Keep Your Feet Feeling Young

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.

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!

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.

Dr. Mehmet Oz is a MD who has been a fixture on Oprah Winfrey’s show and recently started his own talk show that focuses on explaining medicine in a way that the general public can understand. On one of his recent shows he explained how a person’s foot structure can affect their entire body. He showed the audience that there are three main foot types: high arch, normal arch and low arch.

On the show, he showed that there are two quick ways to determine what type of foot structure you have. First you can lay some paper down dip your feet in water and then take a couple of steps on the paper. In a normal arched foot you will be able to see the heel and toe of your foot as well as most of the arch. In a person with high arches their foot print will only show the ball and heel of the foot. A low arch, or flat foot, would look like a paddle.

Dr. Oz also explained that by looking at the bottoms of your shoes you can also get an idea of what your foot type is. The bottoms of your shoes will wear out in the areas where you apply the most pressure. If you have a low arch then the inside of the shoe will be worn down more quickly. However if you have a high arches the outsides of your shoes will wear out more easily.

Dr. Oz did an excellent job of quickly explaining that by having either a high arch, low arch or normal arch your body is more prone to getting different problems. For example if you have a flat foot (Pes Planus) then you are more a risk for developing heel pain and biomechanical deformities, such as bunions or hammertoes.

Although Dr. Oz only skimmed the surface of foot structure and related problems this helps give you an idea of how structure can really affect function. If you have more questions regarding what kind of foot type you have and if your foot structure is causing your health problems then, as Dr. Oz recommends, you should visit your podiatrist.

I am a HUGE Disney fan! Keeping up with road races, I’ve always been intrigued by the “Goofy Challenge” which is when a marathoner completes the Donald Duck Half Marathon on Saturday and the Mickey Mouse Marathon on Sunday for a 39.3 mile experience. My friend Barry Tobias completed his first Goofy Challenge and was good enough to share his thoughts of training and the race itself:

There’s a reason they call it the Goofy Challenge. Every January Disney World hosts the Mickey Mouse Marathon weekend. For those who are willing to step up to the challenge, you can sign up to run both the Donald Duck ½ on Saturday and the Mickey Mouse full on Sunday. In all seriousness, it’s not that goofy of an idea. After running a number of marathons it was clear that breaking any speed records is beyond my ability, additionally pursuing goals of ironman races still needs a bit of time to transition into, and ultra-marathons…well that’s just crazy! The goofy run seemed to be the right ‘next move’.

Somehow I was able to convince my running buddies to sign up with me and months later training started. Like all marathon training, I have found that training with friends is the key to success, if not more so for the goofy challenge. I took my typical 16 week training plan and moved the medium mid-week run to the day before the weekly long run. The biggest challenge we faced was dragging ourselves out of bed early on both weekend days to run. Surprisingly, only the first couple back-to-back runs were bad. Amazingly enough our bodies got used to this schedule pretty quickly and after the third or fourth week we were physically comfortable with this schedule. The one noticeable difference in these runs was that the long one was not as fast as they were when they were the only weekend runs we did. Our medium runs we’d run at our normal pace and then on the long run back off about 20-30 seconds/mile, which seemed to help a lot. Honestly, the slower run was probably more of a natural response from our bodies than a mental decision to slow down. Of course, our best runs were those that were cut short and ended at IHOP instead.

The actual race itself was “memorable”. As most of those in the southern states dealt with the Arctic freeze by staying in bed, we (along with 17000 other people each day) spent it waiting to run. As we stayed at a Disney resort, we had to be on the bus and over to the start area by ~4am for a 5:50am start. Saturday we spent the 2 hours sitting under ponchos getting nailed by sleet. The run itself was not bad, although only ~2 miles were through Disney parks, the majority was spent in parking lots and streets. I believe what made the runs so much easier than expected was keeping the mentality that “Saturday’s run was nothing but a training run and we did that every week, so no biggie.”

Sunday was slightly better in that there was no sleet or rain. Unfortunately the temperature was quite colder. Sitting around huddling under mylar blankets that we got after the ½ marathon run, we shivered our way through 30 deg F weather, only to have the temps drop to ~27 (plus wind-chill that came near the end of the race) during the run. It was so cold that by the time we got to the water stops, the PowerAde drinks were icing over and all the spilled water at the water stops turned the streets into an ice rink. The full marathon took us through ~4-5 miles through all four Disney Parks, entertainment by a number of Disney characters and music kept us going. Mad props have to go out to the spectators and volunteers who all battled the cold to support our runs. The last mile through EPCOT was run to the theme song of the Olympics, which is the greatest song that exists to put some kick into very tired muscles. Overall I think Disney did a very good job organizing the race (sans the cold and lack of heat lamps). I’m still trying to decide if shaking hands with former President Bush at Houston’s 23rd mile or high-fiving Goofy at the end of 39.3 miles is more memorable.

It may have been goofy, but running the Goofy Challenge was a great experience. If anyone is looking for a step up in challenges after a marathon, I highly recommend it. 39.3 miles in two days seems daunting, but with some slight modifications to one’s training schedule and of course, good friends to keep you company, it is worth taking on that challenge. And if that still isn’t enough, may I suggest dressing up in a full blown costume of your favorite Disney character, you’ll be the most popular runner out there…and it may keep you warmer!

-Barry Tobias (4:21:12)

On a recent episode of Ellen, Jenny McCarthy was one of the celebrity guests. When they introduced her she came walking in wearing a pair of 4-inch high heel shoes, which seemed very difficult for her to walk in. When she sat down the first thing Ellen asked her was why she was wearing shoes that were so difficult to walk in and Jenny replied that these are the only shoes she can find right now because very high heeled shoes are what is “in”.

Although we all know that high heel shoes can make a woman’s legs and butt look flattering, wearing high heel shoes definitely has its share of disadvantages as well. The first thing to realize about high heel shoes is that no matter what size you are wearing those shoes are too small for your feet! High heels don’t have laces to hold you feet in so in order for these shoes to stay on your feet you must wear shoes that are too small for you in order for them to suction your foot into the shoe will you walk.

High heel shoes can lead to many foot and ankle problems. One of the most obvious problems that many women are very familiar with is blisters. When you wear high heels you have a greater chance of developing blisters on your feet because the shoes are too small for you. This causes the shoes to rub on your usually bare skin creating blisters.

Another common injury that occurs from wearing high heel shoes is ankle sprains. A lateral ankle sprain is the most common type of ankle sprain which occurs when the outside of your foot rolls under you causing stretching and tearing of the ligaments in your ankle.

The last common injury that high heels cause that most women are not aware of is bunions! Studies have shown that women who wear high heel shoes have a greater incidence of bunions. If you notice yourself starting to get a bunion then stop wearing high heel shoes immediately. If you choose to ignore this problem then it will only get worse and eventually your foot will no longer be able to fit into those cute little high heel shoes that you like so much.

Even though high heel shoes are undoubtedly fashionable right now they can leads to some serious foot and ankle injuries. It is understandable that women may be required to wear high heels at certain points during the week but the key is to try and minimize the time when you are cramming your feet into your high heeled shoes.

With the start of a New Year and the end of all the holiday parties and family get togethers people start to focus on getting themselves in shape and healthy for 2010. Keeping your feet healthy in 2010 will definitely help to keep you happy for the year. Below are ten facts you should know about your feet in 2010 in order to keep your body health and happy the entire year.

1) Structure – The standard foot has 26 bones and 2 sesamoid bones which are small, irregular bones under the base of your big toe.

2) Flat Feet vs. High Arched Foot – Flat Feet (Pes Planus) is a condition in which you have less of an arch on the bottom of your foot. There are 2 types of flat feet: rigid and flexible. A rigid flat foot is the type that commonly leads to further biomechanical problems. High arched feet (Pes Cavus) is when you have an increased arch which may require you to need good support in your shoes to prevent them from hurting.

3) Diabetic Feet – If you or someone in your family has diabetes then make sure that they monitor their blood glucose levels closely. It has been shown that uncontrolled blood glucose levels can lead to peripheral neuropathy, numbness or nerve pain in the feet and legs, and ulcerations of the feet.

4) Smoking and Feet – Smoking can lead to many terrible side effects but one that many people don’t know about is peripheral arterial disease (PAD). Smoking decreases the circulation of blood to your feet leading to loss of hair on the extremities and can also result in loss of sensation.

5) Athlete’s Foot – If you are an athlete of any kind then one thing you should always be trying to avoid getting is athlete’s foot, which an infection of the foot caused by a fungus. Of course, you don’t really need to be an athlete to get this. To avoid getting athlete’s foot it is important to wear moisture wicking socks while you workout to prevent your feet from getting too moist. It is also important for everyone to dry their feet thoroughly after they get out of the shower.

6) Nail Fungus – Nail fungus can be cosmetically troubling due to the ugly discoloration of the toe nails. If you think that you have nail fungus it is important to go to a podiatrist who can provide you easy ways to eliminate it.

7) Bunions – A bunion is when the tip of your big toe points toward your second toe causing a bump on the inside of your foot. Bunions can be caused by a person’s inherent foot mechanics and is often inherited. It is important to seek medical help as early as possible if you have a bunion to prevent it from getting worse and requiring surgical correction.

Weight and Feet – With an ever increasing incidence of obesity in the US population, a link has been discovered between foot pathology and weight. The more you weigh the greater incidence of developing diabetes, plantar fasciitis, and osteoarthritis.

9) Shoe Gear – What kinds of shoes you wear is very important to the health of your feet. Avoid wearing high heels and flip flops at all costs as they do not properly fit and support feet and try and wear gym shoes with good arch support as much as possible.

10) Plantar Fasciitis – This is one of the most common foot pathologies. Plantar fasciitis is irritation and swelling of the thick tissue of the bottom of the foot. It most commonly presents as heel pain and may occur in conjunction with a heel spur. Most cases are well managed with medication and custom orthotic devices.

Your feet are the base that supports your entire body. Make sure that you keep your feet healthy in 2010 in order to ensure that your can do all the activities you are looking forward to this year.

It is that time of year again when all the stores have huge sales to draw customers in to buy products for the holiday season. In a perfect world holiday shopping would be a time of happiness, with cheerful people buying gifts for their loved ones. In reality, however, holiday shopping is usually a frustrating experience consisting of crowded malls, long lines, terrible traffic and overheated stores.

One thing that many people don’t really think about when they leave their homes to go holiday shopping is how much walking they are going to do or how long they are going to be on their feet. Even if you are expecting to be in-and-out of a store because you know exactly what you need, the overcrowded shopping centers and long lines can triple your time spent shopping.

Although you can never know exactly what to expect when you go holiday shopping one thing you can count on is tired feet by the end of the day. The best way to take care of your feet so that they last the length of your shopping experience is to make sure you are wearing the proper shoes and socks.

The best bet when deciding what to wear when going holiday shopping is to choose a comfortable pair of gym shoes and some moisture wicking socks. Make sure you avoid any shoes with a heel or any shoes that are open toed because they put you at a higher risk of spraining your ankle or getting hurt if your foot is stepped on in a crowded store. Moisture wicking socks are also important because they will help to keep your feet dry and blister free when you start getting overheated from the crowded stores.

Holiday shopping can be stressful but by keep your feet happy you are more likely to stay happy yourself. So good luck when you start fighting the crowds in the stores this holiday season. Don’t forget to bring along your gym shoes and a good pair of socks.

Wishing you all the best for a very Happy and Safe Holiday Season!

I’ll admit that it’s cute, but three year old Suri Cruise, the daughter of Katie Holmes and Tom Cruise (aka TomKat) should not be wearing high heels at this age.  Too often, parents fall into the “but it’s cute” trap.  Parents of non-walking infants will put shoes on their babies because they match the outfit.  Both little girls and boys enjoy dressing up in their parent’s shoes around the house.  To actually wear a high heeled shoe when out…that’s another story.

Suri is probably the most photographed child in the world, thanks to her two superstar parents.  Many photos show her in these silver dancing shoes with high heels.  When asked about Suri in the shoes, her mother stated that it’s every girl’s dream to wear such shoes and who is she to stop her?  Will all due respect, you’re her mother.  Of course you want her to be happy, but you also want her to be healthy and wearing such shoes can certainly impact that.

It’s true that the shoes Suri is wearing is probably an appropriate size.  Just because they make such shoes doesn’t mean they should be worn constantly.  In this case, the shoes are ballroom dancing shoes.  Of course Suri can wear them when she’s taking dance lessons for an hour or so, but the photo doesn’t look like a lesson.

Wearing a high heel at such a young age can cause shortening of the Achilles tendon.  This can happen in adults too, but is much more likely in kids.  If this happens, there will be undue stress on the back of the heel, where the tendon attaches, and can become a painful condition known as Sever’s disease, or calcaneal apophysitis.  It is an inflammation of the growth plate on the back of the heel bone causing sharp heel pain.  As she grows older, the shortened tendon will lead to compensation of the rest of the foot, causing the foot to become unstable and pronate.  This will put her at risk for developing bunions and hammertoes in the future. She is already at risk for these deformities, since her mother suffers from bunions and hammertoes already.

Why put Suri’s future health and happiness above her 3 year old desire to wear the shoes all day.  Katie and Tom, show Suri how much you love her by limiting her time in her favorite shoes to an hour a day.  She’ll thank you for it in the long run.

I am confronted on a daily basis with men and women who think their toenails are ugly.  Especially here in Houston, where open-toed shoes and sandals are commonly worn year-round, people are embarrassed to expose their toes.

Damage to toenails can be caused by a number of factors.  Fungal toenails are common, due to Houston’s heat and humidity and shoes harboring the fungus.  Even after treatment, the disfigurement of the nails can remain.  Trauma is another major cause – stubbing a toe, being stepped on, or dropping something on your toenail can cause permanent damage.  Runners and other athletes develop a condition appropriately called “runner’s toenails” due to the impact of the toes against the end of the shoe.  Sometimes the trauma could cause the nail to no longer grow or be missing altogether.

No one – women and men alike – enjoy others seeing gnarly toenails.  Acrylic false nails were available for fingernails but most find them uncomfortable in shoes.  They also suffocate the toenails, causing more damage.

I was introduced to a product that I didn’t think existed – KeryFlex.  It’s premise:  a healthy and comfortable toenail replacement that acts and feels like a natural toenails.  It can be shaped and polished, just like a real nail too!  KeryFlex uses a flexible resin to reconstruct a new toenail in place of a nail that is damaged or missing.  Hard to believe?  I thought so too, but I spoke to doctors in the northeast that have been using it and they told me that their patients love it!

Our office was one of only two podiatrists in Houston trained to provide KeryFlex.  So far, everyone loves it!  the procedure is completely painless and requires no laser or surgery.  It only takes about 20 minutes and you’re ready to go!

To learn more about KeryFlex, visit www.fixmytoenails.com or call us to schedule an appointment

It seems like it has always been a problem. Kids just don’t like to tie their shoes. Sure, it only takes a few seconds, but look at all the time is saved by just slipping them on. Even kids who have Velcro closures on their shoes still don’t undo them…they just slip them on!

A shoe is meant to provide stability for your foot. Tying your shoes daily will make them secure and prevent your foot from slipping around. When a shoe is untied for a period of time and just slipped on and off (you should see the size of some of the knots I see!), the laces loosen and the foot slips around in the shoe. This causes the foot to have to work harder to stabilize itself, often leading to overuse injuries.

Does this really make a difference? Absolutely! I’ve seen kids with infected ingrown toenails because they are hitting the ends of their shoes. Others who developed shin splints because of wearing shoes that are too loose. Still others with Achilles tendon pain or Sever’s disease because they don’t tie their shoes. The more active a kid is, the more important it is for them to tie their shoes well.

The same goes for adults. In fact, I am constantly on the case of my trainer (who tortures me twice a week) for not having his shoes tied. Not such a big deal when he’s working, but I’ve seen him the same way when he’s working out! Think about how much stability your body needs when you’re lifting weights! I’m finally getting through to him after he started feeling some foot pain. Now, I’m a really nice guy so I certainly didn’t tell him “I told you so!” Well….of course I did!

It is important to tie your shoes and to make sure your kids’ shoes are tied every day. If you’re running late, resist the urge to tell them to just slip it on…If you give them permission once, they’ll do it always.

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.

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.

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.

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.

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.

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.