely comes close to me in Houston, TX so I have to travel to see them. Most recently I took my family to see Furthur, the latest incarnation, in San Francisco for shows over New Years and took friends and colleagues to Fairfax, VA, where I happened to have a meeting. All agree – there is nothing like the unique experience of a Grateful Dead concert. In fact, it’s an experience I try to adapt to my office.

What is your typical experience at a doctor’s office? I know that I often have to wait long past my appointment time and then feel rushed because the doctor is running late. Since I have been in practice, I’ve never wanted to be that kind of office! We schedule our days in my podiatry office based on who is coming in and for what. Our staff is warm and friendly and we’re always happy you chose to visit us. Believe it or not, we will even schedule extra time with some patients who we know like to stay and schmooze! I want your time in our office to be more than a positive one – I want it to be exceptional!

The Dead are famous for each show being unique with a completely different setlist each night. In fact, in their Spring 2009 tour, they went more than the first ten shows without repeating a single song! During a show, their ability to improvise and blend one song into another is legendary. This is also something I adapt into my day.

No two patients are the same and no two conditions present exactly the same. Although I will follow a protocol for a particular issue, such as heel pain, different people will respond to different treatments and will have different results. many doctors will stick to their standards and become befuddled if it doesn’t produce the expected results. It is vital to recognize when a therapy is not working for someone and redirect the focus for that patient. It is just as important to explain to a patient that just because a treatment worked for their friend, it may not be right for them.

It is easy to reconcile my love for the Grateful Dead with being a better doctor to serve my patients. Attending a show also allows me to clear my head and refocus when I return to the office. My next trip is around the corner – I’m off to San Francisco with my friend and travel buddy Wayne to see Furthur and celebrate bassist Phil Lesh’s 70th birthday. No doubt I’ll return refreshed with some new stories to tell.

Even here in Houston, TX, where winter means we put on a light jacket, many are glued to the TV watching the Winter Olympics in Vancouver. The athlete’s focus and dedication is inspiring and we’re disappointed to see it come to an end after eighteen days of competition. I’ve overheard kids ask their parents for a snowboard, even though there is no place to use it in Houston. This is what the Olympic games are all about.

On February 12th, 2010, at the Opening Ceremony, a moment of silence was observed in honor of Nodar Kumaritashvili, a Georgian luge slider who died in a training run on the Vancouver luge track. The moment was a chilling reminder to all the athletes from around the world that were there that night that many of the winter games aren’t without risk.

The Winter Olympics separate themselves from the Summer Olympics by the high level of risk involved with many of these sports. Running, swimming, and track and field do not even compare to luge, ski jumping, alpine downhill skiing, and half pipe snowboarding in respects to real danger to the athlete. Many people watch the winter games and feel a rush of sheer thrill because the athletes are doing things that seem crazy to some and near impossible to others.

Nodar Kumaritashvili participated in a sport that few have the opportunity to ever try, luge. Luge is a sport in which a person lays on their backs on a luge, which is an aerodynamic sled, and speed down a half enclosed ice tube at speeds in excess of 90 miles per hour. If an athlete makes any mistakes the end result is almost always life threatening, as what was the unfortunate fate of Nodar. The luge track is also used for bobsledding and skeleton and can be just as dangerous for these sports as well.

Although many winter games are noted for their extreme speeds and heights, this does not mean that caution should be avoided in order to increase these two factors. Many athletes and experts commented that the Vancouver luge track was simply too fast and therefore dangerous. Unfortunately nothing was done to fix the track until it was too late and Nodar was fatally killed. Hopefully this 21 year old Georgian luge sliders story will help to caution and improve safety protocols for more winter sports so that the amazing athletes from all over the world will be as safe as possible for future winter games.

The main thing that really separates the Winter Olympics from the Summer Olympics is the extreme danger that many of these sports present to the athletes. With events such as Alpine downhill skiing, luge, ski jumping, and skeleton, athletes find themselves going at speeds over 90 mph, being at heights of over 50 feet, and traveling in the air over the length of a football field.

The one thing that many of the winter sports have in common is the athlete going from extreme heights to ground level in a matter of seconds. Even if the athlete is on skis, a snowboard or figure skates, the amount of pressure that is put on the foot and ankle during landing can be disastrous if anything goes wrong.

It’s not only landing from a height that is challenging for winter athletes but also the conditions they are forced to land in. Take pairs figure skating for example; female skaters are thrown in to the air spinning and then attempt to land on one leg wearing a 1/8 inch blade. The physics of these throws makes them very hard to land and if not done properly can lead to terrible ankle sprains or fractures.

Although many of the Winter Olympic sports put athletes at high risk of injury, only some of these sports are prone to increased ankle and foot injuries due to the different types of equipment and protection that are used. Figure skating is a winter sport with one of the highest incidences of ankle sprains, while skiing and snowboarding offer more protection to the ankle due to the heaver barrier provided by the boots.

The Winter Olympics are truly amazing to watch because these athletes participate in sports that are not as commonly accessible to everyone as are sports in the Summer Olympics like running or swimming. Although these sports may seem cool to watch it is important to remember that they are trained athletes and that injuries are very common to not only beginners but also to Olympians.