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Tucson Lifestyle Magazine Burger Masters

Burger Masters

There are lots of places to go for a good burger in this town, but these six spots are a cut above.

KIMBERLY SCHMITZ
PHOTOGRAPHY BY THOMAS VENEKLASEN PHOTO ASSISTANTS JACKSON AND NOLAN VENEKLASEN

Divine Bovine

Super new on Tucson’s burger scene, Divine Bovine bursts out of the gate like a bucking bull with a mission. Though it’s only eight months into the game, don’t dare discount this hot new spot owned and operated by Ben Rine, former owner of BrushFire BBQ Co. With around 15 pre-conceived options or a deep well of build-it-yourself ingredients from which to choose, guests can order a highly anticipated delight and watch it come to fruition in the open kitchen.

The scratch kitchen offers beef patties that are house ground with brisket, chuck and short rib; buttermilk fried or seared chicken breast; Arizona-farm raised bison; or the Impossible 2.0 veggie burger. Any one of these tantalizing offerings may be placed between a fresh La Baguette Parisienne bun, under a mountain of house-made mac & cheese, triple-fried fries, or cradled in a bed of greens. Rine’s playful passion for building a bodacious burger experience is apparent in the wickedly fun and dutifully scratch-made delights. He explains, “I always wanted a burger joint. There is so much you can do with this medium. I can really play and goof-off with this.” After pulling together the Funny Farm Hand, resplendent with creamy peanut butter, jalapeño raspberry jam, candied bacon, sweet hot pickles and white cheddar, Rine recalls, “I had to rest against the table for a minute. I needed a picture of this — it’s pretty amazing!”

Rine recognizes and respects that food is a personal thing, so whether you dare to devour one of his creations or build your own delicious concoction, belly up to the counter and order away. Under no circumstances, however, should you forget to grab at least one amazing side. A weeks-long experiment led to the perfectly prepared Pure Gold Potato French fries, punched, brined, and triple-fried daily to order. If you’re determined to go somewhat rogue, the heavenly mac & cheese or near sinful hushpuppies with jalapeño raspberry jam perfectly complement any of Rine’s or your own creations. Wash down the indulgence with a local soda or one of more than 40 beer options served individually or by multiples packed in a bucket of ice.

1021 N. Wilmot Rd.; 203-8884 divinebovineburgers.com

Charro Steak

Picture of The Charro Burger
The Charro Burger, available at Charro Steak.

The Flores family has served Tucsonans and visitors iconic Sonoran-style Mexican food since 1922 at El Charro Café. More recently, the city’s longest-running culinary legacy expanded to include pub, seafood, and Mediterranean-inspired cuisine spots. One of the latest additions to the Flores restaurant concepts is Charro Steak, with Executive Chef Gary Hickey at the helm. With an eye to purity of their main ingredient, Ray Flores explains, “We only buy grass-fed meat. No hormones, no antibiotics. The animals drink from natural springs. These are important details.”

The best bits and pieces trimmed from the naturally raised Arizona and Montana grass-fed beef are ground and formed into delectable half-pound patties known as Charro Burgers. Grilled to order over a hybrid mesquite fire/gas grill, and stacked with Willcox tomato, queso Manchengo, and Charro sauce, they are encased in Sunrise Bakery heritage Sonoran wheat buns. Oh, but wait, the Charro Burger fun isn’t over just yet. Add an over-easy cagefree egg, avocado, charred poblano, bleu cheese, pork belly or grass-fed chorizo (or any combination therein) for a blow-your mind, taste-bud-blasting experience. Pair the Charro Burger with hand-cut French fries, the Sonoran Au Gratin-style Papas de la Casa, or an order of classic Charro beans and prepare to stare down a serious case of food coma. Insider tip: Do not succumb to the coma before topping off the meal with a little dulce (sweet). Will it be the margarita lime flan, the tamal del Nutella or the PB&C (peanut butter & chocolate) tres leches cake? Maybe throw caution (and your top button) to the wind and go for the Dulceria Sample Board.

Naturally, working one’s way through all these amazing offerings will create a hearty thirst. Sip a glass or flight of red, white or rosé from the chef-curated wine menu. Choose from more than 25 whiskey, bourbon and scotch options, 20-plus beer labels, or an array of unique cocktails. Keep an eye out for one of the many local brands offered. Designated drivers and teetotalers may indulge in a non-alcoholic brew or the Charro Steak peach tea served with grilled peaches. With so many options, there’s one thing each and every diner will have — an unmistakably Old Pueblo dining tradition experience that won’t disappoint.

188 E. Broadway Blvd. (520) 485-1922 charrosteak.com

Truland Burgers & Greens

Photo of Truland Burgers & Greens’ Western Bleu Cheese Burger
Truland Burgers & Greens’ Western Bleu Cheese Burger.

Co-owners Jeff Katz and Paolo DeFilipis combined the concepts of Graze Premium Burgers and Choice Greens to serve Tucson’s north-siders with Truland Burgers & Greens, with a new location slated to open in Chandler in early 2020. Now in its fourth year, it’s humbly upscale with the heartbeat of a true “joint,” evidenced by the availability of canned beer, and beer and wine on tap. Certainly, we appreciate the delectable green offerings, of which Truland has many, but our gaze is on the plethora of things served in a bun. For vegetarians, there’s the locally sourced, smokey tepary bean and superfood veggie burger, which is pretty scrumptious by all measure. Chef strongly suggests burger fans enjoy two patties of Niman Ranch hormone/antibiotic-free beef or locally sourced Double Check Ranch grass-fed beef seared to medium well. The Truland Classic sports two slices of American cheese, lettuce, caramelized onions and Tru-sauce, and there are 15 available addons such as grilled crimini mushrooms. Maybe a double-patty chorizo burger with pepper jack cheese and Hatch green chiles tempts you, or perhaps you want to check out Katz’s fave, the Early Riser, with two slices of American cheese, a cage-free fried egg, all-natural nitrate/nitrate-free bacon and organic ketchup. The magnum opus of Truland’s burger offerings is the Western Bleu Cheese burger, adorned with bleu cheese, bacon, crispy onions, and barbecue sauce.

Without doubt, a perfect side for every Truland burger is an order of Kennebec potato French fries. They’re Belgian-style, twice-fried in non-GMO rice bran oil, and seasoned with kosher salt. Take it up a notch with the truffle fries treated with truffle oil, Parmesan, pecorino, parsley, and served with truffle mayo. If you manage to get a hand free from your burger of choice, wrap it around a Dragoon IPA or Barrio Blonde from the tap, or a can of Guinness or Bells Two Hearted Ale. A really nice assortment of wines is on tap or by the bottle if a little natural sulfite infusion is more to your liking. If, by some miracle, there is room for dessert, top off your Truland experience with a piece of their legendary carrot cake or an ambrosial all-natural ice cream milkshake. Warning, one or two bites or sips just won’t do — you’ll go big and go home super satisfied and planning another visit.

7332 N. Oracle Rd.; 395-2975 trulandburgers.com

Beaut Burger

Vegans, vegetarians and omnivores alike are flocking to the Mercado San Agustín (MSA) Annex for a feel good/tastes good meat-free burger bite. Five years ago, a seed was planted when vegan cuisine chef Kerry Lane and serial entrepreneur Ari Shapiro were on a hike in Canada and jonesing for a quick and good veggie burger. Not long after, the concept of Beaut Burger was born and realized by the duo — a no-frills lower-price-point veggie burger joint with cheap beer. It’s an everyman/ woman spot where people can enjoy a primal burger and fries experience minus the animal product.

Having recently celebrated its oneyear anniversary, Beaut has been warmly embraced by Tucson, and the people of the westside in particular. Shapiro admits that he, a vegetarian, and Lane, a vegan, are very particular about their food. Therefore, the vast majority of menu items were conceived by Lane and made inhouse daily, by hand — including buns, pickled poblanos, tamarind chutney, radish sauce, barbecue sauce, slaw and burger patties. “I’m not a culinarian. Kerry is the mind and hands-on genius behind the menu. I’m just a scrappy entrepreneur who wanted to be able to get a veggie burger minus a linen napkin and steep price tag,” Shapiro explains.

Loath to pick a favorite of Beaut’s fabulous fare, Shapiro points to the B4 as the best-selling burger, proudly proclaiming it as his late-game contribution. Piled atop a proprietary hand-formed patty of grains, walnuts, beans, vegetables, and spices, the griddled mushrooms and caramelized onions harken back to a favorite of the entrepreneur’s youth. Beaut fanatics also are partial to the B9, a near-heavenly compilation of roasted eggplant, pepita pesto, and house-made mozzarella. And for the chile-pepper-loving and socially sensitive veggie burger connoisseur, the B Kind burger stacked with jalapeño and roasted zucchini, slathered with vegan sour cream also offers proceeds donated to Ben’s Bells. A side of the hand-cut russet fries are always an amazing bet, but beer-battered cauliflower bites or some zippy housemade coleslaw won’t be regretted, either. Between cow-friendly bites, wrap your hand around house-made limeade, a $2 Miller High Life, or a 12-ounce can of wine. Oh, and don’t forget to grab Fido a homemade dog-biscuit. High-style, out-of-sight flavor combinations, and delightfully industrial- chic atmosphere make Beaut Burger Tucson’s every-man, -woman, and -dog spot for a quick, tasty, healthy, burger bite.

267 South Avenida del Convento 344-5907; beautburger.com

Lindy’s on 4th

The OMG Burger, a 12-patty, threepound monolith of insane indulgence and bragging rights, may have put Lindy’s on the national foodie radar with appearances on Man v. Food, Meat & Potatoes, the Travel Channel, and Food Network’s Ginormous Foods. But since opening in 2005, Lindy’s has been considered a daytime or late-night hot spot to grab a bite for Tucsonans, especially UA students. Originally more of a sandwich spot, owner Lindon Reilly proves it pays to play with your food. With a menu eventually skewing toward the burger bandwagon, Lindy’s has become a favored new/old burger joint in Tucson.

Even after moving across the street, burger lovers still flock to Lindy’s on Fourth, some for the burger challenge, but most for the scandalously delicious seven-ounce (base) patty creations. Use a BUSS pass (Build Up Something Special) by choosing a beef or black bean patty, or fried or seared chicken breast. Select a “holding medium” — salad bowl, lettuce wrap or brioche, gluten-free, or honey bun (to name a few). Then get to building — fries, tots, grilled veggies, Lil’ Smokies, bacon … you name it. You can leave the stress of so many choices behind by picking one of Lindy’s own concoctions. The OG, a classic with lettuce, tomato, onion, and Lindy’s sauce stands strong, but if you really want to arouse your senses, opt for the Big Bang, with homemade jalapeño macaroni salad, Lil’ Smokies, potato chips, cheddar, lettuce, tomato, onion, pickles, and sour cream n’ onion spread. One of their signature burgers is for pyromaniacs only, with green chile, jalapeños, pepper jack cheese, guacamole and ghost pepper sauce. Of course, no man or woman can live on burgers alone, so a Lindy’s side is a must. The Phat chips — house-fried and smothered with mac & cheese, sour cream, chives and bacon bits is a popular choice, but there’s also French fries or tater tots fighting for breath under guac, green chiles, jalapeños and pepper jack. Whet your whistle with dollar-off craft draft or a $5 signature cocktail during happy hour or $5 Mimosas and Bloody Marys all day on the weekends. If you can still walk comfortably after your meal, be sure to work off some of those calories with a stroll around Fourth Avenue. The walk will help you decide which of Lindy’s burgers to tackle on your next visit.

500 N. Fourth Ave.; 207-6970 lo4th.com

Union Public House

A Foothills staple since October 31, 2011, Union Public House has been an anchor for good eats in St. Philip’s Plaza since its opening. Aside from the superstitiously macabre opening date, the only thing scary about the cornerstone eatery is the frightful decadence of its offerings. As many dishes as possible are infused with Chef Tony Coluci’s version of “flavor crystals” — bacon. From the beginning the Union Burger has been a constant menu item and far-and-away fan favorite.

Photo of Union Burger
Union Public House’s famed Union Burger.

General Manager David Serafin explains that the staple is “an exquisite creation exactly the way it is served. It’s not made to put a bunch of sauces on and cover up.” A half-pound Union Grind patty of 80/20-ground grass-fed beef is perfectly seared to taste and dressed with English Red Dragon cheddar, house-made bacon jam (i.e., Flavor crystals reduced with sugar, vinegar and apples), and red winepickled red onions. All this deliciousness is surrounded top and bottom by a brioche bun made in house by baker Travis Evans. Serafin explains that it’s a burger made for a purist — pure ingredients, scratch made, to order. If hoisting this massive feast is a little scary, opt for the sliders instead. Union Sliders are smaller-in-stature, spicy offerings of the Union Grind topped with bacon (of course), cheddar, and house-pickled jalapeños. For the burger lover unwilling to buck tradition, the All-American burger sporting the more traditional costuming of lettuce, tomato, onion, cheddar, mustard, and mayo inside a house-baked sesame bun awaits.

Whichever amazing burger is chosen, make sure it doesn’t come to the party alone. Invite some of the house-punched Chipperbec French fries or hand-sliced potato chips along. Or pick the insanely amazing Poutine fries bathed in housemade gravy, white cheddar cheese curds, and chives, or a cup of Yesterday’s Soup (house-made soup given time for the flavors to marry and blossom). Stop into Union Public House anytime for an amazing burger or slider, but make a point of dropping in for the joint Halloween/anniversary party complete with live music, spirits (of all kinds), and a costume contest. 4340 N Campbell Ave., Ste. 103; 329-8575 uniontucson.com

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Tucson Lifestyle Magazine Silent Sky Banner

An Extraordinary Star

Astronomy, the achievements of women of science, and our place in the universe are all explored in an ATC production that features a gifted, Tucson-based performer.

Scott Barker

“There’s so much that’s relatable for me,” observes Veronika Duerr about the character she portrays in Arizona Theatre Company’s production of Silent Sky. “In the very opening moments of the play, Henrietta is onstage by herself looking up at the sky, and she admits to always searching for something extraordinary. That she’s never been able to be satisfied with just enough. And I have always felt like that; I have a desire to live an extraordinary life. To do something extra special.”

Image of Veronika Duerr
Veronika Duerr Photo by Vanie Poyey

Duerr’s life has, indeed, been a series of exceptional accomplishments, and she can add Silent Sky in bold characters to that list. Lauren Gunderson’s play, based on real-life Harvard College Observatory astronomer Henrietta Swan Leavitt, takes audiences both on the scientific search for where we are in the universe, as well as where each of us fits into the glittering expanse of humanity.

It is a perfect fit for Duerr, who — having just recently moved to Tucson with her husband Sean and their baby — is navigating a new world. And she has long been an explorer, both of the cities in which she’s lived, but also the craft of the theater.

Growing up in Atlanta, Georgia, she discovered her calling when she was barely out of diapers. “My parents took me to the theater, and I remember the first play I saw being a touring musical production of Peter Pan when I was in kindergarten,” she reflects. “The next day in school all I would do is draw pictures of the different scenes and tell everybody what had happened, and about the sets and costumes. I was just enamored of it.”

It wasn’t long before she was watching mainstage productions at Atlanta’s prestigious Alliance Theatre, and dreaming of the day when she would be in the footlights. Showing her talents in school productions was a big step in her development. “I would say that I was a drama kid through and through,” she says of her formative years. “I didn’t miss out on any high school experiences, but I was so super-focused that I was doing community theater, as well as theater programs downtown, drama camps, productions at school, drama club and all that.”

She enrolled at the Savannah College of Art and Design, where she prepared to lead a far-from-ordinary life of telling truths through the art of professional make-believe. After graduating, she took a big leap of faith. “I started a theatre company called The Weird Sisters Theatre Project,” she notes, “which is committed to putting women into the power positions of director, playwright and producer. That came about because when I was living in Atlanta in my 20s and trying to get directing and producing jobs, fairly often I would be passed over for an untested male. I was like, ‘Let’s just build something where we can create a body of work to represent ourselves, and then maybe we’ll start getting the work that we want.’”

Named for characters in Macbeth, the theater company has given a huge boost to the careers of the women who produced and directed its productions. “Everybody involved has really benefited from it, and it’s been awesome,” says Duerr.

Her journey to the Old Pueblo encompassed numerous trips back and forth across the country for job opportunities. “I went from Atlanta to New York, back to Atlanta, then LA, Atlanta, then Lowell, Massachusetts, and finally Arizona. I always went back to Atlanta to save up some money before the next adventure!” she says with a laugh.

The adventures show no signs of letting up. Though ATC audiences will watch her portray a scientist from 100 years ago, theatergoers in Scotland recently saw her in a very different role. “It’s really out there,” she says of her one-woman show. “It’s called GLOCKENSPIELSEXPARTYBAVARIA GOODBYE. It’s a fast, funny, sexy comedy about an agoraphobic phone sex dominatrix who goes on a whirlwind journey through Bavaria, as well as deep within herself, to rescue a friend in need from the claws of a mythical beast.”

Duerr wrote the piece with her New York-based friend Johnny Drago, and despite the nontraditional subject matter, she says she can identify with key components. “I have a social anxiety disorder that can manifest itself in agoraphobia, and I’ve worked on that my entire life,” she reveals. “My parents came over from Germany in the 1970s, and all my family still lives there in a small town. I knew that I wanted to touch on the ideas of agoraphobia, but also someone who is capable of being an extrovert, and to be whoever other people need her to be, but can’t always do it for herself.”

Though Silent Sky wasn’t written specifically for her, it easily could have been. Playwright Lauren Gunderson, a longtime friend of Duerr and her husband, explains, “Since I first wrote the play, I have always wanted Veronika to do this role.”

Photo of Playwright Lauren Gunderson
Playwright Lauren Gunderson Photo by Kirsten Lara Getchall

Gunderson is very comfortable writing about science, and the roles that women have had in discoveries, and this play gives her the opportunity to explore things from several sides. “One reason I wanted to write it is that oftentimes we see stories of women — even celebrated, strong characters — but they are alone,” she elaborates. “They are in a man’s world, or they are only in the world of their family. What’s interesting about this story is Henrietta is one of several incredibly brilliant female scientists who worked at the Harvard Observatory at the same time. So we have the characters of Willamina Fleming and Annie Cannon, both true, historical characters, as well as Henrietta. And then we added Henrietta’s sister Margaret, who held a more traditional female role, kind of wife/ mother/domestic. So we have this quartet of women who tell us the story, which makes it the story of not just one woman, but of four different, amazing ones.”

In the early part of the 20th century, Leavitt was a “computer” at the observatory, doing calculations to arrive at a method of determining the distance from earth to other galaxies. “The question of this play is ‘where are we?’” Gunderson comments. “That’s kind of a general question, but it can mean a lot of things the more you dig. For the scientists in the play, it means, ‘where are we in the universe … how big is it?’ We can’t know where we are until we know how big the thing is. That is part of the science that Henrietta was able to crack into for the first time in human history. And it’s a deeper question about where we are in terms of the relationship between men and women, and human, social and political progress.”

Lest anyone think that this will be an egghead play, chockfull of baffling scientific theories, Gunderson interjects, “I have written about science for the majority of my career, so I have an instinct of how to do it, what are too many details, what’s too much math.”

She also notes that there are unexpected elements to the play, including very strong visual and musical components. “There is a theatricality to Henrietta’s science. It’s based in almost a musicality because the astronomy that she was able to uncover is about patterns and amplitude. She is looking at those patterns in terms of light, but in the theater we can use it for light as well as sound. It’s a really cool exploration for any theater because of what it asks in terms of lighting, scenic and sound designers … it brings out the best of theater.”

And if that’s not enough to entice people, she adds that there also is an unconventional romance in the piece. “There’s a love story, but it’s not one that you might anticipate. Neither of the lovers expect, or even want, to be in love. It’s a bit of an accidental, ‘Wait a minute … what’s happening here?’ sort of thing. It’s fun and refreshing.”

And while the characters in the play explore their places in the vastness of existence, and the niches they fit into in the lives of others, the playwright and the lead actress will both be exploring life in a city that has been called an “astronomy capital.” Gunderson says that she has never been to Tucson, and is looking forward to the chance to see it during the run of her play. Duerr has lived in the city a short while, but is rapidly acclimating to it. She loves the opportunity to hike around the state, ski when the weather accommodates, and indulge in one of the key features at her home. “I love swimming in my pool. That’s a new thing, to have a swimming pool. It feels so luxurious!” she exclaims.

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September Gardening Calendar

Sunny days still bring the heat, but cooler nights hint of things to come. It’s time to dig out your gardening tools!

PLANT

Plant citrus while the weather is still warm. Choose varieties that are better adapted to desert conditions.

Plant strawberry varieties that perform in low-desert conditions. Choose a location that has protection from afternoon sun.

Plant fall herbs such as chives, thyme, catmint, cilantro, cumin, dill, fennel and parsley.

Transplant herbs such as lemongrass, marjoram, mint, oregano, rosemary, sage and thyme.

PREPARE

Dig compost into vegetable beds. Rearrange container plants to sunnier locations as the sun’s arc slips southward.

Chill tulip, crocus, daffodil and hyacinth bulbs in the refrigerator for eight weeks prior to planting.

PRUNE

Cut back tomatoes and peppers that made it through the summer to promote a new bloom before frost.

Trim roses and remove dead twigs to promote a second bloom in the fall.

Prune shrubs such as oleander, privet, xylosma, Texas ranger and Arizona rosewood that have become overgrown.

 

 

 

WATER

Cut back on water for deciduous fruit trees, grape vines and citrus to slow growth and get ready for cooler temperatures.

Water citrus deeply out to the plant’s canopy every two weeks.

 

MAINTAIN

Hose off dusty plants to control spider mites.

Divide iris this month. Dig up large clumps and cut rhizomes into small pieces.

Pull and compost the last of the summer annuals.

Refresh garden beds by incorporating four to six inches of organic matter. FERTILIZE

Fertilize with nitrogen in early September to provide nutrients to summer-stressed plants. Water the day before and after applications to prevent burn.

Feed roses with a slow-release fertilizer that will last through fall. Fertilize citrus with the third and final application of nitrogen for the year.

Add organic nitrogen sources to the soil, including alfalfa meal, blood meal, coffee grounds, cottonseed meal, fish emulsion and guano.

TIP OF THE MONTH

Chile peppers are available in many colors, shapes, sizes and degrees of heat. The key factor affecting how fruit set is night temperature, which ideally should be between 65 and 80 degree. Bell pepper varieties do not set fruit when temperatures are over 90 degrees, but may begin to do so once the weather is cooler. If bell-type peppers are desired, consider the smaller pod “Carmen Sweet Pepper.”

Chiles need six hours or more of sunlight. Provide full sun in the morning and 50 percent afternoon shade. In the fall, fewer blossoms will appear as the weather turns cooler.

Tucson Lifestyle Magazine Brick

Bricked & Beautiful

A little-used yard got a complete re-do to become a great space for entertaining.

BY DEBBY LARSEN

PHOTOGRAPHY BY MATT VACCA

The owners of a midcentury-style home wanted to create a landscape that would honor the design aesthetic of the house. They contacted Landscape Designer Kathryn Prideaux of Prideaux Design to re-envision their barren, 1,500-square-foot backyard. She reached out to Cimarron Circle Construction Company to build the pool, and Sonoran Gardens Inc. for the green spaces.

The plan was to retain one key existing element — the brick walls. They were in good condition, which helped with the budget, and also complemented the home’s architecture. However, the walls’ original wood panel inserts were too worn to save. They were replaced with rusted steel panels set within a one-inch frame. Continuing the rusted steel aesthetic, a new self-closing gate and steel screen panels were fabricated and placed at opposite ends of the garden.

 

The patio’s support beams were replaced with four-by-four-inch square steel posts. An integral color concrete patio with a pebble-etched finish was installed and extended to the pool’s edge. A small area adjacent to the pool features stabilized decomposed granite defined by steel strap edging. Prideaux’s jewel-like design of this raised-edge pool takes center stage, with its turquoise glass tile exterior and pebble finish interior. The stunning contrast between the rusted steel components and the glass-tiled pool creates a modern vibe.

Prideaux chose drought-tolerant plants in her design, such as Yellow Bird of Paradise and Palo Verde “Sonoran Emerald.” The shrubs included Artemesia, Desert Milkweed, Gopher Plant, Deer Grass, Lady’s Slipper and Rosemary. Agave “Blue Glow,” Weber’s Agave, Grass Tree and Mexican Fencepost added sculptural elements to the space.

Now, the backyard encourages entertaining and relaxing, plus it creates a beautiful space to view from indoors.

Sources:

Landscape Design: Prideaux Design, Prideaux-Design.com

Garden Contractor: Sonoran Gardens, Inc., SonoranGardensInc.com

Pool Contractor: Cimarron Circle Construction Company, CimarronCircle.com

Foot Notes

Keeping your feet healthy involves preventive care, and knowing when to see a professional.

by Kimberly Schmitz

Think about feet for a moment. They are really quite a marvel. Twenty-six bones, 30 joints, more than 100 muscles, tendons and ligaments, and nearly 7,000 nerve endings all work together to get us where we want to go, test the water, cut a rug, or shut the door when our hands are full. So why is it that so many people dismiss, ignore, self-diagnose or You-Tubetreat foot pain?

Dr. Glesinger
Photo by Thomas Veneklasen

 

 

Tucson native April Ross Glesinger, DPM, of Arizona Podiatry Associates, understands the struggle. She regularly shares with her patients the reason she went into podiatry — her “terrible feet.” She has flat feet, suffers from plantar fasciitis (heel pain) and neuromas (painful nerve bundles), and has worn orthotics most of her life. Dr. Glesinger has dedicated her career to ensuring people are able to lead active, pain-free lives. She shed some light on why many patients hesitate to see a podiatrist when issues arise. “Feet are such a personal issue. Patients tell me all the time that they were afraid to come in because they didn’t want to hear that they needed some painful procedure or would have to wear unflattering ‘old-lady’ shoes.”

Simple, painless and non-invasive solutions are available to treat many foot and lower leg issues to help people return to their favored activities. Often the causes of foot complications are as individual as the patient and may require a specific combination of treatments for resolution. Yet, some conditions, left untreated or treated incorrectly, may become life threatening. Fortunately, Tucson-based podiatric physicians, as well as interdisciplinary teams of practitioners and researchers throughout the country, are dedicated to diagnosing, treating and resolving minor and severe maladies below the knee.

Take The First Step

Dr. Aung, Bob Hitchcock, Design Photography

Undoubtedly, feet take the brunt of daily living, especially here in the desert. Toes get stubbed, Legos are stepped on, and stickers or cactus spines find their way into feet one way or another. Even just a long day of standing or exploring a new desert trail may leave our “dogs” feeling a little more beat up than usual. So how do we know when it’s time to consult a professional with a foot problem?

Barbara Aung, DPM, DABPM, CWS, CPMA, CSFAC, of Aung FootHealth Clinic, suggests people imagine whatever problem they suffer on their feet is happening to their eyes. “If people have a recurring lesion on their eye, they’re not going to perform some procedure they see on an infomercial,” reasons Dr. Aung. “They’re going to go to a professional to have it treated properly. The same should be true with foot issues.” She suggests paying attention to warning signs such as pain, swelling, sores, or any deformation or sudden change in the feet. “That’s your body telling you that something is wrong, and you should see a professional.”

When patients visit a podiatrist they should be prepared to provide as much information about their medical history, lifestyle, and current condition as possible. Prepare a list of questions about your physician’s diagnosis of your foot problems, and ask about available treatment options to create a partnership with a practitioner. Patients also should be open to learn preventive self-care and address problems in other areas of the body that may be manifesting in the feet.

“A good biomechanical evaluation of patients is important,” Dr. Glesinger explains. “We watch patients walk and ask a lot of questions about lifestyle — what surfaces they usually stand on, what kind of shoes they wear, etcetera. Sometimes issues like leg-length discrepancy or shoulder tilt may be affecting the gait and causing problems in the feet. We’ll treat the immediate issue and recommend a good physical therapist to create an exercise regimen to prevent the issue from recurring.”

“We don’t just trim toenails all day. We really are looking at the function of the foot to help people move and walk better. Sometimes with minimal intervention, or otherwise with drastic action,” Dr. Aung adds.

The most common issues podiatrists treat include ingrown toenails, plantar fasciitis, corns, bunions, and diabetes-related ulcers and neuropathy.

Nailed It

Most people can identify an ingrown toenail. Children as well as adults may experience them. It’s a common condition that occurs when the toenail grows into the soft flesh around the nail bed. The imbedded nail causes the surrounding skin to become red, tender, and may even result in an infection. In minor cases, a quick, precise trim of the nail will resolve the issue. However, if the issue is recurrent, or the affected skin is hot, draining, or there are red streaks originating in the affected area, further treatment is required. A podiatrist may remove part of the nail and apply a chemical to prevent that section from regrowing.

Podiatrists also will offer to train their patients on how to trim nails properly to prevent recurrence. Some feet are genetically predisposed to have ingrown nails. In other instances, the condition may be caused by gait mechanics or improperly fitting shoes. Often, by the time adults seek professional treatment for ingrown toenails, they have become a recurrent issue. In these cases, orthotics or physical therapy may be part of a treatment plan.

A Time for Heeling

Plantar fasciitis, most common among women and very active people, is inflammation of the soft tissue, or fascia, that connects the calcaneus (heel bone) to the toes. Symptoms may range from an irritating dull ache in the heel to extreme, debilitating pain when active or at rest.

The pain is caused when ligaments become taut and pull so hard the pressure creates micro-tears and swelling at the anchor point in the heel. Dr. Aung sees many plantar fasciitis cases. She notes the condition usually results from body form and mechanics, and 90 percent of the time, it can be resolved with anti-inflammatory drugs, stretching, icing, and use of orthotics. Although over-the-counter “quick-fix” solutions abound, Dr. Aung explains that patients often come in after they’ve tried many of them to no avail. “Custom-made orthotics are the key,” she states. “Something hard that won’t lose its shape should be created for each foot. One-size-fits-all arch supports or shoes with built-in support may not control the arch enough.”

Slightly more invasive plantar fasciitis treatment may include injections to the affected area. Dr. Aung is currently participating in a clinical trial of a procedure to apply Botox directly to pain receptors to relieve symptoms. More extreme cases of plantar fasciitis may require a minimally invasive surgery. The plantar fasciotomy procedure involves surgically releasing tight fascia tissue through a small incision in the bottom of the foot. Patients may bear weight right after surgery and can fully recover and return to previous activities in several weeks.

Where the Corn(s) Grow

Corns on the feet are hardened layers of skin that develop on pressure points to protect the deeper tissue from friction or pressure. They generally develop on the bottom or side of the foot and have a central core. Improperly fitted shoes and biomechanical imbalances are most often the cause of corns and calluses. Dr. Glesinger vehemently discourages patients from purchasing and applying over-the-counter medicated pads to corns. “People usually spend a lot of money and order the wrong treatment for specific issues,” she states. Often the medication or acid in these remedies is too strong and burns holes in the area that can become a much larger problem. Patients are urged not to pick, cut, or peel corns, but rather to have them treated by a professional.

Treatments may include application of topical medication or precise shaving of the built-up, hardened skin. Per a biomechanical analysis, orthotics use or a change of footwear may be recommended to keep the issue from recurring.

Out of Joint

Bunions are a deformity of the big toe joint causing the toe to lean at an angle toward the outside of the foot. They develop slowly and are not always painful. The condition may become painful if the toe places pressure on, or even dislocates, the adjacent toes. Tight shoes can exacerbate pain in the joint and may contribute to the condition, but bunions generally are structural defects. Treatments range from proper shoe fitting, to orthotics, to joint replacement surgery.

Experts recommend seeking professional care long before bunions become painful. Most over-the-counter fixes, which include toe separators and bunion-adapted shoes, will not hurt or exacerbate the condition, but they won’t repair it, either. Without proper treatment, bunions will get worse, placing pressure on the joint cartilage and even damaging nerves. “If you treat the problem when it’s a smaller one, you don’t have to be so invasive. Orthotics don’t reverse the issue, but they help people function better and keep things from getting worse,” explains Dr. Aung.

Struck a Nerve

Dr. Armstrong Photo by Kris Hanning

Taking excellent care of our feet is important for everyone. However, for people with diabetes, it can be a matter of life or death. Diabetes affects 30 million people in the U.S., and 415 million worldwide. Diabetic foot complications cost more than the five most-costly cancers in the U.S. today. According to David Armstrong, Ph.D., DPM, UA Professor of Surgery and author of more than 240 research papers on the subject, every 1.2 seconds someone in America gets a diabetic foot ulcer or wound. Every 20 seconds someone gets a diabetes-related amputation. After an amputation, 50-75 percent of patients die within five years.

In diabetic patients, a pro-inflammatory state created by high blood sugar and resultant high triglycerides deadens the nerve response in lower legs and feet, often called neuropathy. This condition causes numbness, or “loss of the gift of pain,” as Dr. Armstrong describes it. “These patients literally can wear a hole in their foot. They can’t feel it. It’s akin to walking on a broken leg that you didn’t know was broken.” Injuries sustained to neuropathic limbs can develop devastating infections that can necessitate, in extreme circumstances, amputation of the foot or even the leg.

Experts agree that people with diabetes should include a podiatrist in their treatment team and be examined by them at least annually. Diabetics should always take any foot issue very seriously (whether it is painful or not) and consult a medical professional as soon as one is noted. Regular podiatric care can reduce a patient’s risk of developing complications 20-80 percent according to Dr. Armstrong.

In 2008 Dr. Armstrong established the Southwestern Academic Limb Salvage Alliance, and more recently became the co-director of the Southern Arizona Limb Salvage Alliance (SALSA). He joined the University of Arizona’s Department of Surgery to build an advanced clinic for wound care as a part of an interdisciplinary team there.

“Feet are an anatomic peninsula. This forces us to team up with colleagues in other disciplines to solve problems,” Armstrong observes. “We have the team, and we are building the technology.”

There are currently more than 30 clinical trials SALSA-associated clinicians and researchers are conducting to investigate seemingly futuristic treatments, such as stem cell wound care, spreadable skin graft paste, and in-shoe exoskeletons to offload foot pressure. All are focused on saving limbs and lives.

However, Dr. Armstrong’s most prominent message, aligning with the sentiments of Drs. Glesinger and Aung, is that prevention pays. Don’t wait. Don’t perform a procedure from the Internet to cure foot issues. Collaborate with a podiatric physician to alleviate issues and learn how to keep your feet in optimal condition so they can keep you healthy, active, and moving well through life.

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