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Below are articles regarding different topics concerning foot health. Click on the article of interest to link to that page.
Broken Bones in the Foot: Bunions: Corns & Warts: Frostbite: Flat Feet: Hammer Toe: |
Heel Pain: Medicare: Numbness: Orthotics: Toenails: Treatments for Foot Pain: |
What is a foot doctor?
To be honest with you, I did not even know what a “foot doctor” or podiatrist was, let alone they existed, until I was searching for what type of medical degree I wanted to obtain before graduating from college. My first exposure to “who they were and what they did” was via a lecture in college at a career colloquium by a podiatrist my senior year. He had a slideshow of what he did in his office from trimming toenails, to foot injections for pinched nerves, and finally on foot surgery. Needless to say, my experience was rather memorable, but graphic. I had some interest before that time in podiatry, but after that lecture, I had to really think twice about my future a foot specialist.
Why did I just give this walk down memory lane? Because, it was to show that perception has an affect on how we will respond. I almost made a choice to not become a foot doctor because of that one experience. I am glad that I made the choice I made rather not making it. I believe that I choose the right profession for my future. However, that choice was made only after I investigated further what exactly a podiatrist did, their history, where they went to school, how they were trained, how much they made, and so on. It was only after this rigorous research that I decided to become a podiatrist.
That is why I am here writing this article, I want to educate you, the reader, on podiatry. Most people know that a foot doctor trims corns and calluses, but we do far more than that. Our history has allowed us become the leading premier provider in expert foot care. Through our former years as chiropodists, we have evolved into the well-trained podiatric medical physicians we are today. We can diligently care for the feet and lower extremities through the most advanced medical and surgical procedures available. What used to take just months to become a foot care technician (chiropodist) now takes four years of college (BS degree), four years of podiatry school (accredited medical school), and a three year hospital residency program in foot surgery to become a podiatrist.
After graduation from the surgical residency training, a podiatrist enters the medical field and begins to practice the art of foot care. To become a staff physician at a local hospital the podiatrist must be a board certified podiatric physician or surgeon. We are equal in training to the allopathic (MD) and osteopathic (DO) when it comes to medical school. But, it is our post-graduate training which allows us to be the leading medical providers in foot care. We can manage any problem related to foot and ankle. In some parts of the country, a podiatrist can do surgery on areas above the ankle as long as it is related to the foot problem in question. We are even allowed to perform our own history and physicals on patients prior to foot surgery.
We have come a long way and it looks like we are not stopping. Whether you are young or old and suffer from heel pain, ingrown nails, diabetic foot problems, abnormal skin or toenail conditions, flat or high feet, slow healing wounds of the foot /leg, sports medicine maladies, or just foot deformities like bunions or hammertoes, then a podiatrist is the doctor to see. Foot pain is not normal. So, don't become a statistic like millions of Americans that have not sought foot care when they needed it. The fact is that 80% of all Americans will have a foot problem some time in their life and only 3% will seek care from a podiatrist. Now you know the facts and the homework has been done for you. Get going and get on the road to relief!
Why Diabetic Shoes
This question is asked most often by patients who are diabetic. They see all kinds of ads on the television and in the newspaper and wonder why they need these “special shoes”? Once they find out why, then they are usually convinced on how important it is to take care of their feet by wearing the “right” shoes. Diabetics are always afraid something “bad” or “serious” is going to happen to their feet or legs. They will do “anything” to prevent this from happening once they find out what they can do to help themselves.
The months of November and December are dedicated “Diabetic Foot Care Aware” months in the State of Illinois. This is a sponsored event by the Illinois Department of Human Services Diabetes Education Division and the Illinois Podiatric Medical Association (IPMA). These months allow any diabetic to get a “free diabetic foot exam” from a podiatrist affiliated with the IPMA. The podiatrist will exam the diabetic patient’s feet and lower extremities and see if there are abnormalities with the skin, bones, blood flow, and/or sensation of the feet. They will provide a prognosis and treatment plan to resolve or help prevent any diabetic foot problems from becoming worse with time.
One of the treatment options may include a pair of extra-depth “over-the-counter” or custom molded prescription diabetic shoes with three pair of accommodative inserts for the shoes. The purpose of this type of shoe and insert is to prevent any on-going or potential diabetic foot complications from getting worse. They are made of special materials to allow this to happen. They provide not only comfort, but the necessary protection against developing corns, calluses, and even sores from occurring on the feet. These are especially useful in the diabetic who has loss or reduction of sensation in their feet.
Diabetic patients who are on Medicare Part B may qualify for coverage because of the diabetic shoe program developed by Medicare in1993. They would need to be evaluated by their podiatrist to see if they meet the necessary qualifications. This can be done through a physical exam (like the one mentioned above). Then, the podiatrist would need a certificate of medical necessity from the physician who is treating them for their diabetes. Once this is done, then the patient may order the shoes from their podiatrist. Many attractive styles are available for all walks of life and daily activities. Call your podiatrist today. To get further information or an appointment from a local foot doctor call 1-800-366-8397 or 1-800-323-4769.
Keep Your Feet Out of the “Cold”
By now, winter has certainly taken a toll on us all. The holidays are long gone, the dreary days of the season are monotonous, and most people are looking for the sun. Exercise is usually at a minimum at this time of year, but for those who do venture out of doors there are some helpful hints one should know to keep their feet healthy and safe from cold injury.
Outside of “frostbite” there many other cold injuries that can occur. But, the nature of this article is not talk about the typical cold injuries, but rather to explain simple ways to prevent these cold injuries. The most important step in preventing these types of problems is concerning the type of socks and boots/shoes are worn. Both are a necessity and should be considered when partaking in outside winter activities.
Socks are to be made of a wool blend and possible water proof materials (Gore-Tex). They should not only keep the feet warm, but dry as well. Any time socks get wet through perspiration or water should be changed immediately. Individuals who may be involved in winter sports, camping or hiking must be prepared and have an extra pair of socks on hand, just in case of any unfortunate incidents that may occur.
Winter boots or shoes are, of course, the next and most important protective measure one can do for their feet during the winter months. There are currently so many shoe/boot manufacturers it can be rather confusing to know which ones are the best for cold weather conditions. Just like socks, the winter boots/shoes should keep feet dry and warm at all times. Cost can play a factor when purchasing these types of items, but when it comes to your feet it is imperative to do the “right thing”.
Cold injuries can be caused by the environmental temperatures that are cool enough to harm to the skin due to exposure over a certain length of time. Every effort should be made to protect your feet in the winter. Take the advice that I have given you and put it into practice. You will be much happier for it and so will your feet.
Cosmetic Surgery and Podiatry
Some may call it “cosmetic surgery of the feet”, but some podiatrists would rather call it "preventative foot surgery" or "surgical enhancement of the foot”. With the unbelievable rise in the cosmetic surgeries done in the US, some foot surgeons in the podiatric profession has recently "stepped into the ring" as well. There is, however, much discourse between the certifying podiatric surgical boards and some newly formed podiatric groups that have cropped up in recent years. These foot surgeons want to concentrate on the "cosmetic surgical ability" in the podiatric profession. Since third party payers have started to decrease reimbursement to the medical profession in general. Some podiatrists have decided to get creative and provide aesthetic foot care services to there patients.
While there is nothing wrong with providing these types of services in a podiatric setting, the problem arises when a patient’s health insurance companies are being billed for these services. These "aesthetic" foot care services can include and not be limited to corrective surgery for deformed toes (bunions and hammertoes) which are not painful, collagen injections to soles of the feet or around bony prominences to provide cushioning, or any surgical procedure that is resolved because the patient doesn't like the way it looks.
Surgery of any kind has the potential for complications. So, foot surgery of this caliber should not be performed unless a thorough consent by the surgeon is obtained and the patient has signed a waiver stating they have sought out this type of treatment and accept full responsibility for a potentially bad outcome. Even with this type waiver of liability in place a patient still has a right to file a malpractice claim against a foot surgeon.
If an individual is seeking this type of foot surgery, then may want to seek a consultation from accredited board certified plastic surgeon that specializes in the field of cosmetic orthopedic surgery on the feet. Since these types of surgeons are trained in providing this type of service and solely practice on a patient population who electively seek cosmetic surgery, then the risk of liability may be less on the surgeon. So, it is important for an individual to investigate the credentials of any physician who performs surgery of any kind before "going under the knife".
A foot specialist is well-trained physician who specializes in diagnosis and treatment of all diseases related the foot and ankle. They are best medical and surgical providers when it comes to foot care. They seek to maintain and uphold the highest quality of care when it comes to the feet. So, if you have a foot problem that may look rather funny, but is causing you no symptoms, then it is still important to get it checked out. God gave you one pair of feet and they need to last a lifetime!
Why Diabetic Shoes?
This question is asked most often by patients who are diabetic. They see all kinds of ads on the television and in the newspaper and wonder why they need these “special shoes”? Once they find out why, then they are usually convinced on how important it is to take care of their feet by wearing the “right” shoes. Diabetics are always afraid something “bad” or “serious” is going to happen to their feet or legs. They will do “anything” to prevent this from happening once they find out what they can do to help themselves.
The months of November and December are dedicated “Diabetic Foot Care Aware” months in the State of Illinois. This is a sponsored event by the Illinois Department of Human Services Diabetes Education Division and the Illinois Podiatric Medical Association (IPMA). These months allow any diabetic to get a “free diabetic foot exam” from a podiatrist affiliated with the IPMA. The podiatrist will exam the diabetic patient’s feet and lower extremities and see if there are abnormalities with the skin, bones, blood flow, and/or sensation of the feet. They will provide a prognosis and treatment plan to resolve or help prevent any diabetic foot problems from becoming worse with time.
One of the treatment options may include a pair of extra-depth “over-the-counter” or custom molded prescription diabetic shoes with three pair of accommodative inserts for the shoes. The purpose of this type of shoe and insert is to prevent any on-going or potential diabetic foot complications from getting worse. They are made of special materials to allow this to happen. They provide not only comfort, but the necessary protection against developing corns, calluses, and even sores from occurring on the feet. These are especially useful in the diabetic who has loss or reduction of sensation in their feet.
Diabetic patients who are on Medicare Part B may qualify for coverage because of the diabetic shoe program developed by Medicare in1993. They would need to be evaluated by their podiatrist to see if they meet the necessary qualifications. This can be done through a physical exam (like the one mentioned above). Then, the podiatrist would need a certificate of medical necessity from the physician who is treating them for their diabetes. Once this is done, then the patient may order the shoes from their podiatrist. Many attractive styles are available for all walks of life and daily activities. Call your podiatrist today.
Getting your Feet Ready for Anything
See the foot doctor if you have any problems with your feet:
- long, ingrown, thick or fungus toenails (easy convenient low-risk treatments are available to rid you of these problems)
- bunions ( bump on the side of the big toe or fifth toe joints): foot surgery may need to be considered)
- chronic heel pain (heel spurs): non-invasive or minimal incision type procedures(with little disability)are available to resolve heel pain)
- hammertoes or overlapping toes: left unattended they will progress into corns and pain with shoes
- pinched nerves in the feet causing pain and numbness in the ball of the foot (usually between 3rd and 4th toes): minimal invasive procedure available to resolve)
- Are you a diabetic? -you should have a foot exam every year (Nov. and Dec. are Diabetic foot care aware months): diabetic shoe program approve through most insurances)
- Apply skin moisturizers daily to your feet to prevent dry cracked skin: check for rashes, skin discoloration, and any problems between toes which may be irritating (soft corn/ athlete’s foot): these problems will worsen if left untreated
- Have your orthotics (arch supports) checked by a foot doctor for age related problems: considered a new pair if greater than 3-5 years old
YOUR FEET NEED TO LAST A LIFETIME VISIT A FOOT DOCTOR!!
Numb Feet in Diabetics
Most diabetics who have had the disease for a sustained period of time may experience feet that become numb or just have abnormal sensation. This feeling can range from pain to stinging and/or burning sensation. Some diabetics have most of the pain at night while in bed. The whole foot may or may not be affected. This condition is known as “neuropathy”. It can be rather debilitating for the diabetic if left untreated.
As neuropathy progresses, it can cause a number of foot problems for the diabetic from imbalance to even the possibility of ulcerations of the feet that do not heal. Many theories have been formulated “to why” neuropathy occurs, but the major reason may just be in the individual’s foot structure. Long before a person’s diabetes was diagnosed, their foot structure may have played a role in acquiring neuropathy.
This abnormally flattened or pronated foot structure can be the precursor to a diabetic getting their “neuropathy”. The reason is because the nerves traveling through the ankle on the way to the foot can get compressed and pinched as the person walks and stands. Over many years, the diabetic slowly causes damage to these nerves. Because of the decrease in circulation caused by the diabetes, the nerves in the foot cannot heal and eventual irreversible nerve damage occurs. This condition causes the symptoms of numbness which spreads from the toes, up the foot, into the ankle and lower leg.
Diabetics, who are suffering from pain in their feet, especially at night, may have poor circulation. So, it is important that their doctor treating them for diabetes or foot doctor screen them for peripheral vascular disease (PAD). Once this is ruled out, then the diagnosis and treatments can be centered on identifying the diabetic’s foot structure causing any nerve involvement. Usually a foot doctor or podiatrist can make the proper evaluation a diabetic’s feet. They will identify whether or not the “neuropathy” is truly related to the diabetes or inherent to the patient’s foot type.
Once this evaluation is made, then a proper treatment regimen can be formulated. The whole goal of the treatment plan will be to decrease symptoms of the numbness and/ or pain by controlling the pronation or flattening of the feet. Along with physical therapy, medication, and other supportive therapies the patient’s symptoms should improve. After this is done, then the “hope” will be to reverse the process of “neuropathy” and prevent future complications in the diabetic’s feet.
"Local Foot Doctor Eliminating Foot Pain"
Charleston, IL- Podiatric surgeon and specialist, Dr. Joseph Borreggine, who practices in Charleston and Effingham, IL, has begun to see excellent and long lasting results on his patients from two minimally invasive procedures that he performs to eliminate foot pain.
Recently interviewed, Dr. Borreggine has become an expert, well-versed, and trained in performing these two highly advanced procedures. He has done this by not only by attending the necessary surgical workshops and seminars needed to become certified, but also by performing many of them over the last few years.
Borreggine said, "To perform either of these procedures requires nothing more a small surgical opening to be placed strategically on the foot. One procedure eliminates the complaint of heel pain and the other can literally eliminates flat feet once and for all. Recovery has very little disability afterward".
The procedure that stops heel pain is called the "Kobygard plantar fascial release" and the other than alleviates flat feet is called "The HyProCure procedure". Whether they are done independently or at the same time, they can be performed in an outpatient setting under "twilight sedation" either in an ambulatory or hospital-based surgery center.
The Kobygard technique can stop heel pain (plantar fasciitis) by releasing the abnormally tight section of the plantar fascia located on the bottom of the foot. Borreggine said, "The results of this procedure have been phenomenal". He went onto say that his results have mirrored what is in the podiatric literature regarding the Kobygard procedure. "Over 90-95% over the patients who have this procedure are pain free (in the heel) within a few weeks of having it done", Borreggine said.
Borreggine explained that after the Kobygard procedure patients need to be a surgical shoe or boot for 5-7 days and can weight bear to tolerance. Borreggine also said that the post-operative pain varies from patient to patient and can be controlled by pain medication. "Usually in a week or so patients can go back into an athletic shoe in about a week", explained Dr. Borreggine. He also said, "After this procedure, people can have a better quality of life and return to the normal activities that were limited or stopped because of the heel pain".
The same can be said of the HyProCure procedure. Borreggine stated, “Again, by making a small surgical opening on the outside aspect of the ankle, this procedure uses a small stent that is placed under an ankle bone known as the "talus". It realigns the talus and prevents it from having excessive motion that can cause painful flat feet or "hyperpronation" (hence the name "HyProCure", which is short for "hyperpronation cure"). The anesthesia needed and recovery is very similar to the Kobygard”.
“This procedure can be done on children as well. The results have been excellent and whether you are child or an adult, flat feet can cause a myriad of foot, ankle, knee, hip and back problems" "Performing the HyProCure procedure, may insure that future problems, like arthritis of the knee, hip and back can be curtailed.", said Borreggine.
Finally, Borreggine related, "Podiatric surgery is on the "cutting-edge" of these types surgical advances and they are available right here in East Central Illinois".
For more information you may log onto www.hyperpronation.com for the HyProCure and www.osteomed.com for the Kobygard system. Dr. Borreggine lives with his three children in Charleston, IL and is a Diplomate of the American Board of Podiatric Surgery and Fellow of the American College of Foot and Ankle Surgeons. More information on foot problems can also be found at www.myfeethurt.net
People Need Not Suffer From Bunions: IL
Podiatrist
Most people think they have to live with bunions or go through a very disabling surgical procedure to resolve it. These facts are not true, and therefore, a foot specialist should be consulted if this deformity is present. “The cause the bunion deformity is not the shoes that a person wears. It is actually caused by abnormal foot joint alignments around the great toe.”, says podiatrist Dr. Joseph Borreggine. The large bump around the great toe is usually red, swollen, and painful. The bone sticking out around the great toe actually has not ``grown,' but rather it is the joint that is becoming subluxed or dislocated.
photo
“Pain occurs when the shoe presses on the bunion deformity. However, bunions may not always be painful, but asymptomatic bunions can cause debilitating arthritis if left untreated.”, says Borreggine. Bunion deformities are hereditary, usually caused by flat (hyperpronated) feet, and are more prevalent in women (since, statistically, women seek care for foot pain more than men).
Borreggine says bunion pain can be relieved through many treatment regimens, including arthritis medication, steroid injections, wider shoes and arch supports. Bunion surgery could be the best treatment to correct the problem, if all else fails. As always, it's advisable to consult with a podiatrist and see which treatments is available.
Source: Herald Review [2/7/08]
"Podiatry Keeps America Walking Healthy"
For years, dentists have touted to their patients the importance of good oral hygiene. This has been done by public education through the American Dental Association (ADA) recommending we brush our teeth after every meal, when we get up in the morning, and before bed time. Dentists also recommend that you see them at least twice a year for a teeth cleaning and exam. I would say that from all that prevention most people would probably never get cavities or lose their teeth due to decay. Well, as we know, this is not the case. Even with all the education and preventative care, people still do not get the message.
Podiatrists are the leading foot care experts in the country. We, as a profession, have not done the job that dentists or optometrists have done with public. That is, most Americans do not value their feet like they would their teeth or their eyes for that matter. The feet are prone to a multitude of problems and can become much more serious if they are not treated appropriately. The fact is that 80% of all Americans will suffer a foot ailment in their lifetime and only 3% will seek relief from a foot doctor. This is amazing and unfortunate at the same time. Podiatry still has much work to do in foot care education, let alone prevention.
Podiatric physicians, like me, are cavaliers who continue to provide information on the profession's behalf to the public. Any opportunity made available through public relations is the best way to educate the patient population at-large on how important foot care is to maintaining good health. Since there so much information disseminated through multiple multi-media sources like radio, television and the Internet, then it becomes very hard to dispel the wide variety of misinformation which most people foster as the truth. So, it is important to visit a podiatrist when a foot problem arises. They can and will use their expertise to make the proper diagnosis and provide a treatment regimen to resolve the foot problem.
Since preventative measures are the key to success to eliminating many of the health problems today, podiatry has partnered with a company called "Walk Healthy Foot care Pharmacy". These foot care products are now available to podiatrists to dispense to their patients right from their office location. The company prides itself on a simple two-step approach to ensure proper hygiene and optimal foot functionality. Step one: is "The Foundation" and step two: is the "Ailment Specific Treatment". Both of these work concomitantly to provide an insole system to provide proper foot biomechanics in a "clean" environment and incorporate number superiorly alternative remedies for the feet which have more sophisticated technology than what is currently available.
From the highly advanced insole system to the topical sprays, creams, gels, and pads, "Walk Healthy Foot care Pharmacy" is taking a "giant step" in the right direction to not only have options available for sound foot care, but they are the current leaders in prevention against common foot ailments that continually plague the general public. To obtain more information on this revolutionary concept in foot care medicine, contact foot specialist, Dr. Joseph Borreggine at 1-800-366-8397 or email by clicking here. Dr. Borreggine practices in Charleston and Effingham, IL.
To obtain any other information on Dr. Borreggine practice, go to www.myfeethurt.net.
"Your Feet need a 'Resolution' from your Weight"
Most Americans are currently suffering from a slow debilitating condition that will have far reaching effects in the future if it is not curtailed sooner than later. This condition can cause a number of other life-threatening diseases if it is left unchecked. This problem has been on the rise for decades without any end on the horizon. People are seen with it everywhere you go. No matter where it is you will find it. It is inescapable. What is it? Well, it is obesity.
Unfortunately, we are at an “all-time” crisis when it comes to people being overweight. With the rise of fast-food restaurants and dining out, the fast pace life styles we lead, and the general lack of physical exercises, obesity is now the "norm" for most Americans. Recent studies have shown that we are becoming (if not already) the fattest nation in the world! This statistic is nothing to be proud of and must change soon! I, myself, have become part of the statistic and need to make another New Year's resolution to change for the better.
I know one thing (and your feet know it as well). This is not healthy at all. Over time, our feet can become irreversibly damaged by the amount of weight put on them daily. As we age, we can have arthritic changes, but excess weight can injure the ligaments and tendons along with the bony structure of our feet. Regrettably, this can create problems like heel spur syndrome (plantar fasciitis), bunions (crooked big toe joint), ankle pain/sprains, and others. And with painful feet, who wants to do any exercise to lose weight?
Outside of the foot problems caused by obesity, there are diseases that can have general effects on the feet that normally can be managed by the patient. However, if you cannot reach to see or take care of your feet because of unnecessary excess weight, then a simple problem can become rather severe left unattended. For example, the diabetic who is overweight can have poor circulation, and numbness to their feet. They can always be prone to having non-healing foot sores that can be caused by undue pressure or irritation on their feet. As mentioned, if they cannot see these problems, then serious complication may (or can) occur.
According to a recent article in the September 2007 American Podiatric Medical Association (APMA) News, The North American Association for the Study of Obesity (NAASO)/The Obesity Society, almost 90 percent of people with Type II diabetes are overweight. They also noted that the number diabetes cases among American adults have increased by one-third in the 1990's.
So, you can see the problem is not going away, but rather hitting us like “a freight train out of control”! So give yourself, your body (and your feet) "a break"! Get on the new "live-it" instead of that old "die-it" lifestyle and exercise daily for thirty minutes by walking, eat healthy along with smaller portions, and drink lots of water. If you do this starting in 2008 and beyond, then the results will be phenomenal. Make that resolution and “get on the road to relief”! And I know, your feet will like you even better!
For further information on taking care of your feet you can go to www.myfeethurt.net or contact Dr. Joseph Borreggine, foot specialist, toll-free at 1-800-366-8397 and make an appointment for a complimentary foot exam and consultation.
Topaz is the Jewel Treatment for Heel Pain
Numerous treatments through the years have been used to resolve heel pain. From oral anti-inflammatory medications, prescription arch supports (orthotics), cortisone shots, to radical heel surgery, therefore one would think that there is no cure for this foot problem? There may not be. Because the variables involved in the cause of heel pain certainly has a wide array of underlying conditions.
The traditional diagnosis made by most doctors is "Heel Spur Syndrome". But this is really a misnomer. This so-called "heel spur" is never the cause of the pain, but rather an injury of the ligamentous structures in the bottom of the foot attached to the heel. This is known as "plantar fasciitis" (PLAN-TER FASH-E-I-TIS). This is an actual inflammation and swelling of these soft tissue structures caused by overuse and/or injury. In most cases, this leads to thickening of the plantar fascia and is known as "plantar fasciosis" (PLAN-TER FASH-E-O-CIS).
This condition causes the ligamentous structures (fascia) to not be as elastic as it should be. So, the classic foot symptoms of pain in the heel after getting out of bed in the morning or getting up from rested or seated position with pain resolving with activity and it returning at the end of the day are what a person may experience. This problem may get better with stretching, ice, oral medications, or some sort of arch support, but this can be very limited in its result.
Professional care by a podiatrist (foot doctor) may include injections, physical therapy, and orthotics, but again the results are not permanent. The podiatric physician may evaluate their patient for other underlying back problems and/or structural abnormalities of the leg, ankle, and/or ankle to see if that may be the cause of the pain. Further examination must also rule out any cause of heel pain related to nerve conditions or compressions of the foot (neuropathy) caused by metabolic diseases like diabetes and/or arthritis.
Once a definitive diagnosis of plantar fasciitis or fasciosis is made and all therapies have been tried or failed (or the patient does not want to have non-surgical treatment), then a decision must be made to resolve the heel pain more invasively. Historical procedures have included "heel spur" resection with or without plantar fascial release. But this procedure was rather disabling and has fallen out of favor by podiatric surgeons. More advanced procedures like the non-invasive Extra Corporeal Shockwave Therapy (ESWT) (www.unitedshockwave.com) and Minimally Invasive Plantar Release (www.Kobygard.com) have certain been less disabling, but have not quite had the results expected.
Today, an FDA-approved use of radio wave therapy (www.topazinfo.com) to treat heel pain is now available in the US. Many podiatrists have been able to successfully resolve heel pain using a special wand to place strategic holes in the plantar fascia to increase blood flow and allow it to heal and stop the pain. This procedure should be used in patients with heel pain strictly caused by plantar fasciitis or fasciosis. Topaz is performed with a minimally invasive technique on an outpatient basis. Disability is a few days in a surgical shoe. The technology came from Arthrocare Inc. (www.arthrocare.com) which has been used extensively for years in the ENT and orthopedic community to resolve chronic ligamentous and soft tissue problems.
Further information and consultation for treatment can be obtained from Joseph Borreggine, DPM at 1-800-366-8397 or www.myfeethurt.net. Borreggine is well versed in the Topaz procedure and trained in the use of the equipment to resolve heel pain.
'Growing pains' are real for children
By NATHANIEL WEST - H&R Staff Writer
Youth may not necessarily be wasted on the young, as some kids do pay a price for their seemingly boundless energy.
It's estimated that up to 40 percent of children suffer from "growing pains," which may result from the daily activities of on-the-move youngsters, although the specific causes remain a mystery.
As far as local medical experts are concerned, the safest and best way to diagnose growing pains - an ambiguous term that is used loosely at best by health care professionals - is to rule out other, more serious ailments first. And parents are advised to have their children evaluated if symptoms are ongoing or inconsistent with those typically associated with growing pains.
"If it's a recurring problem such as daytime pain, pain with activity or pain at rest, I would say they need to be looked at," said Michael Wagner, a family nurse practitioner with Orthopedic Partners in Charleston and Mattoon. "We don't take it for granted that it's just growing pains." According to KidsHealth.org, growing pains - if they can be called that - are a "normal occurrence" for 25 percent to 40 percent of children, especially among 3- to 5-year-olds and 8- to 12-year-olds. Experts say there is insufficient evidence that bone growth causes growing pains, which some physicians believe is a misnomer because the condition affects muscles rather than joints.
Most children with so-called growing pains complain of discomfort in their thighs, lower legs or behind their knees during the late afternoon or early evening. "It's usually after a big day of activity," said Wagner. "But nobody knows the (cause) of it." Even so, experts warn that if the pain seems concentrated in joints instead, or if it's a regular problem, a medical evaluation is needed. Other symptoms that may merit more drastic action include:
- Morning pain;
- Inflammation or redness in one isolated area;
- Limping, or pain possibly related to an injury;
- Fever or rashes;
- Lethargy or loss of appetite.
According to Dr. Joseph Borreggine, a foot specialist in Charleston, serious heel conditions can be mistaken as growing pains. These include Sever's Disease, in which the heel's "growth plate" - the softer, cartilaginous part of children's bones where growth occurs - is stretched by the Achilles tendon. "When they're running or jumping, they're just pulling that growth plate," said Borreggine.
When a child is brought to a physician's office for suspected growing pains, Wagner said a thorough physical examination is conducted, which may also include
X-rays, lab work and even an MRI.
He said it is better to err on the side of caution, as there are a multitude of other afflictions that could be prompting the aggravation. These include trauma from a fracture or sprain; inflammation from a disease such as juvenile rheumatoid arthritis; developmental illnesses; neurological problems; or even cancer.
"A practitioner can't just say, 'It's growing pains, see you later,' " Wagner said. "We have to do a work-up." If the hurt is from a "disturbance" of a growth plate rather than simple growing pains, Borreggine said the typical recommended treatment is "rest and inactivity." "But try to keep a 9-year-old down," he added. "Kids are resilient. They play with pain."
To alleviate typical growing pains, KidsHealth.org advises parents to massage and stretch the afflicted area, apply a heating pad or administer ibuprofen or acetaminophen.
Nathaniel West can be reached at nwest@jg-tc.com or 238-6860.
Experts say take care of your tootsies be aware
of salon safety
By NATHANIEL WEST - H&R Staff Writer
MATTOON - Most salons stay afoot of the best pedicure safety measures. However, there are a few pedicure providers who toe the line.
"The majority of the salons I am in contact with follow procedures to a 'T,' " said Loretta Hernandez, cosmetology and nail tech adjunct instructor at Lake Land College in Mattoon. "But there are several salons out there that are more concerned about time and money (than) keeping their clients safe.
"That's like cutting your nose off to spite your face. If you don't follow safety procedures, you're going to lose clientele," Hernandez said. "If you have one client leave with a staph infection, your business is basically going to be over." Even though infections resulting from carelessness during pedicures are rare, such problems do occur. With the popularity of pedicures on the rise, local experts advise salon clients be wary of improper sanitation.
"We're not trying to put nail salons out of business," said Dr. Joseph Borreggine, a podiatrist in Charleston for 15 years. "We're trying to educate our patients." In a January article in Podiatry Management Magazine, Dr. Robert T. Spalding discussed two deaths in Texas and California last year that were attributed to complications from pedicures at poorly disinfected salons.
"The biggest concern in nail salons is proper equipment cleaning and sterilization," Spalding wrote. "Since nail technicians are not supposed to be working in a blood field or sterile environment, the standards for keeping their instrumentation clean from bacteria, fungal and viral organisms historically have been more relaxed than those in the health care profession. "The question is not whether disinfection works, but whether the nail techs are taking the time to do it right."
Hernandez said her students learn about the dangers of bacteria and the need for rigorous sanitation long before they tackle actual pedicures. Such education "is really, really necessary, especially in this day and time when there are so many communicable diseases out there," Hernandez said. She added that students also are taught to consult with clients about whether they have any preexisting ailments such as diabetes, high blood pressure or a history of stroke that could make an otherwise simple pedicure potentially harmful.
Borreggine said he treats patients with pedicure-related problems only on occasion, but some of the cases have proven quite serious. He cited a diabetic with poor foot circulation who required a leg amputation after a bad pedicure led to an infection. "The fact is, that's how severe it can be," Borreggine said. "It's not something we see often, but when we do see it, you always hear the same story: The patient has gone into the nail salon, and they get an infection."
To lessen the dangers of improper pedicure sanitation, Borreggine recommends that clients bring their own pre-sanitized instruments to the salon. Hernandez believes kits available for purchase designed specifically to address this present their own problems, in that clients sometimes put their used instruments back in a moistened bag that becomes "a little greenhouse, a breeding ground for bacteria."
"I would rather trust my nail technician and her stainless steel implements. And if you don't trust your nail tech, you need to go somewhere else," she said. Along those lines, Hernandez, who also is a partner at Hair Benders Salon & Day Spa in Mattoon, said clients can learn a lot about their cosmetologists or nail technicians simply from the cleanliness of their businesses.
"Go investigate the salon you want to go to," she said. "Ask them what their safety procedures are. And watch them." Hernandez added that unsanitary pedicure instruments, such as nail files, aren't the only sources for unwanted organisms. The small whirlpools used during pedicures also require frequent cleaning. However, she stressed that the vast majority of cosmetologists and nail technicians go above and beyond to make sure pedicures are as sanitary and safe as possible.
"I do feel we kind of get a bad rap because there are so many salons out there that do follow safety procedures," Hernandez said. At You Look Marvelous in Charleston, nail technician Marny Fitzpatrick said she runs disinfectant through her whirlpool for at least 10 minutes between every pedicure. She also scrubs her implements with soap and water after each use, followed by a long soak in a germ-killing solution.
Fitzpatrick said she always asks new clients about medical conditions that could turn a pedicure into disaster.
These precautions "are very important," she said. "You don't want to injure somebody or yourself."
Contact Nathaniel West at nwest@jg-tc.com or 238-6860.
“Get Proactive…Promote yourself”
Many practitioners commit lots of energy and money to their practices, only to see modest gains in their patient base and profit margins.
But, according to Dr. Joseph Borreggine, podiatric physician, “A little PR could help and go a long way!” Borreggine has been in practice for over fifteen years in East Central Illinois, and is the owner of The Family Foot Care Center in downstate Charleston and Effingham. Borreggine takes the “proactive” approach when using public relations to promote himself and his practice.
“If you just sit around and wait for stuff to happen, it’s not going to. You’ve got to get up and make it happen,” he says. His promotional efforts, in addition to public relations, have included print ads, yellow pages, billboards, cable TV, and radio. All have certainly played a role in growing his practice to what is today. Borreggine believes that many podiatrists rely much too heavily on word of mouth to obtain the bulk of their business, and though he agrees that it’s important, he cautions those who rely on it for all their referrals. For example, “Mrs. Jones, who thinks you’re a wonderful doctor, may not talk to Mrs. Smith until six months from now. The doctor that you get referrals from may forget about you; or, for some reason, doesn’t like you today or next week,” says Borreggine. “You can’t always bank on word of mouth.”
Since 1992, Borreggine has practiced what he’s preached by actively pursuing opportunities to promote not only his practice but podiatry as well. “Through the years, I’ve gotten involved with a lot of the civic organizations as a member and speaker. These include the local Kiwanis Club, the Rotary Club, the Knights of Columbus and the Lions Club.” Other promotional opportunities involved partnering with his local community hospitals, senior centers, employer human resource departments, chambers of commerce, and the county health departments where Borreggine has provided foot screenings to the public as part of annual health fair events.
“I feel it’s important to educate the medical community as well as the public on what podiatry is all about,” says Borreggine. Borreggine also has contacted local school athletic trainers, directors and personnel and has provided medical consultation services to sports teams during the school year. “A lot of these things didn’t come into fruition until years later,” Borreggine explained. “People just don’t respond to you immediately to use your services. It took some time to plant those seeds, and more time still before they actually began to grow.” But grow they did.
He currently is the consultant podiatrist for sports teams affiliated with Eastern Illinois University, in Charleston, IL, and Lakeland Community College in Mattoon, Ill., and he can be seen on the sidelines during many sporting events. Also, by meeting face-to-face with lifestyle-section newspaper editors, Borreggine has become a major and frequent media contact. He has been published numerous times in local newspapers, such as the Effingham Daily News, the Mattoon Journal Gazette and the Charleston Times Courier. Borreggine also has written articles for the APMA News and this publication. He is a regular contributor to the Health Illinois Magazine, a periodical that highlights healthcare specialists and has many human interest stories.
Borreggine also has been a “call-in foot-care expert” or been interviewed on several Illinois radio and television talk shows, including The Morning Show on WCIA-TV (CBS) in Champaign, Health Wise on WEIU-TV (PBS),Eastern Illinois University’s broadcasting station in Charleston, Foot Wise on WCRA-AM radio in Effingham, and Ask the Expert on WAND-TV(NBC) in Decatur, IL .“Doing the television spots, specifically Ask the Expert, allowed me to spread the word about podiatry all across Central Illinois,” says Borreggine. “People came in from as far as 150 miles away.”
When it comes to promoting your practice, Borreggine offers the following advice. First, be “a lantern” for the podiatric profession in your public relation efforts. Second, educate different groups about podiatric medicine and how you can help them. Third, be judicious with advertising dollars. It can be very expensive, and it may not always give you the return you expect. Finally, Borreggine says, “Do what you’re comfortable with, whether it be public speaking, writing articles, offering free services, etc.
Just get your name and face out there as much as possible and then you will see what happens!”
Five Myths About Foot Care
From bunions to broken toes, local foot and ankle surgeon has heard it all
(Charleston or Effingham, IL) “Don’t cross your eyes, they’ll stay that way!”
Old wives’ tales and myths like that example are fun to laugh at. We believed them as children. “Step on a crack and you’ll break your mother’s back.” But there are other myths that are no laughing matter, especially when they involve your health.
From bunions to broken toes, foot and ankle surgeon Joseph Borreggine, DPM, FACFAS, has heard it all. Borreggine treats patients at offices in Charleston and Effingham, IL. Borreggine shares five myths about foot care and the realities behind them.
Myth: Cutting a notch (a “V”) in a toenail will relieve the pain of ingrown toenails.
Reality: When a toenail is ingrown, the nail curves downward and grows into the skin. Cutting a “V” in the toenail does not affect its growth. New nail growth will continue to curve downward. Cutting a “V” may actually cause more problems and is painful in many cases.
Myth: My foot or ankle can’t be broken if I can walk on it.
Reality: It’s entirely possible to walk on a foot or ankle with a broken bone. “It depends on your threshold for pain, as well as the severity of the injury,” says Borreggine. But it’s not a smart idea. Walking with a broken bone can cause further damage.
It is crucial to stay off an injured foot until diagnosis by a foot and ankle surgeon. Until then, apply ice and elevate the foot to reduce pain.
Myth: Shoes cause bunions.
Reality: Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types make a person prone to developing a bunion. While wearing shoes that crowd the toes together can, over time, make bunions more painful, shoes themselves do not cause bunions.
Although some treatments can ease the pain of bunions, only surgery can correct the deformity.
Myth: A doctor can’t fix a broken toe.
Reality: Nineteen of the 26 bones in the foot are toe bones.
“What I tell patients is, there are things we can do to make a broken toe heal better and prevent problems later on, like arthritis or toe deformities,” Borreggine says.
Broken toes that aren’t treated correctly can also make walking and wearing shoes difficult. A foot and ankle surgeon will x-ray the toe to learn more about the fracture. If the broken toe is out of alignment, the surgeon may have to insert a pin, screw or plate to reposition the bone.
Myth: Corns have roots.
Reality: A corn is a small build-up of skin caused by friction. Borreggine says many corns result from a hammertoe deformity, where the toe knuckle rubs against the shoe. The only way to eliminate these corns is to surgically correct the hammertoe condition.
Unlike a callus, a corn has a central core of hard material. But corns do not have roots. Attempting to cut off a corn or applying medicated corn pads can lead to serious infection or even amputation. A foot and ankle surgeon can safely evaluate and treat corns and the conditions contributing to them.
Walking Keeps You Healthier Than You Think
Your ability to maintain a good exercise program may be cheaper than you think. It may only cost you thirty minutes a day and it is as close as walking out your front door. Yes, I said "walking"! Walking has become probably the best way to keep those unwanted pounds off for good! Just a daily brisk walk for a half hour a day is better than running or any other heavy impact aerobic exercise program.
Getting started is probably the hardest part, but once your walking program commences you will be amazed how much better you will feel in just a short period of time. Eventually, the benefits will pay off as the inches melt away from your waistline. No matter your age walking is good for you because it is safe to do and has very few health risks involved doing g it. But as with any exercise program, if you have concerns about any health issue get examined by your physician before getting started.
A walking program has many health benefits including not only weight loss, but it is good for your heart and circulation. It will also help strengthen leg and arm muscles and provide a better physical tone to your body. Walking requires a good foundation, so your feet are very important to this type of an exercise program. Make sure you have a good brand name walking or athletic shoe that fits your feet properly. Any on-going foot problems or ones that may occur can easily be evaluated and treated by your local podiatric physician.
In a lifetime a person will walk on average 60,000 miles. To get a quick sample of how much walking you do in day obtain a pedometer and attach it to your waist. After wearing it just a day, the number of steps you take will be in the thousands. To get a pedometer either purchase one at a local running shoe store or you may receive a free one from a podiatrist in Illinois who is affiliated with the Illinois Podiatric Medical Association (IPMA). A public relations program started by the IPMA this past April involved it membership to provide pedometers to the public in effort to make more people aware of how healthy walking can be for you.
Contact your local foot doctor in your community and if they are a member of the IPMA, they may be able to get your that free pedometer so you can get walking toward a healthier lifestyle. Why not start today!
Keep Illinois Walking
Charleston, IL- Podiatrists from the Illinois Podiatric Medical Association (IPMA) are joining downstate and Chicago affiliated New Balance Shoe stores to encourage Illinoisans to get out and walk by providing free pedometers to any Illinois resident who visits a participating podiatrist. It's part of the "Keep Illinois Walking" campaign. Dr. Joseph Borreggine, podiatric physician of the Family Foot Care Center said his office received 50 pedometers from the IPMA in late April '08. The offices of Dr. Borreggine located in Charleston and Effingham will provide free pedometers to patients while supplies last.
According to Borreggine, walking can combat obesity, diabetes and other weight-related diseases that have a direct impact on one's overall health as well as foot health. For more information log onto www.myfeethurt.net or call 1-800-366-8397
“The Jones known for fractures”
The "Jones fracture" was a fracture named after a physician who experienced a fifth metatarsal base fracture (long bone just behind the fifth toe making up the outside of the foot). He had turned his foot under and inward (ankle sprain or inversion) and put an excessive force on the outside of his foot. His accident happened around 1900 while dancing which inspired him to author a medical journal article. This article became quite famous during its time. It described the injury causing this type of fracture, the best treatment for it, and prognosis for those suffering this injury.
Through the last century and up until today, this fracture has plagued many patients and dumbfounded many physicians. The injury can be quite minor and its treatment elusive. The reason is because the base of the fifth metatarsal has many tendonous attachment and poor bone stock. The combination of the two makes it difficult for this part of the bone to heal properly. The problem really does not arise because of the injury, but rather because of the under treatment and misdiagnosis of the fracture.
An individual having this fracture will usually present to an emergency room physician after an acute ankle sprain. An X-ray will be taken and the fracture will be noted. Instructions, for non-weight bearing with crutches for a short term along with an ACE wrap applied to the foot will be given. The foot will remain swollen and become black and blue in the area of trauma. It is impossible to bear weight without pain. The swelling, discoloration, and may subside after a few days but, weight bearing will always be difficult over the following weeks to months. The fracture will start to heal but cannot do it fully because the foot is not immobilized properly. The fracture site is being pulled apart constantly because of the multiple tendonous attachments at the fifth metatarsal base. This can create a mal, fibrous, or non-union of bone.
A foot specialist may immediately recognize the type of fracture and either immobilize the foot in a cast for six weeks or perform surgery. The foot immobilization may allow the fracture to heal through secondary processes, but surgical repair through open reduction internal fixation (ORIF) with screw, wire, and/or plate is better. ORIF approximates the bony ends back together and allows primary healing to occur. Surgery is the more favorable option when it comes to this type of injury because it out-weighs the possible complications of secondary healing. Secondary healing of this fracture is a slow process extending as long as three months, rather than primary healing which can take four to six weeks.
“The facts of broken toes”
One of the most annoying and painful foot injuries is a broken toe. This occurs by blunt trauma or stubbing the toe. Most people getting this injury have awoken out of a sound sleep to get a drink or use the bathroom in the dark and hit their toe on the bedpost, table or chair leg. This injury is sometimes called a "bedpost fracture" and frequently occurs on the fifth toe. Another way of fracturing a toe is done by dropping a heavy object on it. This frequently happens when getting something out of the freezer and a frozen food item (like a can of juice) drops on the foot.
When a toe is fractured it causes an acute amount of throbbing pain, which turns slowly into an achy type pain. It is difficult to walk or put the foot on the floor. The toe becomes swollen, painful to touch, and black and blue. Normally, people with broken toes do nothing because they do not think anything can be done. This may be the case, but a podiatrist should always evaluate the toe injury. The foot doctor will examine the affected toe for any abnormalities. These may include subluxation, dislocation, displacement of the possible fracture, (done by X-ray), and any other relative condition caused by the trauma.
If the toe is not dislocated or fracture displaced, then the podiatrist may do nothing more than tape the injured toe to the adjacent one and put the affected foot in a surgical shoe. The surgical shoe must be worn for no less than two weeks. Post-injury treatment not only includes the shoe, but also requires elevation and periodic icing to the foot. Pain can be reduced by an over-the-counter analgesic (aspirin or Tylenol) or non-steroidal anti-inflammatory (Motrin).
If the toe has been dislocated or the fracture displaced, then more aggressive treatment may ensue. A dislocation will require manual manipulation of the affected toe under a local anesthetic (Novocain) to be put back into place. A displaced fracture will always require a surgical procedure to re-align the fractured bones. Either way, the patient will still require a surgical shoe for a period prescribed by the foot doctor. X-rays may needed from time to time during the healing process to help the podiatrist evaluate the position and healing of the affected toe bones.
“When the foot stresses it breaks”
The foot stress fracture goes by many names, but can be difficult to treat if not diagnosed properly. Most podiatrists will call the stress fracture a "hair-line" or "march" fracture. The bones mostly affected by this injury are the long bones behind the toe called the metatarsals. These bones are the mostly prone to stress fractures due to their structure, function, and their role creating the foot's arch.
There are five metatarsals corresponding to each one of the toes. When a stress fracture occurs, a "stress riser" occurs in the mid-shaft portion of the bone. The cause of this abnormal stress riser is related to a concentrated force being applied to the bone. The bone's mid-shaft region is affected by this concentrated stress because there is not much shock absorbing property in that area of the metatarsal bony structure. Impact type activities such as running, jumping, and marching can cause a stress fracture to occur.
Symptoms of a stress fracture usually appear the same day. These symptoms are caused by this non-displaced "hair-line fracture" in the bone. There is a vague type pain to the center of the foot and most noticeable just behind the top portion of the second through fourth toes. The next day, the foot is very painful to walk on. The injury will have some swelling and redness associated with it. The symptoms of pain, swelling, and redness are caused by the inflammation related to the fracture. Warmth may also be noted. Throbbing can also occur, but not always.
The symptoms of a stress fracture can be confused with infection or even a metabolic disease known as "gout". Since X-rays do not show any bony abnormalities with a stress fracture, most physicians will diagnose and treat this benign problem improperly. If a stress fracture is not identified and another diagnoses are made, then a patient will be put on improper medication unnecessarily and treated inappropriately.
Therefore, it is imperative any foot pain be evaluated by a podiatrist.
With a proper history and examination, a podiatrist will most likely diagnose the stress fracture without expensive tests or even with an X-ray. Since most stress fractures acutely will not show up on an X-ray until two to four weeks after the initial injury, radiographs of the affected foot are useless. The podiatrist can discern the cause of the foot pain through a good history and with examination will be able to provide, not only, the proper diagnosis, but a treatment regimen as well. Since an X-ray is not usually taken for stress fracture, most physicians will send a patient to hospital for a very expensive radiographic test known as "bone scan" which requires approximately fours to obtain a positive diagnosis. Rather, a podiatrist will take simple vibration tool (tuning fork), strike it on his hand and place it over the symptomatic part of the foot. If the patient jumps out of the seat (literally), then in four seconds, not hours, a stress fracture diagnosis is made (the tuning fork actually irritates the raw nerve endings exposed around the bony cover (periosteum) torn because of the fracture).
The podiatrist will treat a stress fracture by dispensing a surgical shoe and recommend an over-the-counter anti-inflammatory with an occasional ice pack to the foot. The pain will subside in a day or two and the surgical shoe must be worn for two week to stabilize the foot when the patient walks. In two weeks, the stress fracture will begin to heal. An X-ray should be taken to verify the healing process. On the foot X-ray, the affected bone will have a prominent bony callous ring (collar) noted in the area on bony injury. This bone callous ring is the body's response to the fracture. The bone covering or "periosteum" has created new bone to hold the fracture together. This bone callous may be noticed on X-ray and even felt under the skin for six months. The body will eventually absorb the bony collar.
If a patient suffers multiple stress fractures repetitively, then the physician must rule out other causes such as metastasis (cancer), osteoporosis (thinning bones), osteogenesis imperfecta, Paget's disease, and/or metabolic diseases.
“You don’t have live with bunions”
The bunion (BUN-YON) deformity is a bump of bone present around great toe joint and can be painful with shoes, walking and standing. Most think they have to live with the problem or go through a very disabling surgical procedure to resolve it. These facts are not true, and therefore, the foot specialist should be consulted if this deformity is present. They are the “foot care experts” when it comes treating foot problem just like these.
The cause the bunion deformity is not the shoes that a person wears. It is actually caused by abnormal foot joint alignments around the great toe. The large bump around the great toe is usually red, swollen, and painful. The bone sticking out around the great actually has not “grown”, but rather it is the joint that is becoming subluxed or dislocated. Pain occurs when the shoe presses on the bunion deformity. However, they may not always be painful, but asymptomatic bunions can cause debilitating arthritis if left untreated. Bunion deformities are hereditary, usually caused by flat (hyperpronated) feet, and are more prevalent in women (since statistically women seek care for foot pain more than men).
A foot doctor can relieve the bunion pain through many treatment regimens. They may try arthritis medication, steroid injections, wider shoes and arch supports. A foot doctor is a well-trained foot surgeon and may perform a bunion surgery. This may be the best treatment to correct the problem if all else fails. Bunion surgery may require removing the bony bump and/or require repositioning the bones around the great toe. Disability can be from two weeks to six weeks and the patient can ambulate post-operatively in a walker boot. Bunion surgeries are routinely done as outpatient surgical procedures. Recovery after bunion surgery is procedure dependent and requires patient compliance. Physical therapy or prescription arch supports may be needed afterward.
Having a painful bunion is not comfortable and therefore should be treated. If you or some you know has a bunion, then consult with a podiatrist today and see what treatment is available.
“Corn confusion”
Corns are pesky areas of skin occurring on the top or inside of the toes (soft corn) caused by small bone spurs and irritated by shoes. People are confused on how to treat and make them go away. Many will try to seek relief from a multitude of self-care over-the-counter remedies, including corn pads, cushions, and wider shoes. Finding out, over time they have made the problem worse. No topical medicine or pad will ever resolve a corn. Temporary relief may occur with these remedies. The most frequented toe deformity associated with corns is the "hammertoe".
Surgery for corns has advanced greatly through the years. Most foot surgery for corns is done on an outpatient basis in a foot doctor's office or surgery center. A minor surgical procedure is done through tiny openings in the skin to straighten the toe, remove any bone spurs causing the corn, and is done under a local. The procedure takes a few minutes to correct the problem, without stitches, and the patient goes back into shoes the same day and has minimal disability. However, in more severe cases, a patient may need to have the procedure done at an outpatient surgical facility. Whatever the case, having a surgical procedure performed may be the best treatment to resolve a corn problem.
“Frostbites when its cold”
The most important thing when it comes to cold weather is protection of body parts. If certain body areas are left uncovered, then this can cause a tremendous loss of body heat or become injured by the cold temperatures. The head should always be covered with an insulated hat along with some sort of ear and nose protection. The head is responsible for the greatest percentage of body heat loss and the ears and nose lack proper insulation tissues (fat). The hands and feet also need good protection against the cold because they are so far away from the heart and also do not have adequate insulation properties. Always clothe in layers to protect the rest of your body so you can remove the layers, which may cause perspiration or wetness. Common sense should always prevail when it comes to cold weather. Pay close attention to weather reports and wind chill factors when going out-of-doors in the winter.
Frostbite like thermal burns have degrees of injury.
First-degree frostbite is related to exposure to a cold temperature of body tissue, which is not protected properly or under a sustained time period. The symptoms usually occur in the hands and feet and possibly the nose and ears. When exposed these areas generally feel cold to touch as well as a feeling of cold sensation. The body part exposed will look flushed or red due to increased blood flow to the area. This redness is the body part means the body is trying to keep the exposed area warm. The immediate response should be to get out of the cold, try to re-warm the area, and apply more layers. This degree of injury is reversible. If left unattended, second-degree injury may occur.
Second-degree frostbite generates symptoms of cold sensation, numbness, tingling, and pain. The exposed area will look dusky or white in color. This means the blood has stopped flowing to the affected area. Immediately get out the cold environment and gently re-warm the body part. An individual suffering from this injury will experience pain while frostbite occurs and especially after the body part is re-warmed. The pain during the injury is lack of blood flow (ischemia) and afterward is the blood moving back into the tissues. When a human tissue is stimulated by cold the blood vessels may dilate at first, but overtime, they will constrict to protect other tissues by re-routing blood flow from the area of cold exposure. This degree of injury is reversible only if the body part is re-warmed or brought of the cold. If left unattended, third degree injury may occur.
Third degree frostbite is the last and final degree of this injury and is not reversible. The symptoms of this degree are very painful due to lack of blood flow. Blisters will appear on the skin of the affected body part and the skin will be very dusky (blackened). This degree of injury is truly a cold exposure burn of the body tissue. The body tissues at this point have died (necroses) due to lack of blood flow. If a third degree injury has occurred, then the individual is most likely suffering from hypothermia and needs immediate treatment. Treatment requires re-warming of the body with heated intravenous fluids, thermal aluminum blankets, body-to-body contact, and hospitalization. Amputation of affected third degree injured body parts may ensue. Scars, like thermal burns, will remain in any body area with a history of third degree frostbite.
The feet and toes are very prone to any degree of frostbite because of their location on the body (farthest from the heart) and the constant exposure to cold environment due to walking. When going in the cold weather, the feet must be protected with warm (preferably wool and not in layered) socks, insulated boots or shoes (Gortex lined). If shoes or socks become wet due to perspiration or the elements remove them immediately and change into dry ones. Never depend on using battery-powered sock warmers or electric type gadgets to keep your feet warm. Always be prepared for the worst by having proper shoe and sock gear. Depend on common sense when it comes to cold weather.
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“The truth about flat feet”
A person complaining of arch pain and a foot flatter than normal compared to the other foot is usually suffering from posterior tibial tendon dysfunction or fallen arch. Many tendons and ligaments support the foot and ankle, but the posterior tibial muscle and tendon are the keystones to the foot having a proper arch. Once this muscle becomes weak and eventually non-functional, a person will suffer a number of foot maladies.
The posterior tibial tendon muscle belly starts deep in the mid calf region of the leg and ends with its strong tendonous end attaching to every bone in the foot expect the toe and anklebones. Its major role is to hold the foot bones, making up the arch, in proper place and position. This muscle points the foot down and inward. During walking, its role allows the foot to act as a "rigid lever" to help propel the foot forward into the next step.
Over time, due to abnormal forces traveling done the leg or through repetitive impact type activity, this muscle can become weak and unable to support the foot arch any longer. Once this happens, a person may begin to feel the effects of "a fallen arch". This may occur in one foot at a time or in both feet. The resultant symptoms include pain, fatigue, cramping, and swelling in the affected foot. The pain is always localized to the foot mid arch region just below the inside aspect of the anklebone. The affected foot looks flatter than the other foot because of the weakened and dysfunctional posterior tibial tendon. This condition can be confused with heel spur syndrome or plantar fasciitis.
A podiatrist must make diagnosis of this foot ailment. The patient will be examined weight bearing (standing) and walking. Evaluation of foot structure and function must be made to definitively make the diagnosis. X-rays will taken to evaluation both feet and their comparative bony structure. The podiatrist will always be looking for the "tell-tale" signs of one foot being flatter than the other and painful with standing and walking.
Treatment for this condition will include therapeutic taping and padding to the affected foot along with a non-steroidal anti-inflammatory (Motrin) to take pressure off the arch and reduce pain. Further evaluation may include MRI's of the foot to see if the posterior tendon is torn or ruptured.
Treatment may also include an orthopedic walker boot or cast, custom molded arch support (orthotics), ankle braces, etc. These treatments may be used singularly or in combination. Physical therapy including isometric exercise, ultrasound, and passive range of motion activity are used to strengthen the posterior tibial tendon. If all else fails, surgery may be employed to help resolve symptoms of this condition. Surgery is usually a last option. Surgical procedures may include joint fusions, tendon repair, or a new technique called an "MBA implant" which is placed in the foot (under the ankle bone) through a small incision under live X-ray. These all help to increase foot arch height and restore function. Procedures are patient dependent and will be reviewed by the podiatrist regarding post-operative disability.
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“Toes that got hammered”
A very painful foot condition is a "hammertoe". The cause of hammertoes is not the shoes. They are caused by mechanical imbalances around the toes, which can deform them. Corns are associated with hammertoes and they are a build up of a thickened protective skin layer located on the top, side, or in-between the toes. They are caused by shoe friction. Pain is elicited by shoe gear compressing the corn. They can be easily removed through trimming them off by a podiatrist. Hammertoes are prevalent in both sexes, however they are more frequent in women due to ill-fitting shoe gear. There is confusion about corns because they may look like an "athlete's foot infection" or a "wart". Corns between the toes are known as "soft corns".
The first form of treatment for corns caused by hammertoes is to relieve the pain. The patient will try over-the-counter remedies to stop the pain. The podiatrist, if consulted, may use one or all of the following to relieve the discomfort caused by corns: a non-steroidal anti-inflammatory (Motrin), steroid injections, wider shoes, padding, toe straighteners, and arch supports. Surgery to resolve hammertoes may include just smoothing down a prominent bone spur causing a corn or can involve removing bone to help reposition the deformed hammertoe. Depending the procedure, post-operative pain, swelling, and disability may vary from days to weeks. Most hammertoe surgeries done by a podiatrist are on an outpatient basis. Proper diagnosis by a podiatrist is essential to a proper treatment and prognosis of hammertoes. If left untreated, hammertoes will cause an individual to experience pain and possibly eventual arthritis in the toes.
“Count to TENS and heel pain hides”
TENS or trans electrical nerve stimulation is an excellent non-invasive treatment modality for heel pain. It principally uses the "gate theory" of pain threshold stimulation. The inflammatory response has four components including: pain, redness, warmth, and swelling. It is the pain component of inflammation which is controlled by TENS application. TENS will elevation the body's pain threshold naturally by over-stimulating the nerve endings at the source of pain. This elevated pain threshold thereby requires more pain stimulus (substance P) to generate a pain signal. Therefore, TENS application will decrease pain in the affected area and allow healing to occur without the disabling effects of pain.
The most common cause of heel pain is plantar fasciitis (fash-e-i-tis). This is a result of an injury to the heel bone. This is caused by overuse or trauma to the heel. For example, long periods of walking, standing, and/or wearing a pair of ill-fitting shoes during increased physical activity can be principle reasons for heel pain.
The classic signs and symptoms for heel pain may include any or all of the following: pain in the inside and/or bottom aspect of the heel when getting out of bed the morning, usually accompanied by pain reducing in the heel with activity, pain in the heel at the end of the day, and pain in the heel when getting up from a seated or rested position.
Prior to making a diagnosis of plantar fasciitis, the podiatrist must rule out any other causes of the heel pain. This is done through a good history and physical exam. Once a definitive diagnosis of plantar fasciitis is made, an X-ray should be taken to identify any bony involvement (bone spur). The podiatrist should tell the patient the heel spur, if present, is not the cause of the pain, but rather is a result of an injury of some sort to the tendons attached to the bottom of the heel.
The first form treatment for heel pain includes symptom relief. Once the diagnosis of plantar fasciitis is made, the podiatrist may try one or all of the following: a non-steroidal anti-inflammatory drug (NSAID), like Motrin, a cortisone injection, taping and padding, stretching program or exercises, ultrasound physical therapy, heel pads, and/or night splints. One or more of these will reduce symptoms dramatically in the first 7-10 days.
A preventative treatment typically follows to resolve heel pain. This will reduce the abnormal forces going through the foot, which ultimately made the heel pain worse in the first place. By having a podiatrist prescribe a pair of custom molded prescription arch supports, known as orthotics, the foot will then be properly aligned. Once the foot and leg examination is performed, the podiatrist can generally make judgments that will aid in the manufacture a pair of such devices. These will control abnormal foot function and put the feet in proper place and position, thereby allowing the causes of the plantar fasciitis to be reduced. Orthotics should be of prescription caliber provided by your local podiatrist. Store bought orthotics or arch supports will not be effective enough in the long-term to resolve heel pain.
The final treatment should include more aggressive treatment if the orthotics and other therapies fail to reduce the heel pain by 50% or more over a six-month period. During the initial assessment of the patient's heel pain, the podiatrist should inform the patient of their prognosis. Based upon the above therapies, heel pain may take from 9 to 18 months to resolve completely.
Surgery, if performed, may include aggressive heel spur resection and tendon release. This surgical procedure is rarely performed today because it is rather disabling, usually provides no relief, or can cause pain elsewhere in the affected foot.
Modification of this procedure has included only tendon release by a more modern technique, known as, endoscopic plantar fasciiotomy, (an arthroscopy type procedure). This procedure is less disabling for the patient because of its decreased invasiveness. This newer surgical procedure has improved upon previous post-operative disabilities and pain.
In the last 18 months, a European technique, known as extracorporeal shockwave therapy (ESWT) has come to the United States and has revolutionized the treatment for plantar fasciitis. This procedure is totally non-invasive and has eliminated the need for surgical approaches. The procedure uses high pitch sound waves (similar to the machine used to break up kidney stones), but rather than "breaking up a heel spur", as most people think, it actually re-injures the heel injury which increases blood flow to the already non-healing soft tissues that surround the heel. This non-invasive procedure is highly effective in resolving chronic (> six months) plantar fasciitis. The patient is walking the same day the procedure is performed. They are usually pain-free in three weeks and will always need to wear a pair prescription orthotics post-ESWT to prevent return of the heel pain.
“Foot care and Medicare”
A number of elderly Americans have difficulty taking care of their feet or are "at risk" for complications if left to self care. Since this is the case, most of the geriatric population at-large is uninformed with respect to the Medicare program's coverage for foot care.
Medicare does not cover routine foot care. This includes simple toenail and callus trimming. However, there is a tremendous number of Medicare patients who suffer from a systemic disease, such as diabetes or poor circulation, which need the professional expert care of a podiatrist. The foot doctor will properly evaluate and assess the patient's feet for potential foot complications. They will provide the necessary foot care, give preventative foot care information, and make an appointment for proper follow-up.
If you are on Medicare, then you should know what is covered regarding foot care. Presence of fungus or thickened toenails, poor circulation, diabetes, sensation disturbances, with or without one or combination of systemic diseases, put you "at risk" if left to self-care. The podiatrist must follow certain local medical review policies set by Medicare. During the foot exam, they must document the imperative findings from the to verify proper Medicare coverage for the services they provide. These services include dystrophic and/or non-dystrophic toenail trimming, toenail debridement for thickened (non-fungus) toenails (removing >50% of the diseased nail plate), debridement of fungus toenails, and/or corn/callus trimming. These services may be provided at minimum of every 63 days to allow for Medicare reimbursement.
Medicare also covers other ancillary services provided by a podiatrist. These services include office visits, X-rays, surgery, diabetic shoes, ankle braces, ingrown toenail treatment, taping/padding of the feet, cortisone injections, etc. As with Medicare coverage for foot care, the podiatrist must document why he is treating a particular foot problem with the necessary supportive medical notations. General foot care is not covered, such as treatment for flat feet, but as long as the podiatrist can provide medical proof the feet are flat due to an orthopedic condition and causes pain with walking/standing, then reimbursement will ensue.
In a case where the podiatrist knowingly provides services not covered by Medicare, then they must inform the patient of the services not covered and have them sign an advanced beneficiary agreement (ABN) prior to instituting the treatment. Once signed, the patient is fully responsible for those charges. If they do not sign the ABN, then services will not be rendered.
Medicare allows medical providers to "accept assignment" or not accept it. This means those providers "accepting assignment" will only get paid 80% of the Medicare fee schedule (after deductible) and the 20% outstanding from co-insurance from the patient for the services rendered. Those medical providers not "accepting assignment" can charge only 10% higher than the mandated fee schedule set by Medicare. This means Medicare will pay the 80% it usually pays (after the annual $100 deductible is met), co-insurance or the patient will pay the 20% Medicare does not pay, and the patient will be responsible for the remaining 10% the physician is allowed for not "accepting assignment".
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“Numbness in the Feet”
Neuropathy is a condition affecting sensation. The classic symptoms of neuropathy include numbness, burning, tingling, or pain in feet or hands. Complaints of neuropathy can vary and may include abnormal sensations like walking on pillows or blocks of wood or sharp shooting pains.
The cause of neuropathy is related to a nerve function disturbance. This problem leads to loss of sensory signals back to the brain. Sensory loss to the feet is detrimental because it can lead to imbalance and falling, healing problems, and disabling pain. Daily activities eventually will be encumbered. Diagnosis, treatment, and prevention are essential if one suspects neuropathy.
Prior to making a diagnosis of neuropathy, other causes must be identified. Poor circulation, spinal problems, and other medical conditions may cause neuropathy. Once a diagnosis and cause of neuropathy is made, then a nerve test on the legs and feet must be performed. This will identify the amount of sensory loss.
Diabetics should seek immediate treatment if they suspect neuropathy.
A podiatrist may try one or all of the following to reduce symptoms: anti-depressants (amitryptiline), anti-epileptic drugs (Neurontin), topical pain relievers (Biofreeze), or poor circulation remedies (Trental or Pletal). As of May 2002, Anodyne therapy is available to help patients get true long-standing symptom relief from neuropathy. This new non--medicinal technology has revolutionized the treatment for neuropathy.
A preventative measure must be provided after a diagnosis is made. This may include extra depth shoes with cushion insoles. In-home Anodyne therapy should be considered. If neuropathy is left untreated complications can occur.
“Computers can rule the feet”
Computers have become the latest tool in medicine to provide the best and most accurate treatment to patients. Podiatrists have taken this modern tool and used it to provide cutting edge technology when it comes to manufacturing prescription arch supports (orthotics). Recently, new computer software and hardware have been created for this purpose. The podiatrist no longer has to make guesswork when prescribing orthotics.
The purpose of orthotics is to balance the feet and put them in proper place and position. This allows the feet to function in more normal state and thereby reduce pain. Orthotics are to feet like glasses are to the eyes. Orthotics can reduce foot pain caused by heel spurs, pinched nerves (neuromas), bunions, corns, calluses, and hammertoes. They may even arrest knee and back pain. They improve posture and generally create overall better foot health.
To manufacture a computer generated pair of orthotics; the patient must stand on a “a static force plate” or “plantar pressure pad”, which will show on a computer screen the major pressure points occurring on the bottom of the feet. The areas of most pressure will show the color red and least pressure will be blue. This image of the feet is known as “plantar pressure analysis”.
This information is vital to the podiatrist and helps immensely to evaluate the patient’s feet. It can help identify hidden pressure areas of the feet, which are causing pain. This technique can also determine whether one leg is longer than the other, just by the pressure coloration scheme noted on each foot. This plantar pressure analysis can be viewed in two or three dimensions. This information is stored digitally in the computer’s memory and can be transferred via modem to a lab to manufacture the orthotics.
The next process of computer analysis is known as “computer gait analysis”. The patient walks across the plantar pressure pad. Again, this information is displayed on the computer screen in variant red to blue coloration scheme to help the podiatrist diagnose the cause of the foot complaint. This technique allows information about the walking cycle to be revealed, which cannot be seen by the naked eye.
Any abnormality in the walking cycle will be compared to normal. Playback of this data can be produced in two or three dimensions, as well. The podiatrist can show the patient their actual walking cycle in the immediate computer playback. The podiatrist can better educate the patient to why they need orthotics.
All the computer information can be printed out and taken home. The patient may even want to show it to family and/or friends to help educate them on how important proper foot function is to everyday foot health.
Once the computer analysis is performed, the patient will need to have prescription orthotics made. Ordering information is prepared on the computer. They patient will visualize their shoe type and corresponding orthotic. The podiatrist writes the orthotic prescription and send the order directly via a modem to the orthotic lab and devices will arrive and be fitted to the patient 2-3 weeks later.
This advanced computer analysis is best and most accurate way to produce a pair of orthotics. Long gone are the days of messy plaster foot and unreliable foam foot impressions. There is very little room for error with this technology. Orthotic manufacture will never be the same and will certainly provide a better prescription device with greater patient satisfaction. Consider visiting a Podiatrist if you are considering getting orthotics.
“Ingrown toenails have resolve”
The ingrown toenail is most prevalent on the great (big) toes. They are painful with tight shoes. Outside of being trimmed wrong, the toenail may be misshapen or injured. The offending toenail is pressing into the toe. Ingrown toenails can become infected. Most people are confused with respect to ingrown toenail treatment. When ingrown toenail procedures are performed, the patient afterward goes back into the same shoe, have no pain or disability.
A patient may try numerous ways to resolve the discomfort of an ingrown toenail. They include over-the-counter remedies, self-treatment, and family doctor care. The podiatrist, who is an expert treating ingrown toenails, may try one or all of the following: A corrective nail trim, soaks, topical or oral antibiotics, wet-to-dry dressing changes, and pain reducers. This treatment plan may be tried for a period time to see if relief occurs. Ingrown toenail correction should be immediately considered, based on the foot doctor's assessment of the situation. The whole goal of surgery is to reduce pain and the possibility of infection.
The whole toenail is not removed, just the ingrown nail border. The toe is numbed with a local anesthetic. Once the toe is numb, the offending nail is removed and a special chemical is applied to kill the nail root to prevent a recurrence. After the procedure is performed, the toe is dressed with a light bandage and the patient goes back into a regular shoe and walks out of the office.
Surgery to resolve ingrown toenails may sound complex and create undue anxiety, however if the patient is properly informed about the ingrown toenail procedure, risks involved, consequences if not performed, then I think the patient would agree that they should have correction of the ingrown toenail. However, as always, patient compliance is of essence to obtain an excellent prognosis after this procedure.
“Healing Through Light Energy”
Recently, light energy has been specialized to heal chronic wounds, muscle aches, edema, and neuropathy in the form of a new infrared light therapy. This therapy is called monochromatic infrared light emission (MIRE). This new technology is available in a treatment called "anodyne" The Anodyne therapy unit is manufactured by the MedAssist Group in Tampa, Florida. "Anodyne" is derived from the Greek word roots and meaning "without pain".
Everyone has a natural occurring substance known as "nitric oxide" in his or her blood vessels. This compound is responsible for increasing the blood vessel size and flow. Normally, the cells lining the blood vessel wall produce this nitric oxide. Nitric oxide is stimulated as blood flows through the vessel.
When nitric oxide is depleted as blood flow slows down, it will diminish circulation in small blood vessels and can prevent chronic wounds, known as ulcers, from healing. These ulcers can occur on the legs and feet especially in diabetics or those with poor circulation. Today, Anodyne has allowed for the improvement of the healing potential in chronic foot and leg ulcerations sooner than any other remedy available.
Concomitantly, proper blood flow in small blood vessels, known as capillaries, is important because they continuously nourish the nerves in the feet and legs. These nerves provide proper sensation and balance. As the blow flow decreases, and these nerves are starved for nourishment, they become non-functional. The lack of sensation puts an individual "at risk" for leg and foot problems, such as, a condition known as "neuropathy". Neuropathy mostly affects the diabetic population, but can also affect non-diabetics. The neuropathic symptoms can be pain, burning, numbness, and other abnormal sensations in the legs, feet and hands. If left untreated, then this process of neuropathy can become irreversible and cause nerve damage. Today, Anodyne is the only "ray of hope" for neuropathic symptom reduction and reversibility.
Anodyne works harmoniously to stimulate the bodies own naturally occurring compounds to achieve the success of healing.
Anodyne therapy is non-invasive and painless. It has specialized pads, which can be applied directly to the legs and feet. These pads convert electrical current to infrared light energy. This light energy stimulates the blood vessels to stimulate nitric oxide in blood vessels and increase blood flow. A 45 minute treatment every other day to the to lower extremities and feet is all it takes. This process may help heal wounds, decrease the sensations of pain, numbness, burning, and abnormal sensations attributable to neuropathy, decrease edema, improve balance, and decrease pain due to injury. This unique treatment can be applied at home after a 3-4 week trial period in the foot doctor's office. Most insurance, including Medicare, will cover the Anodyne therapy and home unit.
Free consultations are available by Dr. Joseph Borreggine at any of his locations and he is an exclusive provider of Anodyne therapy in East Central Illinois. More information can be obtained on the website:
http://www.anodynetherapy.com
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Flip-Flopping may not be the best thing for your feet
Sandals and flip-flops used to be something one would only wear to the beach or summertime activities and now they have become a common fashion statement to most women and young teenage girls. They are worn not only in the warmer months, but all year long. These types of shoes are easy to slip on and seemingly light weight and comfortable to wear. However, not matter how convenient they are to wear; they have become a troublesome problem for the feet.
The younger population may believe that this type of shoe gear is harmless, but in reality this not the case at all. Actually, flip-flops and sandals can cause a myriad of foot problems especially for those who wear them constantly. Since this type of footwear are not shoes, they provide literally no support or protection for the feet. The arch and heel especially are prone to undue impact trauma and continually wearing this style of footwear will cause chronic pain. The lack of cushion overstresses these areas of the foot.
The toes and toenails are also subject to problems as well while wearing sandal type shoes. There are issues related to not only trauma (cuts and scrapes), but the skin and toenails can be infected by warts (virus), fungus and bacteria. This can lead to multiple treatments or long-term medication to solve these issues.
The ankle can also be injured as well while wearing this footwear. Sprains are more likely than fractures, but both can happen if wearing them in inappropriate terrain. The lack of support around the whole foot and ankle is the primary reason for these types of injuries with this footgear. So, extra caution should be taken when wearing sandals or flip-flops.
Style and convenience can mean everything when it comes to shoe gear, but being sensible is the smart thing to do when choosing proper footwear for not only the reasons mentioned above, but for continual maintenance of good foot health. So, next time you want to make a fashion statement think of your feet first.
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