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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