Foot Care

Chiropodist

CHIROPODIST

In the United States, the term “Chiropodist” is an old term that was used to define a person who treats the foot. The term is still used in the British Isles and some countries in the European Union; also in Australia and New Zealand. In the United States, the term “Chiropodist” has been replaced with “Podiatrist” many years ago.

The word Chiropodist originated from a term referring to hands and feet. At some time in past years that may have been true, but in recent times a Chiropodist only treated foot problems.

The Chiropodist degree has not been awarded by Medical schools in the United States for quite some time. Chiropodists were generally trained in non-surgical treatment of the foot. A Podiatrist, however, is trained in both medical and surgical treatment of the foot, ankle, and lower leg and is recognized as a Physician and Surgeon of the Foot. The Doctor of Podiatric Medicine degree, or D.P.M., is the commonly recognized designation for a Physician treating foot and ankle pathology.

Discussions regarding proper foot care can be widely diversified. The feet are our “organs for propulsion”, and just like our brain functions to keep our body organized and functioning and the heart keeps our blood circulating, our feet keep us moving. If they are neglected, just as any organ of our body, they can fail. Unfortunately, our feet are the most widely neglected part of our body.

Proper care of our feet is important for us to be able to stand, walk, run, work and enjoy our leisure time. Make sure to wear sensible shoes that fit well and fit the activity you are participating in. Wearing flip-flops to the beach is fine; not for all day shopping at the local mall.

Every-day care:

Our feet are always in contact with a surface and require protection from contaminants located on these surfaces such as bacteria, viruses, fungi, and chemicals (to name a few). We protect our feet and body with shoes and good hygiene. Proper bathing of you feet with soap and water on a daily basis, with careful drying, especially between the toes, is necessary. Pathogens love to grow in dark, moist areas, and what is better that damp feet inside of a dark shoe? Application of a cornstarch- based bath powder after bathing would be beneficial. Inspect your feet – top, bottom, and in-between the toes on a daily basis. Take action if redness, itching, blisters, cuts, rashes or bruises are noticed. Wear shoes or sandals routinely.

SHOES and Hosiery

It is common sense to wear shoes that fit, or else they will be uncomfortable and could cause irritation and pain. But it is also important to wear proper fitting hose. Socks that are too tight can cause constriction resulting in swelling. Hose made with some synthetic products in hot climates can cause excess perspiration, resulting in dampness. “Support” hose should be recommended by a medical professional and fit professionally, or could cause circulation problems.

When in doubt, have your shoes fit by a professional. Be sure your shoes are wide enough around the “ball” of your foot (where your toes connect to the rest of your foot) so as to not be constrictive and that when standing you have ½ inch of toe space from your longest toe to the end of the shoe. Make sure the tops of your toes are not rubbing on the shoe, and when trying shoes on be sure you are wearing the type of socks you will be wearing with the shoe you are going to purchase. Walk around the store to make sure they are comfortable. Finally, make sure that the soles of your shoes will match the activity you are wearing them for; shoes with a hard sole with no traction control would not be good if you were working on damp, slippery surfaces.

Common foot problems

Corns, calluses, blisters, rashes (athlete’s foot), warts, ingrown toenails, heel pain, bunions and hammertoes are some of the common foot problems. Injuries can result in strains, sprains, or fractures. Many can be treated effectively with conservative methods, and others need professional (sometimes surgical) care.

CORNS AND CALLUSES

Corns and calluses, if never present before, often follow blistering of an area of the skin of the foot or toes, secondary to irritation from shoes, hose, or abnormal activity. Corns are associated with the toes, whereas calluses are associated with the side or bottom of the foot. Over a period of time the blistered area can harden into a thickening of the skin over an area that was irritated, and becomes painful If the irritation is removed, the corn or callus, and pain, should gradually disappear. If the corn or callus is a chronic condition, it is usually associated by a contraction or deformity of the toe (hammertoe, or a problem with a prominent metatarsal bone. Professional examination and treatment is recommended in these chronic conditions.

RASHES, ATHLETE’S FOOT, WARTS

Rashes and athlete’s foot can be caused by an irritant such as a fungus, chemical, or an allergen (poison ivy or insect bite). Warts are caused by a virus. There are many non-prescription remedies available for these skin conditions, but if no results are seen with a 7-10 days professional assistance is recommended

INGROWN TOENAILS

Ingrown toenails are conditions whereby the edge of the toenail pinches the skin alongside, causing pain and many times infection. Sometimes these are caused by improper nail trimming or a tight shoe, but oftentimes there is an actual nail curvature that causes the nail to grow improperly. Chronic infected, ingrown toenails can easily be treated by your medical professional.

HEEL PAIN

Heel pain is usually associated by plantar fasciitis (an inflammation of the plantar fascia or arch ligament) where it attaches to the bottom of the heel bone. Heel pain can also be associated with a heel spur, or an enlargement of the attachment point of the heel bone to the plantar fascia. Sometimes pads help the problem, but oftentimes professional help is needed, and if a chronic problem, orthotics with physical therapy, stretching and icing is necessary. Some situations may need surgical intervention.

BUNIONS

Bunions are dislocation or deviation of the great toe (hallux) at the big toe joint (first metatarsal joint). The medical term for a bunion is “hallux valgus”. This is not a temporary condition; it is a progressive problem that gets worse with time. Bunions can be irritated by improper footgear and result in temporary pain, but usually it is a chronic problem resulting in constant pain (with or without shoes) requiring appropriate medical evaluation and treatment.

SPRAINS AND STRAINS

Injuries to the foot and ankle are common, and fortunately our body is able to heal minor injuries quickly. However, if there is considerable swelling, eccymosis (black and blue), and pain either at rest or when bearing weight, should NOT be dismissed as a simple strain or sprain. Professional examination and treatment with X-rays and possible a MRI is necessary to rule out a significant injury. Without proper treatment, an injury passed off as a simple strain or sprain may result in a lifelong problem.

The “common-sense” approach to foot care should result in the prevention of many common foot ailments. Unfortunately, injuries and our environment can cause problems that even the best preventative methods cannot avoid. Contact your local Podiatrist or medical professional whenever there is a foot related issue that persists for any length of time.

Tags: bath powder, blisters, bruises, circulation problems, cornstarch, daily basis, dampness, excess perspiration, moist areas, proper foot care, rashes, sensible shoes, soap and water, support hose, synthetic products, top bottom

BUNION TREATMENT

Before talking about “bunion treatment” it is important to understand what a “bunion” is. Many times it is used generically (and incorrectly) to refer to a bump or lump on the foot. A “bunion” is correctly described as an angular deformity with dislocation of the large toe (hallux) where the large toe meets the rest of the foot (first metatarsal-phalangeal joint). Treatment consists of removing pressure from the deformed joint surface (conservative) or actual straightening of the toe and joint by surgery.

A “bunion” is usually an inherited deformity. In over 90% of patients suffering from bunion pain, there is a family history of similar deformities. Bunions are progressive, bony foot deformities, and in most cases, treatment consists of surgical repair. Temporary pain relief can be obtained with wider shoes, thus keeping pressure away from the bone surfaces, but as time goes on the joint can become further displaced, enlarged, or stiff causing chronic pain. When these conditions manifest themselves, surgery is usually the only cure. Improper footgear only irritates the underlying deformity; it is not the primary cause of the problem and pain.

Simple removal of the enlarged bone that forms from the chronic dislocations is usually not enough, since pain is secondary to the joint restriction or dislocation. Surgical procedures where the bones are straightened and allowed to heal over a period of time are usually the most successful in long term pain relief.

Tags: angular deformity, bone surfaces, bones, bump, chronic pain, dislocation, dislocations, family history, foot deformities, hallux, metatarsal, pain relief, restriction, shoes, temporary pain

BONE SPURS

Is there such a thing as bone spurs? Should this term be used to explain pain? This has been a point of contention amongst medical professionals for years. Like many colloquial expressions used in the English language, the term “bone spur” is used “generically” to explain an abnormal bump or growth on a bony surface.

Perhaps the term “bone spur” is easy to understand and less frightening to a patient than advising the patient that they have an abnormal enlargement of bone. Just like the term “cartilage deposit” is used to describe a bony bump, the term bone spur is used so as to not alarm the patient.

In all actuality, the term “bone spur” is used to describe an enlargement or overgrowth of bone, usually associated with a joint or the heel, where the bone has enlarged due to a genetic or biomechanical abnormality. The “bone spur” takes years to develop, and is not noticed by the patient until pain is present. Often the term “bone spur” is used to describe a enlargement of the bottom of the heel, and looks like a “spur” when visualized with an X-ray. This type of spur is actually an elongation of the bottom portion of the heel secondary to stress exerted on the heel due to tightness of the plantar fascia, or arch ligament. It is associated with chronic heel pain, usually noticed after periods of rest or first thing in the morning.

Abnormal enlargement of bone (bone spurs) are usually associated with joint surfaces. As the bone enlarges, restriction of joint motion occurs, and pain will ensue. The enlargement of bone can very often take on the appearance of a spur when visualized with an X-Ray. In these situations, the pain caused is due to the restriction of motion of the joint, not the actual spur. Unfortunately, we use the term to describe the appearance of the problem, not why the problem exists.

“Bone spurs” cannot be dissolved by physical therapy or cortisone injections. The pain associated with spurs is reduced with these treatments. The only way “spurs” can removed is by surgical excision.

Tags: Bone Spur, bone spurs, cartilage, chronic heel pain, cortisone, cortisone injections, physical therapy, x ray

PODIATRY DOCTORS

Podiatry Doctors, or Doctors of Podiatric Medicine, (or Podiatrists), are physicians specializing in the diagnosis and treatment of the foot and ankle. They are Physicians and Surgeons of the foot, with their scope of practice limited to the lower leg (in some states), the foot and ankle. Their training consists of 4 years of medical school after college, and extensive internship and residency training after graduating from medical school. Post-doctorate training will establish their credentials and surgical proficiency, similar to any medical specialty. Podiatrists, as with all medical professionals, are licensed by each state.

Common foot ailments treated by Podiatry Doctors (Podiatrists) are corns, calluses, ingrown toenails, heel and pain, warts, generalized foot and ankle pain and bunions. Diabetics greatly seek the help of Podiatrists to assist in proper toenail trimming and prevention of open wounds and ulcers. Generalized foot pain if often treated by Podiatrists with custom insoles for shoes, or “orthotics”.

Podiatrists fill a specialized niche in our society – treating and alleviating foot pain. They have been specifically trained to assist in determining the causes and treatment of chronic foot pain, thus offering the public the relief necessary to obtain a fulfilling and pain free lifestyle.

Tags: common foot ailments, diabetics, foot and ankle pain, Orthotics

Ingrown Toenails

Author – Gary F Ochwat DPM

Ingrown toenails are a common foot condition in which the nail is curved downward and the side of the toenail grows into the flesh of the toe. This irritates the skin creating pain and redness and sometimes leads to infection.

Common causes of ingrown toenails include hereditary, trauma improper trimming and tight fitting shoes. Toenail fungus may also cause the nail to become ingrown.

Prevent ingrown toenails by trimming your toenails properly. Cut the nails straight across and do not cut them too short. Avoid wearing tight fitting shoes. It is a myth that cutting a “V” in the nail allows the nail to grow straight. This is simply not true. The toenail will continue to grow curved downward.

Self care treatment includes soaking the toe in warm water for 15-20 minutes and apply a topical antibiotic ointment twice a day. When an infection is present, seek professional care from a Podiatrist. This is especially true for those at risk because of diabetes or vascular disease. Often a minor procedure is performed to permanently remove the ingrown side of the toenail. This is a common, painless treatment procedure performed under local anesthesia in the Podiatrist’s office.

Tags: diabetes, Ingrown Toenails, podiatrist, professional care, self care, tight fitting shoes, trauma

Arch Pain

Arch pain is a treatable, but chronic condition of the foot that most often occurs from Plantar Fasciitis. This very common condition is the result of inflammation of a ligament in the bottom (plantar) aspect of the foot. The ligament attaches from the inferior aspect of the heel bone (calcaneous) to the inferior aspect of the toes (phalanges).

Symptoms:

- Pain upon waking with the first few steps or after prolonged sitting.
- Inability to tolerate flat shoes or walking barefoot
- A sharp trigger point pain in one or both heels, may cause limping

Causes:

- Flat or high arched foot structure
- Prolonged standing
- Working on very hard surfaces
- Very common among runners
- Associated heel spurs

Differentials:

- Calcaneal (heel bone) stress fracture
- Plantar Fascia partial tear or rupture
- Plantar Fibromas
- Bone cysts
- Foot strain

Evaluation – At your appointment, your doctor will perform a history and physical, take x-rays to rule out causes for your heel or arch pain, beside plantar fasciitis. Be prepared to ask questions about your condition and give details about your habits including work conditions, exercise activities and typical choices for shoe gear. Be prepared to discuss when the pain occurs and what makes it worse or feel better, this will help make an accurate diagnosis.

Treatment – There are many treatment options available, but it is important to remember that this tends to be a chronic foot structure related condition. A person once prone to this condition can see a return of the pain if activities that trigger it are prolonged. Treatment options include:

- Physical therapy, stretching and icing
- Orthotics
- Cortisone injections
- Shoe gear modification to supportive shoes

Most cases will respond to conservative care, but there are surgical options available for those cases that do not respond. This includes resection of associated heel spurs and shock wave therapy.

Tags: accurate diagnosis, bone cysts, bone stress, chronic foot, conservative care, cortisone injections, diagnosis treatment, foot strain, heel spurs, Plantar Fasciitis, stress fracture, supportive shoes

Foot Blisters

Foot blisters are common pathology in our active society. Blisters occur due to skin friction or abrasion in the foot or ankle. The body produces fluid beneath the skin and increases in size leading to pain, irritation, and sometimes infection. Blisters can be seen from people wearing ill-fitting shoes, not wearing proper hosiery, athletes prone to over training or “breaking in” new shoes, sweaty feet, allergic reactions, diabetic patients with neuropathic disease, and excessive sandal use. The foot blisters can cause significant symptoms of redness, soreness, large fluid filled “bubbles”, and can lead to more serious problems as ulcerations and infection.

Foot blisters can be prevented and treated by a podiatrist. Keep the feet dry with foot powder and changing socks/ hosiery to reduce moisture. Make sure to “break in” a shoe or custom orthotic to reduce the friction applied from the new device. Smaller blisters may be treated with soaks, topical antibiotic, and bandages. Larger blisters may have to be drained to reduce the fluid pressures and pain in the foot. This may require a visit to a professional podiatrist to reduce risk of infection and ulceration. The podiatrist may prescribe a topical and/or oral antibiotic, soaking regime, custom orthotic to reduce reoccurrence, proper hosiery, and shoe recommendations.

Tags: diabetic patients, fluid pressures, foot blisters, ill fitting shoes, new shoes, pain in the foot, shoe recommendations, skin friction, sweaty feet, ulcerations

Podiatrist shoes

Podiatrists use shoes and orthotics in the treatment of biomechanical problems. The podiatrist is a specialist in the medical treatment of the foot and ankle. In the course of keeping patients healthy and active, the podiatrist shoe recommendations are an integral part in their healing process. There are many brands and categories of podiatric shoes patients must choose in their shopping experience. These shoes include dress type, walking, running, cross training, casual, sandals, slippers, high to low cut heels, and diabetic custom shoes. An orthotic foot support can be supplemented with the podiatric shoe for added shock support, comfort, biomechanical control, and reduction of pressure.

The podiatrist can perform foot examinations, biomechanical evaluation, gait evaluation, and diagnostic tests as diagnostic musculoskeletal ultrasound and x-rays to clinically determine the most appropriate podiatric shoe for the patient. Some podiatrists may have digital technology machines that can scan a digital impression to view the 3- dimensional structures of the foot and ankle. The podiatrist may recommend certain retail stores or pedorthist to help aid in measurements. A brannock device is used to obtain an accurate assessment of the foot length, width, and circumference of the foot. The podiatrist shoe should have supportive arch, firm heel counter, torsional stability, adequate fit and depth to accommodate for a custom orthotic (if prescribed), and proper material suited for the patients needs of motion and breathability. By having a proper fitting and functional podiatric shoe, the patient is able to live a more active and pain-free lifestyle.

Tags: biomechanical problems, brannock device, custom shoes, digital impression, foot and ankle, gait evaluation, orthotic foot support, Orthotics, pedorthist, podiatrist, shoe recommendations

Diabetic Foot

Diabetic foot disease is an unfortunate complication in patients with diabetes. Diabetes Mellitus (DM) is a disease where the body is unable to produce an adequate amount of insulin. This reduction in insulin leads to an increase in blood sugar in the body that may lead to many complications associated with diabetes. The diabetic feet complications are one of the unfortunate areas affected by this disease.

Patients with diabetes mellitus may have poor circulation, loss of feeling or peripheral neuropathy in the hands and feet, thickened toenails, hardened calluses, ulcerations or sores on the bottom or top of the feet, and increase risk of amputation. In addition, the diabetic foot patient may be imbalanced leading to biomechanical deformities as bunions, hammertoes, collapsed mid-foot arch, equines or tight heel cord, and charcot

Neuroarthropathy.

The diabetic foot should be evaluated and treated by a professional podiatrist. The clinical exam is important to evaluate the skin texture, toenails, pulses for circulation, testing for nerve damage, muscle strength weakness, biomechanical stability, and gait testing. Diagnostic tests as x-rays, diagnostic ultrasound, Doppler studies, nerve tests, blood tests, wound cultures, and MRI or CT scans are other exams used to help the podiatrist gain accuracy in the diabetic foot patient.

Treatment of the diabetic foot is a team effort. It is very important to communicate with the medical doctor, endocrinologist, therapist, dietician, pedorthist shoe maker, and podiatric surgeon. Education is the most important factor in foot health. In order to maintain and reduce complications of the diabetic feet, the patient should begin by following these simple instructions:

Take care of the blood sugar and keep it within control.
Examine and clean your feet daily.
Wear the proper shoes and custom inserts recommended by your podiatrist.
Protect the diabetic foot from extreme temperatures of the different seasons.
Continue with proper exercise to improve blood flow and reduce sugar levels.
Maintain diabetic foot appointments with the podiatrist for check-up.

Tags: diabetes mellitus, diabetic foot disease, patient treatment, peripheral neuropathy, poor circulation

Chiropodist

FOOT CARE