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Keeping Your Feet Healthy Through Education

As a society, we are constantly on our feet.  Whether the problem is growing older, increased weight or the fact that we are constantly becoming more active, our feet are becoming more important every day.  More people are exercising. Children are competing in athletics at a higher level. People are living longer. Weight gain in adults and children are more problematic  Foot and ankle complaints and concerns are touching every life and every family.  As a foot & ankle specialist, Dr Gibson sees these problems on a regular basis and can provide key insights into these concerns.  He also enjoys blogging about these common concerns.

Tell Me About My Diabetes

I Want To Keep Playing Sports

What About My Child's Feet?

Am I Walking/Running Correctly?

Foot & Ankle Health

A Picture Of Health

Date: 11/21/2009

If you had a microscope into your body, an x-ray of the structures, and a mirror into the innermost parts of your body, would you take a look? Maybe you would be even more interested if this picture could help limit future pain or prevent future disease.

As I continue to see patients day to day, many would love to find ways to prevent the foot and ankle problems that are now interfering with their lives. Some even look for options to ensure they can stay active. I feel this information is important and should be available to everyone that desires it.

For this reason, we have created a new free report that will let you not only stay active, but help you understand how careful foot and ankle care can prevent pain, keep you active and even give you a picture into your overall body health.

Request this report and Optimize What You Were Born With...

Dr Brandt R. Gibson
Mountain West Foot & Ankle Institute
American Fork, Utah
http://www.utahfootdoc.com/




What Is A Bunion?

Date: 10/19/2009

I often see patients with the complaint of "bunion" that really don't have this deformity. Often they come in with a bump on a toe, a corn or callus on the inside or outside of the foot or even curling of toes and think it might be a bunion. The truth is, a bunion is a very distinct problem that can easily be diagnosed at home. The presence of pain can then help you determine if it needs to be treated.

Bunion --> A bunion is a bony prominence to the inside of the foot, just behind the big toe, often accompanied by angling of the big toe towards teh second toe. This prominence grows over time and can lead to increased pressure in the shoes, redness and swelling to the area and even significant pain. If significant pain is seen, it is an indication that treatment is necessary including wider shoes, orthotics, toe spacers, bunion splints, bunion pads or even surgery. Surgical correction has improved significantly and often allows quicker return to activity that previously encountered.

Tailor's Bunion --> A tailor's bunion is a similar bony prominence to the outside of the foot, just behind the little toe. Another name for this is bunionette (or smaller bunion). This has similar treatment options and can also produce similar pain.

If both deformities are present, the problem is even exacerbated and may lead to more difficulties in finding good shoes or participation in activities.

The key to both these deformities is the amount of pain. Pain is never normal and can usually be significantly improved or resolved by surgical correction.

Dr Brandt R. Gibson
Mountain West Foot & Ankle Institute
American Fork, Utah
http://www.utahfootdoc.com




Don't Let PAD or Leg Pain Stop You

Date: 09/17/2009

September is National Peripheral Arterial Disease Awareness Month. As part of this month, I have felt it necessary to invite anyone with leg cramps or circulation problems to their legs or feet to be evaluated for PAD or Peripheral Arterial Disease. PAD is a well known entity that can interfere with an active lifestyle, and often indicates increased risk for other life-threatening conditions like heart attacks or strokes.

PAD is defined as disease to the peripheral arteries of the body. These arteries include any vessels away from the trunk of the body (primarily legs/feet and arms/hands). When this disease is present, circulation is less than ideal to the areas served by the arteries. The most common presentation in the legs is cramping to the calf with walking that improves after sitting or resting for a few minutes. Fatigue may also present and lead to inability to walk. If you have pain to the legs with walking, especially if it always presents after a given time or distance (10 minutes of walking, one block, etc.), then you should be evaluated for possible arterial disease.

Don't let PAD stop you from staying active. Don't risk the possible side-effects of additional arterial problems to the heart or brain. It is important that evaluation is done early to preclude any additional risks. Early treatment is important. Mountain West Foot & Ankle Institute can perform the vascular testing that is required to determine if PAD is a problem.

Dr Brandt R. Gibson
Mountain West Foot & Ankle Institute
American Fork, Utah
http://www.utahfootdoc.com

My Numb Feet

Neuropathy Can Be Improved With Alternative Medications

Date: 03/08/2010

As I continue to see increasing numbers of patients with nerve changes to their feet, I am continuing to review traditional and alternative medications for the treatment of these disorders.  Instead of telling my patients that nothing can be done for peripheral neuropathy, I continue to find information that can improve the symptoms.

In a small clinical study run for six months comparing Evening Primrose oil and a placebo, Evening Primrose oil was shown to produce significant improvement of neuropathy over this time.  It was taken at a dosage of 2000mg (2grams) twice a day to get this improvement.  Although the study was small and many individuals don't get the same results, it has been shown to work and should be considered.

Why does it work?  Evening Primrose oil contains an essential amino acid gamma-linolenic acid (GLA) that works with the body to protect nerves and rebuild nervous tissue.  At the above dosage, a patient is getting 360mg a day.  Many people are also trying ALA (alpha-linolenic acid) to get the same results. 

For additional treatment options for peripheral neuropathy, visit our website.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com




"Light Therapy" For Neuropathy Pain

Date: 11/01/2009

Neuropathy is a common condition affecting diabetics and non-diabetics.  This condition often consists of significant pain that may interfere with sleep patterns or even life.  Usually the treatments consist of medications only and often only treat the symptoms not the cause.  "Light Therapy" proports to treat the cause of the pain and often resolve it.  The big question is: "Does 'Light Therapy' improve neuropathy pain?"





Dr Gibson discusses this valuable option, including how it may help you not just treat your symptoms, but possibly resolve them.  Listen to this Podcast at: http://footdoc.mypodcast.com/2009/10/Dr_Gibson_Discusses_Light_Therapy_for_Neuropathy_Pain-252760.html



Dr Brandt R Gibson

Mountain West Foot & Ankle Institute

36 North 1100 East, Suite B

American Fork, UT 84003

801-756-0765

www.UtahFootDoc.com





B-Complex Vitamins Improve Neuropathy

Date: 10/08/2009

Neuropathy is the poor functioning of nerves and can lead to significant abnormalities in the feet and legs including: 

- My feet are numb and may even feel dead.
- I don't feel pain in my feet, even when I have an injury.
- I can't feel my feet when I'm walking, and may trip periodically.
- I have trouble feeling heat or cold in my feet or hands.
- My feet are usually tingling.
- I feel "pins and needles" in my feet, like they are trying to wake up.
- I have burning, stabbing, shooting or electrical shock pains in my feet.
- My feet are very sensitive to touch.  It hurts to have the feet touched, even from a bed sheet.
- Sometimes I feel like I have leather on my foot, or like I have gloves or socks on when I don't.
- My feet hurt significantly at night and keep me awake.

Although diabetes is the most common cause of neuropathy in the United States, neuropathy can present in many individuals without diabetes.  In both cases, nerve functioning may be damaged by decreased blood flow to the nerves or even damaging of the nerves.  As with many natural conditions, there is a natural substance that can improve these symptoms and improve nerve fuctioning.  No longer is neuropathy (diabetic or not) a condition that you need to continue with.

The most common natural substances to improve neuropathy is B complex vitamins: B1 (thiamine), B6, B12 and folic acid.  Many of the over-the-counter vitamins that contain these products, however, are in a form that are not as easily absorbed or utilized by the body.  In our research, we have found two products that provide the vitamins in a form that are beneficial and easily utilized by the body.

1. Metanx - A prescription item that contains L-methoylfolate, Pyridoxal 5'-phosphate and Methylcobalamin (all natural forms of folic acid, B6 and B12 respectively).  These products work together to produce increased blood flow to the nerves and assist in nerve repair.  Many people are finding not just decreased symptoms but improvment of the neuropathy over time.  It should be utilized, however, for at least 4-6 months to ensure it has time to repair the nerves.

2. Neuremedy - A over-the-counter item that contains a form of B1 (benfotiamine) that is absorbed and modified by the body to the active form of B1 (thiamine).  Most forms of this vitamin fail to be absorbed in the body, but the benfotiamine of Neuremedy is easily absorbed and utilized by the body.  It has been shown to nourish dysfunctional nerves and allow them to conduct impulses more normally.  It has been utilized since the early 1960s in Europe and Asia on thousands of patients. 

So, neuropathy although a common problem doesn't need to continue to cause problems in your life.  It can be treated often very effectively through the use of one of these two options.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.utahfootdoc.com/

Utah Running Doctor

When Should I Run Again After A Fracture?

Date: 08/23/2010

As a runner with a 5th metatarsal fracture, I understand the desire to return to running.  This type of fracture doesn't just hurt physically, but interferes mentally because you may need to cancel your race and can't get the runner's "high" that comes with a nice run.  In fact, runners often get in a hurry to get back and can cause additional injury from not waiting until the appropriate time to return to running. 

With this thought in mind, and while currently only 2 weeks into the healing process, I thought it would be useful to discuss how I will be transitioning back to running.

- Pain is improved can I run?  Depending on the extent of the fracture, pain can significantly improve and sometimes resolve at 2-3 weeks, with most fractures being painfree at 4 week.  Although painfree is a good sign it is not a guarantee that healing is complete and running can be initiated.  I am 2 weeks into a fracture and have a painfree foot (finally).  My x-rays, however, show a fracture that is still healing.  If I were to run too quickly, I could create a situation requiring a return to cast or boot and possibly even surgery.

- What is the most accurate indication of healing?  Bone healing, as with fractures, is usually confirmed on x-ray.  If the x-ray shows sufficient callus formation across a fracture, the area is healed.  This means the bone is stable and reinjury risks are decreased.  I wll therefore be confirming healing on x-ray and only start running after the bone is visibly healed on x-ray.  I want to get back to running painfree, and will not rush it for that reason.  I plan for years of running, not just one more race, etc.

- How do I get back to running?  The best way to get back to running is to do it slowly.  You have been limited activity for 6-8 weeks and should take twice to 3 times that (at least) to get back to where you were.  Start slow, preferrably on a surface that will protect you from reinjury.  As I transition back (hopefully in 4 weeks), I will be running upto 1 mile only for the first 3-5 days, and then start progressing slowly back to my normal running routine.  Again, I will take close to 12 weeks to get back to the point where I am ready to train for a marathon.  This will preclude me from running my marathons this year, but will allow me to run many marathons to come.

Just like you use care in training to not under or over train for any particular event or race, you should use care to not progress to soon or too quickly back to running after a fracture.  Your body will thank you!

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com




When Life Interferes With Running

Date: 08/11/2010

We love to run.  In fact, I run to relax and enjoy every run I am able to participate in.  But what do you do when running is not possible because of interferences of life?  I am currently facing this issue with a fractured foot that will not heal with continued running.  Here is what I am doing to "survive" while not able to run.

- Focus On Health:  This includes taking in sufficient fluids (at least 6-8 cups a day of water), eating healthy foods and avoiding unnecessary interferences in my health.  This will allow me to feel better even without the runners high and allow me to heal more easily.

- Focus On Healing:  I can truthfully say that my fracture makes me angry, but I have stopped focussing on that.  I now think about what I need to do to heal.  This includes wearing my cast boot like a cast (24 hours a day, except for showering).  As I focus on these aspects, it is easier to follow the doctor's instructions (even if they came from me for me).

- Be Prepared To Start Back Slowly:  After my injury, I will need to start back running more slowly than usual.  This is important so that I don't get irritated as I start back.

Healing correctly is imperative to returning to running without limitations.  For this reason I need to stay focused and not allow it to interfere with my regular activities or get me down.  Although this fracture is inconvenient, it will not have any longterm effect on me.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com




Barefoot Running, What's The Truth?

Date: 03/13/2010

Barefoot running is not new, in fact it has been around since the beginning of mankind. Often man had to run to find food, or keep from being food. This reasoning is often the justification for barefoot running. They will often even quote "studies" that prove running shoes are bad, or barefoot running is good. 

But what is the truth about barefoot running? Here is a good discussion that was brought to my attention: http://www.prolaborthotics.com/Blog/tabid/90/EntryID/132/Default.aspx

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

My Child's Foot

Too Much "Screen Time" Can Cause Foot Pain

Date: 03/22/2010

If your children are like mine, they like to watch television, play video or computer games, searching the internet and often even spend time listening to iPods or watching videos.  This time has been nicknamed "screen time", because it limits the activity level of the child as they look at a "screen".  Many people wonder if this excessive time can lead to problems.  Studies have shown that as "screen time" increases, so does the childs weight.  Childhood obesity has become more of a problem and can lead to many health problems including heart disease, blood pressure problems, diabetes and many others.  In fact, childhood obesity has even been related to foot or leg pain.

According to a study in Pediatrics, published in the April 2010 issue, obese children have more leg, foot, and ankle injuries than similarly aged children of a healthy weight. The study, after measuring 23,000 children ages 3 to 14 years old, found that the one in six of whom were considered obese had significantly higher risk of injury to the foot or ankle.  This was even taking into account the increased activity level (even in high risk sports) of the healthy weight children.

With this understanding, and the significant risk of systemic health problems, I have continued to encourage my children to remain active.  We involve them in more sports, encourage them to spend time outside and even limit the time television or computers can be on during the day.  As we facilitate this increased activity, and continue to be careful about the childhood eating habits, the risks of childhood obesity is decreased as is the associated risk for foot pain and foot or ankle injury. 

I guess "screen time" really can cause foot pain!  For more information, visit our Children's Foot page.

Dr Brandt R Gibson
Moutain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
www.UtahFootDoc.com




Does What You Eat In Pregnacy Help Your Child?

Date: 11/09/2009

As the father of 10 children, we (although my wife has done all the work) have gone through just a couple pregnancies.  Through each of these 10 pregnancies, my wife is always striving to make the best choices to have a healthy child.  There is a new study that may help protect our children from diabetes even before they are born.

New evidence is emerging for how important it is for pregnant women to eat good, nutritious food. Expecting mothers who eat vegetables every day seem to have children who are less likely to develop Type 1 diabetes, according to a new study from the Sahlgrenska Academy at the University of Gothenburg, Sweden. Full Story .

Although this is pre-birth information.  It is worth considering what your child should be eating on a daily basis to preclude heart disease, circulation problems, diabetes and other systemic diseases.  Many of these problems will present with foot & ankle concerns in my office over their lifetime.

Dr Brandt R Gibson
Moutain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
www.UtahFootDoc.com




When Is Flat Feet A Problem In Kids?

Date: 10/06/2009

On a regular basis, I have parents come with their children worried because of how they walk.  They see flat feet in their children and worry if it is a problem that can cause other problems in the future.  With this question ringing in my ear, I wanted to list several things that should be considered for flat feet in children.

1.  Flat Feet is Normal in Infants.  An infant has "baby fat" in the arch area and will present with flat feet.  These feet will continue to change as the child grows and may develop an arch as the fat is resorbed over time.  I have seen a lot of babies (even in my own home) and flat feet is expected.

2. Does Your Child Trip A Lot?  Flat feet can be a normal variant, but if it leads to walking changes, like tripping and falling or turning in of feet it should be addressed.

3. Do They Have Pain In Legs or Feet?   Pain to the feet is never normal.  If the flat feet are a problem, the child will often present with aching to the feet, ankles or legs.  They may not want to run and play or may ask to be carried on longer walks (if a younger child).  Night pain to the legs may also indicate additional stress from flattening of the feet.

4. Abnormal Shoe Wear.  Another indicator of possible problems is rapid wear of a shoe.  Shoes should have normal wear on the outside of the back heel and inside of the toe.  Too much wear on the inside of the heel, arch area or toe may indicate additional pressure.  Depending on the shoe quality, the upper (cloth part of the shoe) may also rotate in (instead of staying over the sole of the shoe).

So if your child's foot is flat but has no pain, no tripping or falling and no abnormal wear of the shoes, it usually is not a problem.  If any of these conditions present, it is recommended that the feet be evaluated by a foot & ankle specialist.  We want to keep those little feet active, whether they are flat or not...

Dr Brandt R Gibson
Moutain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
http://www.utahfootdoc.com/

Diabetic Foot

Vitamin C May Reduce Damage From Diabetes

Date: 06/29/2010

In a new study on Vitamin C, it was found that oxidative stress can be alleviated by antioxidant activity of vitamin C.  In fact, it helped significantly.  Although the amounts were administered through the blood stream (not by oral over-the-counter treatment), it is promising for the options at treating the complications and injuries commonly encountered in diabetes.

My findings have been similar.  As antioxidants are added to the diet, including vitamins and minerals by supplement or by diet high in fruits and vegetables, diabetic complications can improve.  These are promising findings and more is coming.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.UtahFootDoc.com




Can Nutrition Help Diabetic Complications

Date: 03/23/2010

Many individuals that I meet with diabetes are looking for ways to not just treat, but possibly improve their risks of complications, I have compiled a list of several key factors to limit diabetic complications:

1.  Avoid Excess Alcohol -  Alcohol can rapidly increase the progression of nerve damage and associated neuropathy if consumed in excess.  Therefore, limiting alcohol consumption will decrease the risk of this nerve damage.

2.  Diets Rich In B Vitamins -  Foods rich in vitamin B12 (Fish, meat, poultry, eggs), vitamin B6 (meats, whol grains, vegetables, and nuts), vitamin B1(cereal grains, oatmeal, flax seed, brown rice, spinach, asparagus, oranges) and Folic acid (leafy vegetables, dried or fresh beans) can improve the functioning of tissues, especially nerves.

3. Well Balanced Diets - As you eat a well balanced diet (including many of the foods above), you will also consume the essential amino acids necessary to allow repair and proper functioning of nerves and blood vessels.  This reduces the risk of complications.

4. No Smoking - Smoking, although not necessarily a nutrition item, can lead to decreased circulation to the feet and hands due to the constrictive effect of nicotine.  Smoking therefore increases the risk of diabetic complications.

5. Proper Fluid Intake - A key aspect of any nutrition program should be water rich.  Consumption of sufficient water (other fluids are not as beneficial) can improve the functioning of the kidneys, improve blood flow and overall decrease diabetic complications.

If these key nutrition practices are added to regular exercise, diabetic complications will be limited and the diabetes may even be improved.  Let's work on improving your diabetes and limiting the complications...for additional information visit our Diabetes Page.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.utahfootdoc.com/




New APMA video for the Diabetic Foot

Date: 11/24/2009

The American Podiatric Medical Association has released a new video on the Diabetic Foot, including consequences of vascular compromise (decreased blood supply) to the foot.



To view the video clip on APMA's official YouTube channel, please CLICK HERE.


Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.UtahFootDoc.com

Heel Pain

The Truth About Plantar Fasciitis - What Can I Do At Home?

Date: 03/20/2010

When you step out of bed, do you have severe heel pain? Do you have trouble even walking to the bathroom? Maybe the pain even improves as you hobble around after a few moments. This condition is becoming more common and is seen in both men and women and usually has the diagnosis of Plantar Fasciitis.  If this is your problem, often some self care at home may alleviate the symptoms:


Stretching is an important part of any treatment for Plantar Fasciitis. Since the cause is a tight Achilles tendon (usually), aggressive stretching of this tendon should be done throughout the day. Remember, the plantar fascia is a ligament and doesn't stretch, it only tears. Some common stretches include:

1. Calf stretch – Normal running stretch.

2. Stair stretch – Toes on edge of stairs, drop heels. (Count 10, stretch 3-4 times. Repeat throughout day).

3. Towel stretch – Towel over end of toes prior to getting out of bed and pulling the toes towards the nose.

Some specialized products may assist with stretching including the Pro-Stretch PS-100 or Therabands/Exercise Bands.


Ice Massage is another great way to improve the pain and decrease swelling to the plantar fascia. This can be easily done with a frozen pop bottle or frozen water bottle. The foot is then rolled over this area to massage the plantar fascia and mobilize the swelling.

Other options include using a tennis ball, a golf ball or even a frozen foot roller. Further relief can be achieved with Biofreeze, especially in the roll-on form, since this allows the massage, the cold for swelling and the pain relief through the absorption of Ilex (a pain medication in Biofreeze).


Anti-inflammatory Medications have also been shown to improve symptoms and alleviate pain. These can be ibuprofen (Motrin® or Advil®), Aleve® or prescription strength anti-inflammatory medications. Tylenol® will not reduce inflammation, and will therefore be less effective at alleviating the discomfort.

The Recommended dose of Motrin® for example is 200mg - 400mg every 6-8 hours. Higher doses (600mg - 800mg) may be utilized short-term, but should only be done under the direction of your Physician.


Night Splints have also been shown to improve symptoms. It is designed to maintain the ankle and foot (ie the Achilles tendon and Plantar Fascia) in the stretched position allowing it to heal during the night. Usually the foot will relax when sitting or sleeping and the fascia will try to heal in the shortened condition again. Then each step reinjures the "healing" plantar fascia.

The biggest limiting factor of the night splint is how much it is worn. Many individuals will remove them in the night, due to discomfort. The splint can be anything from a cast boot to specially designed night splints. The Dorsal Night Splint has been shown to be very effective and more comfortable when wearing all night.

If these symptoms fail to work for you, or the symptoms still limit your activities, it is recommended that you visit a foot and ankle specialist.  We can give you additional options for this treatment.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com




The Truth About Plantar Faciitis - What Is It?

Date: 03/19/2010


Plantar Fasciitis is a swelling or inflammation of the plantar fascia (a ligament extending from the heel to the toes) and may even indicate more extensive injury to this area.

This condition can be further aggravated (and sometimes even caused) by a tight Achilles tendon. Since normal walking requires 10 degrees of dorsiflexion (movement of the foot towards the nose) at the ankle. If 10 degrees of motion is not available, the foot will compensate with motion in other joints of the foot and produce increased stretch of the plantar fascia, causing it to tear from the calcaneus (heel bone).

Increased body weight or poor shoegear can also either initiate or further aggravate the problem.

If you have this problem, visit our office for additional treatment options.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.utahfootdoc.com/




Eli Manning Gets Sacked By Plantar Fasciitis. Don't Let It Stop You...

Date: 10/06/2009

What is Plantar Fasciitis, and why would it be stopping a NFL quarterback from playing football?

Plantar Fasciitis is an inflammation of a ligamentous structure located on the bottom of the foot.  It consists of a ligament extending from the heel to the toes and shares an insertion with the achilles tendon.  When walking, this structure remains under stress and can become pulled or torn in individuals with a tight achilles tendon.  When it hurts, it causes severe heel pain that will interfere with walking and running. 

At initial presentation, pain will often not cause limitations while participating in sports, but will cause significant pain the following day.  As it progresses, it hurts all the time and will limit ability to function.  My recommendation for anyone suffering from heel pain (especially plantar fasciitis) is to treat it early so it doesn't keep you out of the activities you enjoy.  It is treatable and should stop you from doing anything you want to do.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.utahfootdoc.com/

My Hurting Feet

Dancing With The "Stress Fractures"...I Mean "Dancing With The Stars"

Date: 10/07/2009

Dancing With The Stars is off and running again.  One of the competitors is Former Republican Majority Leader Tom DeLay who danced through stress fractures on both feet duringa a samba last night.  Since the stress fractures were created through the dancing on the show, he was advised to withdraw by producers and doctors.


A stress fracture is a small break in bone caused by repetitive stress to a bone.  These were once called "march" fractures from the marching produced by soldiers. They have also been common in running and can stop a runner who has created repetitive stress through their training regimin. In DeLay's case, they started as painful pre-stress fractures that progressed to stress fractures in both feet.  Had he undergone the recommended treatments or limited his activities as suggested, it may not have progressed to fractures on both feet.

So once again, pain is never normal and should be treated prior to it progressing.  Pre-stress fractures would be better than stress fractures.  Visit Why Do My Feet Hurt? at Mountain West Foot & Ankle Institute for more information on other reasons your feet may hurt. 

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.utahfootdoc.com/

The Truth About Orthotics

Are Orthotics An Arch Support?

Date: 01/27/2010

Often orthotics are recommended, but are they just an arch support?

As opposed to an arch support that can be purchased at many stores, an orthotic has some distinct advantages:

1. Orthotics are designed to last for years, instead of months from an arch support.

2. An arch support (and most shoes) are designed for the average foot, but an orthotic is custom made for your foot.

3. Although an arch support will provide support to the arch, the orthotic supports the entire foot and cradles the heel.

4. An arch support may flatten with running or increased pressure, where an orthotic will be firm and maintain the position of the foot.

5. An orthotic actually improves or optimizes walking or running patterns by rotating the foot into "neutral position". In this position, the foot functions at the highest level.

Dr Brandt R Gibson, DPM
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
(801)756-0765
http://www.utahfootdoc.com/




What Shoe Insert Do I Need?

Date: 10/09/2009

On a regular basis, I see people looking for a more comfortable shoegear and possibly inserts to place in shoes to make them more comfortable.  Often this is the first step that many take to improve the pain of their feet.  I also see multiple patients come into my office with "orthotics" that they were given by a podiatrist, physical therapist, chiropractor, a specialty store or even a shoe store.  Some even order these "orthotics" over the internet or off the television.  My goal is to educate people on the different types of shoe inserts and help them see what they may need.

Shoe Insert -- Many stores (including grocery stores, sports stores, and pharmacies) carry shoe inserts that are designed by multiple manufacturers.  These are typically pads (especially the gel type inserts) and usually just increase the cushioning to the shoes.  The provide no arch support and usually wearout quickly.  Although they may be more comfortable than the original shoe insert, they provide little or no longterm benefits to the way your feet function.

Arch Support -- Although these inserts can also be found from similar stores as shoe inserts, they typically will provide some increased support to your feet and may even prevent pronation in some individuals.  These are typically designed for average foot types and have little or no benefit for the flat foot or high arched foot.  Some common brands include spenco and sofsole.

OTC Orthotic -- The next level will include arch supports that can be slightly modified for size and foot type.  Among others, these include SuperFeet orthotics, Lynco orthotics, and GoodFeet orthotics if they are fitted to your foot by someone with knowledge of the product.  Again, these are not specifically designed for your feet, but do provide some support and may even modify your walking or standing patterns sufficiently to improve some foot and ankle complaints.  These are a relatively inexpensive alternative for many people that just need some additional support.  These also may not truly function with a flat foot or high arched foot.

Heat Moldable Orthotics (Semi-Custom Orthotics) -- Although these are also off-the-shelf products, they can be modified by heating the product and adjusting them to your feet.  The start with a standard shell and can be modified to better fit your feet.  One type of product of this type is Sole Custom Footbeds, that have helped many people get the mild to moderate support to their feet without the cost of a custom product.  These still are limited in their functioning and will not last more than 6 - 12 months usually in an active individual.  I often use this product in my running shoes and must replace the insole at least every 6 months.

Custom Orthotics -- This is a product that is designed to modify the functioning of your foot, by either accomodation or modification of your gait pattern.  Although there are multiple variations on a custom orthotic, the goal is to produce a more ideal gait pattern and alleviate the stresses and abnormal motions that may produce pain.  I plan to discuss these products in more details, but they should be considered as a more longterm solution that can alleviate pain and help you minimize injury.  The key to remember is although these cost more, you are getting significant benefit for the price.  This is not just a shoe insert or an arch support, but should optimize what you were born with.

Dr Brandt R Gibson, DPM
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
(801)756-0765
http://www.utahfootdoc.com/




What Is An Arch Support

Date: 05/19/2009

We have all seen the commercials about "back pain" or "tired feet" being relieved by an arch support. Companies offer new "supports" or gel pads or even shoe inserts that are promised to help alleviate thes problems. If you walk down an isle in a grocery store or a pharmacy, there are hundreds of choices that can be utilized to "improve the comfort of your feet". The question is what do they do and can they really help your feet.




From an early age, I have had "flat feet" but have never had foot pain or problems. I am very active and wear sensible shoes, but don't add these extra pads or shoe inserts to make me comfortable. What makes the difference why some feet are normally comfortable and others are not?




The foot functions primarily as a mode of gait (the act of walking or running). It is designed to work ideally in a position called neutral, where all the joints, muscles and ligaments align to produce the best motion with the least amount of stress on any part of the foot or leg. When you talk with someone about your walking or running, they will use terms like pronation or supination. Pronation is the act of flattening your arch or rolling the foot towards the arch (away from the neutral position). Supination is the act of increasing your arch or rolling the foot away from the arch (again, away from the neutral position). In both cases, the foot fails to function in the ideal conditions and can cause problems.




An "arch support" is a product from the shelf that is designed to support the foot with an arch. It doesn't account for the neutral position, because it is designed for the average foot, not your individual foot. In a high arched foot, these are usually insufficient to support the foot. In a low arched foot (like mine), the foot is forced into the supinated position and usually leads to arch pain.




Gel inserts or other softer pad products are usually just as helpful. They add only padding to the shoes, but fail to modify the way the foot functions. They are therefore usually only comfortable for days and then flatten and fail to provide benefit.




Orthotics, custom appliances for the shoes to replace arch supports or shoe inserts, produce much more benefit. They should be created custom for your foot by cast molds, foam press boxes, or digital scans. If produced correctly, they will modify the function of the foot to the neutral (or ideal) position allowing they muscles, tendons, joints and ligaments to work simultaneously to produce locomotion. So this could be described as the true arch suppport, but an orthotic is actually so much more.




Some products have taken the arch support theory to a new level by providing some of the customization of orthotics to an off-the-shelf item. The Sole Footbeds have been the best product I have found to provide this functionality in a semi-custom (heat moldable) product. Although these are not orthotics, they will provide a 6 month product that can support the foot, while helping it function closer to the neutral position.




So, what is an arch support? Usually it is a product that wants to be an orthotic but doesn't work for 90% of the population since each of our feet are different. Only a small precentage of the population has the average foot, all the rest of us are flatter or higher arched than the average and need something designed or customized for our foot. For additional information visit us at http://www.utahfootdoc.com/.




Dr Brandt R Gibson, DPM
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
(801)756-0765
www.UtahFootDoc.com

Diabetic Foot Tips

Antioxidants May Hold The Key To Diabetic Complications

Date: 06/29/2010

Over the years, oxidative stress has been implicated with causing many of the complications of diabetes.  Although diabetes and increased blood sugars are the true cause, oxygen free radicals are usually the mechanism for causing the damage to blood vessels, nerves and cells.  Some studies even implicate oxidative stress for heart disease.

Oxidative Stress:  As the cells go through the normal oxygen cycle, active oxygen species are produced that are usually reduced by the enzymes of the body.  If the reactive oxygen species are produced in higher amounts than the body can reduce, we get free radicals.  These free radicals react with tissues and produce the stress that causes tissue to malfunction.  This malfunctioning is called oxidative stress.

Antioxidants have long been utilized to reduce the free radicals and improve oxidative stress.  A new study states that Vitamin C may improve complications of diabetes, consistent with the antioxidant benefits.  Although this study was run using vitamin C at a dosage injected into the blood stream, it shows that antioxidants may be a valuable option to reduce complications of diabetes.  More is to come......




Aerobics Trumps Walking for Health Benefits

Date: 06/01/2010

I found this article very interesting. We always prompt our diabetic patients to start a walking program, but perhaps we should be encouraging them to go to the gym and start an aerobic exercise program! Things that make you say "Hmmmm!."

Aerobics Trumps Walking for Health Benefits




Diabetic Foot Surgery

Date: 04/26/2010

When discussing surgery with patients, I often hear "I'm diabetic, is it safe for me to have surgery?". There are several factors to consider when you are diabetic and contemplating foot surgery. There are times when surgery is not an option, when it is necessary due to infection to prevent limb loss. But there are times when foot surgery is needed to prevent pressure areas that can become ulcers. And as I have discussed previously, ulcers when not treated lead to amputation.


The first thing to know when discussing foot surgery is do you have enough blood flow to the foot to heal the surgery. If your pulses cannot be easily felt by hand then a noninvasive test can be performed to give us a picture of how much blood is reaching the foot. If there is a significant decrease, then a referral to a vascular surgery is necessary before surgery is performed.


Second, understand that you are at higher risk for infection post op due to your diabetes. If your diabetes is not controlled this increases your risk even further. You will be given an antibiotic immediately preop and depending on the procedure may even take an antibiotic for a few days post op to reduce your risk of infection.


Third, are you healthy enough to undergo surgery and the post op requirements? A complete physical needs to be performed to make sure your heart, lungs and kidneys are working properly and there are no surprises.


So, it is ok for foot surgery in diabetic patients. A complete work up should be done before your surgery and you should ask as many questions as you can so that you understand the surgery and why it is needed. At Foot and Ankle Associates of North Texas, we strive to make sure all our patients are fully informed of their procedure and the associated benefits, risks and complications.

More on Foot & Ankle Pain

The Dangers of Lawn Mowers

Date: 08/27/2010

Some people enjoy cutting the lawn. Some give the job to their child or the neighbor. Who would think a common summer chore can be so dangerous? There are over 77,000 lawn mower injuries every year. Over 3,000 of them are in children. Some people even die after a lawn mower injury

I recently had a patient that lost part of his foot from a mower accident. It is devastating to see how much damage a blade can cause. After some research, I discovered exactly how much strength is behind the monster on wheels. Being hit by a mower blade is equivalent to being hit by a 21 pound object dropped from a height of 100 feet or 1.17 pounds traveling 232mph. This is three times the force of a 0.357 magnum gun!

Fortunately, these injuries are preventable, but we have to start taking our lawn mower chores more seriously. So many people choose to cut the grass bare foot. It feels good to have the grass between your toes but it is such a bad idea. First, there are a lot of things to step on especially in long grass where sharp object can be easily hiding. Secondly, the sharp mower blade can easily cut debris in the lawn into smaller sharper object. Though a shoe will not be strong enough to withstand the force of the blade, it will help decrease some severity of the injury.

Make sure you children understand the dangers of mowers. It is hard for a child to understand the complexity of a lawn mower. A push mower looks and sounds a lot like a vacuum. Since children are smaller, the injuries from a lawn mower are much more devastating than those seen adults. Adults will often lose toes or part of their foot, a child may lose their entire foot or part of their limb. Children are also more likely to put their hands near the blades and lose fingers, hands, and arms. There have also been many reports of accidentally running over children with the lawn mower. Remember to pay attention to what is behind you and tell your children they cannot come near you when you are cutting the grass.

These types of injuries are very prone to infections since the blade is so dirty. Luckily, early antibiotic treatments after such an injury cuts the rate of infection to a near minimum. If you suffer such an injury, it is imperative that you report to the ER immediately. The sooner you see a doctor, the less likely you will have complications from the injury.

My patient was lucky his injury was not more severe. He had 3 of his toes cut off with the blade and we then decided to remove his existing toes off to help him with ambulation and shoe fitting in the future. He is now walking normally; he is back to his normal job, and he is wearing normal shoes.






Knee Pain Is A Foot Problem

Date: 07/04/2010

Up to 75% of athletes have chronic knee pain. Is your knee pain driving you crazy? There are a million different reasons why so many people suffer from knee pain. Henry (Hank) Aaron, a home run king, is one of many professionals that suffer from arthritis in the knee. Is there anything you can do to treat or prevent these aches and pains in the knee?

All arthritides are irreversible. Once you have arthritis, you will always have arthritis. The first thing to identify is what is causing the arthritis. Weight is a very important factor. The heavier a person is the more stress and strain that is place on the knee.

Many people attribute activities to knee problems. Though high stress, pivoting, and jarring activities put a lot of stress on the knee, it does not always lead to arthritis. More importantly, a person’s biomechanics can cause chronic increased forces and instability that leads to damage and injuries. The knee is the most unstable joint in the body.

Most other joints have boney boarders that help stabilize the joint. The knee is simply two bones separated by cartilage and ligaments and surrounded by muscles, tendons, and ligaments. These are all soft tissue structures. The knee is surrounded by two more stable joints in the body, the hip and the ankle. However, small problems in these joints easily affect the unstable knee joint. Thus, if someone has chronic ankle or hip problems, it is not unlikely that they will also suffer from knee problems.

Since soft tissues are the major stabilizers of the joint, they can be strengthened with physical therapy, strength training, stretching and range of motion exercises. A biomechanical exam can be done to assess your ankle and hip range of motion, stability and muscle tightness that causes changes in joint function. Most people benefit from several different forms of physical therapy and other treatments gauged at correcting the mechanics of the joint, such as orthotics, custom shoe inserts made by a podiatarist.

Orthotics are not just for your foot pain! You may not have any foot pain and still benefit from orthotics. Many of my patients are extremely active in sports and running. From weekend warriors to obsessive marathon runners, I have heard patients say their orthotics helped their knees, hip, back and everything in between. Biomechanics is the application of mechanical principles to the human body and is studied extensively by podiatrists. Many of the basic concepts are also applied in physical therapy and sports training are biomechanical in nature. Orthotics are devices that enhance function and compensate for biomechanical problems in the leg. Changing joint positions and alignment in the foot and ankle have a direct effect on your knee and hip.
Not everyone needs orthotics, but many people benefit from them.

My clinical experience has me convinced me that orthotics are necessary treatment modalities for a number of musculoskeletal disorders in the lower extremity including arthritis.

From A Running Podiatrist

The State of the Economy Can Be Accurately Predicted by Women’s Shoe Buying Habits!

Date: 08/31/2010

A skeptic you say? Here is a true story borrowed from an article in the Chicago Tribune by Barbara Brotman. Turns out there is good evidence that the Dow Jones Industrial Average can be predicted very well by the Nordstrom’s Shoe Index (my favorite shoe store as well!)

"The biggest swing in spending has been in retailers, such as Saks and Nordstrom, that target high-income consumers, a pickup that coincided with the rally in the stock market." — economist Michelle Meyer.

The science of economic analysis has taken a leap forward with the discovery of a new, highly accurate economic indicator: The Nordstrom Shoe Index.

Economists were intrigued to find that statistics on consumers' attitudes toward the economy coincided with the actions of a single consumer in Chicago. Taking a closer look, they found that they could track consumer confidence and its resulting influence on the nation's economy simply by following this consumer's interactions with the shoe department at Nordstrom.

The phenomenon came to light during a recent surge in consumer confidence. Barbara relates that she happened to be at Nordstrom buying eye shadow. Something, possibly a premonition of consumer confidence, drew her to the nearby shoe department. She began browsing high-heeled sandals, though she did not need a pair of high-heeled sandals, as her husband would later point out. But then she saw them: brown leather sandals with that thick-strapped look that stops just short of dominatrix, strips of leather accents in a fetching shade of salmon and a breathtakingly high heel.

She bought them.

The Nordstrom Shoe Index spiked.

The same day, the Dow Jones Industrial Average went up 21 points.

The purchase also mirrored the Conference Board's Consumer Confidence Index, which in April reached its highest point since September 2008.

Analysts noting the Nordstrom Shoe Index phenomenon were particularly cheered at the price the Nordstrom Shoe Indexer paid — $224.95. They reasoned that consumer confidence had to be surging pretty high for anyone to spend that much on a pair of sandals.

Moreover, the increase in the Nordstrom Shoe Index was accompanied by a high Lying to Spouse score. When her husband asked how much the sandals cost, the consumer claimed they were only $180. Though this still resulted in an increase in the Spousal Irritation Industrials, analysts noted that 20 percent represented an impressive level of lying, significantly above the routine 5 percent spousal lie discount.

However, stock market bears warned of a correction. And sure enough, within days, the Nordstrom Shoe Indexer began to have buyer's regret.

Trying on the shoes at home to defend the "$180" purchase to her spouse, she realized that the heel was so high as to cause intense pain, and not just because of the bunion problem. The heels threw her entire body onto the balls of her feet. She could barely walk in them.

For two days, she vacillated. (Really? Why do we do this to ourselves over cute shoes?)

In the same time span, the Dow Jones Industrial Average dropped 236 points

She brought the shoes into the office one day and tottered along a carpeted hallway, trying to decide whether she could take the pain. An economics debate broke out when several female colleagues stopped to say that her shoes were darling. Upon learning of the pain problem, some counseled her to be practical and return them. Others argued she should man up and wear them no matter how much they hurt because they were so white hot. (Pick some new friends!)

The Dow Jones, aka the Jimmy Choo, rose 49 points, apparently on hope of persuasion.
The direction of the nation's economy hovered in limbo as the Nordstrom Shoe Index progenitor agonized. Stock brokers chain-chewed antacids. Hedge fund managers gnawed on their fingernails. Institutional investors fanned themselves.

Finally, the indexer decided that she couldn't justify spending $224.95 on shoes she could wear only while sitting at her desk.

On Friday, she made the call: Back they would go.

The Nordstrom Shoe Index plummeted.

The Dow Jones dropped 173 points the same day. The Standard and Poor's 500 Index fell 20 points.

Some analysts use complex mathematical formulas to predict the behavior of the economy. Some stock-picking experiments have tried dart boards.

The Nordstrom Shoe Index, however, has earned its place in the economic indicator pantheon. A nation searching for signs of financial direction should consider this:

Barbara laments that she still want a pair of really cute, but lower-heeled, sandals.

Ladies…we all knew our shoe shopping habits were important, but now we know the economy depends on it!

Shop On!
Dr Marybeth Crane is a board certified podiatric foot and ankle surgeon specializing in sports medicine. She is the managing partner of Foot & Ankle Associates of North Texas in Grapevine, Texas. Dr Crane is a life-long runner and an expert in lower extremity biomechanics. For more foot and ankle health information visit her websites at http://www.faant.com or visit her running specific site at http://www.myrundoc.com.



Is Your Metabolism Happy?

Date: 08/17/2010

Why is it that so many people complain that they eat very little, but are still overweight? I have many triathlete friends that eat way better than I do, yet can’t seem to tame the belly bulge. Then there are people like me that eat everything in sight, and never seem to gain weight. We complain that during times of extreme training that we are hungry constantly and work hard not to drop too much weight! No one feels sorry for us! What’s up with that?

Your metabolism is the key. Most people are somewhere between the two extremes. Their intake, metabolism and output are on a roller coaster ride. If only you can tame the metabolism beast, healthy weight and better performance will follow.

How can we make our metabolism happy? The answer is a healthy, consistent diet and regular exercise routine. The key word is consistent! Food becomes energy at the rate our metabolism dictates. Exercise utilizes this energy at a more efficient rate if our metabolism is fast and happy.

This is not only the key to getting stronger, faster and more efficient but also the million dollar answer for weight loss! Losing weight means taking in less than you put out. You have to take into account your personal BMR (basal metabolic rate) which is one part genetics, one part age and many parts lifestyle habits! Seems simple enough; but if you are on a constant fad or crash diet, your body’s BMR is very low. Hence, you burn much less at rest than a hyper runner like me who eats constantly! I love my BMR! I burn more calories when sleeping than the average person!

So what does all this mean? A person who eats very little but can’t lose weight probably has a slow BMR and is often sluggish in their energy output; while in contrast a person with a fast EMR can eat more calories, utilize them more efficiently and have a higher energy out put!

The formula "energy plus metabolism equals output" means that all three react synergistically. High output is always desired, so in order to affect output, more energy either has to come in, or metabolism has to speed up, or both. Metabolism tends to be the limiter in most cases, since we can choose how much to eat. The volume of output can also be manipulated through programming our metabolism to be happier.

How do we affect our metabolism to achieve our goals? The most logical means to improve metabolism is to do more work. Increase your exercise in either duration or intensity. This will encourage your body to pick up the pace!

Many times your metabolism is low genetically and environmentally for many years and is stubborn to move. It is clinically depressed! The way to jolt it into action is not through starvation, which is often a knee-jerk response to the problem. Steady and consistent eating habits will be supported by good and steady energy inputs and high-energy outputs.

It makes sense that we need to increase our output and eat sensibly and consistently in order to change long-term trends. It is important to remember, this is a gradual process, so a commitment to the course of action is necessary.

Small consistent meals five or six times a day with a gradual increasing exercise program over a period of months leading to years will help kick your metabolism back into its happy place! Patience and discipline are the two primary rules of metabolism repair mechanism.

Almost all of us can improve what we're doing at some part of this equation. Grade yourself honestly. Is your metabolism happy and trusting? Is there enough energy? Is there enough exercise? Too much? Is your metabolism depressed and mad at you having been starved and stuffed with bad food and bad habits? Is there enough energy coming in and where is it going? Where can you improve?

Make your metabolism happy for better race results and an added bonus of a better waist line!
Dr Marybeth Crane is a board certified podiatric foot and ankle surgeon specializing in sports medicine. She is the managing partner of Foot & Ankle Associates of North Texas in Grapevine, Texas. Dr Crane is a life-long runner and an expert in lower extremity biomechanics. For more foot and ankle health information visit her websites at http://www.faant.com or visit her running specific site at http://www.myrundoc.com.

From A Houston Running Podiatrist

A Podiatrist's Barefoot Running Blog (Part 5)

Date: 08/11/2010

Another short update from Dr. Randy Beckman and his experience running in the Vibram Five Fingers:

I was in the country with my wife this weekend and we decided to go for a short run, kinda slow, but in the hills. I wore the five fingers from the beginning of the run and we ran for 2 ½ miles. I certainly felt some soreness in my right Achilles after the run. It was interesting to feel more pain when going downhill vs uphill. Also, the next 2 days my feet were pretty sore, making Monday’s run difficult.

Beckman out!

You can learn more about Dr. Beckman at www.TxFootDoctor.com. I thank him for continuing to share his experiences and look forward to more.






A Podiatrist's Barefoot Running Blog (Part 4)

Date: 08/03/2010

Another quick update from Dr. Randy Beckman and his experience running in the Vibram Five Fingers:

Went running this weekend in the Hill country of Texas. Got in 2 pretty good runs and wore the Five Fingers for 1 mile each of the runs. No real foot/leg problems yet, except for Saturday morning early, when running in the park, I saw 1 armadillo, 6 deer, and one skunk!! Yes, I got sprayed by the skunk! After washing myself 3 times, and my clothes 2 times, I finally got the smell out. I also used a local concoction of peroxide, baking soda, and Dawn on my shoes. Will keep on running.

Beckman out.

You can learn more about Dr. Beckman at www.TxFootDoctor.com. I thank him for continuing to share his experiences and look forward to more.

More on Children's Feet

This Little Tootsie Went to the Market

Date: 03/15/2010

Baby Foot Advice

Your bundle of joy enters the world and dad quickly checks to make sure he/she is strong. Ten toes!!! Great, now what do we do? When you have a healthy baby, all you want is to keep them healthy. Here are a few tips to keep your baby’s feet happy.

Many new parents are alarmed when they see discolored, wrinkled, and peeling skin on their new born. This is a normal finding and is not a reason to rush to the emergency room. One must not forget that a baby spends months trapped in a fluid filled sack in mom’s stomach. Imaging what your feet would look like after lying in the bath tub for only a couple of hours! It takes time for the skin to get use to the new world.

Toenails are the obvious foot chore on babies. The nails should be kept short to prevent scratches and sores. Use a baby nail clipper and be sure not to cut the nails too short. If cut too close to the skin, an ingrown nail can develop. It is a good habit to check your baby’s feet regularly after a bath. Look at the nails and the general appearance of the foot. Also, make sure to dry the feet off completely. Bacteria and Fungus can easily accumulate on a moist foot.

Shoes for babies and toddlers have become very popular and stylish. Though we think we are helping our children by putting them in shoes, it is actually better for development for a child to walk around barefoot. It is recommended to always have your children wear shoes outdoors since rough surfaces and outdoor debris can easily puncture the skin. Yes, of course the shoes are adorable and we love to buy them and try them on and put them with their cute outfits, but honestly you’re better off letting them run around in just socks. Pediped’s are a great alternative. They are hand stitched shoes that allow plenty of room for healthy growth.

Your pediatrician will check the feet for any major deformities or problems. It is normal for your child’s feet to look flat up to the age of two. You may think they look funny, too flat, or without an arch. The bones in the foot do not fully mature until 18-23 years of age. Some bones have not even started to grow yet when the baby is born! When you look closely the foot does not really look like a mini adult foot. Pediatricians are trained to look for common abnormalities and to refer you and your child to a podiatrist if a problem is suspected. If you are worried or have questions about your child’s feet, a podiatric physician can evaluate and treat children.




Will My Child Outgrow Flat Feet?

Date: 12/13/2009

Flat feet can also be referred to as pes plannus, pes planovalgus, valgo plannus, or pronation syndrome. It is commonly described as a foot without and arch. Flexible and Rigid flatfoot are the two basic forms. A flat foot is rigid when the arch appears flat when the child is sitting and when the child is standing. The flexible flatfoot is when the foot appears normal when the child is sitting, but the arch collapses when the child bears any weight on the foot. The flexible form is less severe and much more common.

Flatfoot is normal in children under three years old. Young children are very flexible and will appear to have flat feet. It is normal for the child’s foot to appear as it is rolled in and pointing outward until they past their toddler years. You may need to see a podiatrist if you child still appears flat as they near the age to attend school.

The podiatrist will evaluate the entire lower extremity to determine if the child is experiencing any weakness or pain. The child may complain of pain in the foot, ankle or the knee. The child may also have a history of clumsiness, or a voluntary decrease in activity. The doctor will take x-rays to evaluate the joints and alignment of the bones.

A tight calf is a common finding in all flatfoot patients. This may be a significant component to the patient’s present and future pain. Thus, it is common for children to undergo physical therapy to learn stretches and exercises that target the calf muscles.

The gold standard in treating flatfoot is orthotic therapy. Orthoses are custom made shoe inserts that assist in foot function. Since the orthoses are custom made, they are design to address the child’s specific foot structure and associated problems. These devices will help prevent the flatfoot from progressing and decrease the current pain that the child is experiencing.

Surgery is a treatment of last resort. In rare cases, a child will continue to have pain or disabling fatigue after all conservative treatments are attempted. Surgery is invasive and often unnecessary to control flatfoot pain, so it is not attempted until the doctor and parent have exhausted all other treatment options.

In these severe cases, where the child’s flat foot is flexible, an implant can be placed in the rear part of the foot. One type of implants is the Hyprocure. The procedure takes only seven minutes and is made with a tiny incision. The implant causes an immediate arch and rarely needs to be removed. This procedure is done in children with severe pain in the arch or where the arch is so collapsed it will lead to an arthritic condition when they get older.

Many parents worry about their children’s flat feet, but in most cases the children grow out of them by the time they reach kindergarten. At this age, we begin to worry that the child may actually have a flatfoot. Generally these feet are easily managed and the child can have a normal and active life with no limitations. Be aware of children’s feet and their pain. It is common for children to fall and cry, but it is not common for a child to have foot pain or fatigue. It is always better to treat the flat foot immediately on a conservative basis because once they reach the age of three it might be very difficult to correct.

More on Children's Foot Pain

Orthotics for Children?

Date: 04/28/2010

Recently a lot of my adult patients have been asking me when is the appropriate age to have their child's feet evaluated. Most parents wont even think about taking their child to a Podiatrist unless the child complains about their feet. Commonly it will take a parent watching their child walk to realize that something might not be correct and even then they are sometimes told by their pediatrician that it is something the child will grow out of.

Most specialists will agree that as soon as your child begins to have unassisted stance (able to walk without you holding them up) there feet should be evaluated. At 8-13 months a child will begin to weight bear. During this time the immature and misaligned osseous (bones) infant framework begins to be susceptible to the deforming forces of gravity. I believe that early intervention in the developmentally challenged foot leads to bony remodeling which can lead to a more normal alignment of the foot structure.

So how do you know if your Child's feet need Evaluation?

If you notice that your child is unbalanced, seems to be walking with a limp or a rotation in their feet. Toe walking and wearing out shoes on one side only, are also signs that require evaluation.

What to Expect with the Evaluation?

First a bio mechanical exam will be performed. A gait analysis will follow with recommendations for appropriate shoe gear as well as orthotics if crucial for ambulation. Most children are able to use an over the counter support until they are 5 or 6. Once a child is able to walk down stairs one step at a time without holding on to the handrail they have developed a propulsive phase and need more custom devices.

Most children that are placed into custom devices will require lifelong treatment. It is the parents responsibility to allow for adequate control while the child is growing. So remember if you think that your child may walk differently then the other kids have their feet checked. You could be preventing future deformities.




How Do I Protect My Child's Feet This Summer?

Date: 04/25/2010

Summertime is around the bend! I can see it now. Flip flops, bare feet, pool parties, gyms, water parks and such! There are all kinds of wonderful pathogens waiting to invade. The most common for children include warts, athlete’s foot, insect bites and foreign bodies (stepping on something). How do we keep our environment clean enough to keep this stuff away? Simply put, you can’t! How then do we protect our children's feet without keeping them away from the things they love to do? Now this is entirely possible!

Let’s talk warts. Warts are a virus. They are about as preventable as a cold! We still do all we can to avoid a cold by washing our hands and not sneezing on our children. What can we do to prevent warts? Well, number one on my list is to protect your children’s feet as much as you can by having them wear water shoes when they are at water parks (the wart virus thrives around public pools) and flip flops around gym locker rooms and showers. During the summer months, I routinely check the bottoms of my children’s feet to make sure nothing is “popping up”. Warts are very manageable when they are small.

Althete's foot is created by fungus in a moist environment. Conveniently so, the way you protect your children’s feet from getting athletes’ foot is essentially with the same protective foot wear around pools, locker rooms, gym showers and the like. Make sure your children dry well in between their toes after bathing before putting their socks on. Using an anti-fungal powder and changing their socks (if their feet sweat a lot during the day) keeps moisture under control as well. It also helps to spray their foot wear with an anti-fungal spray.

As far as insect bites and foreign bodies go, it really depends on how much freedom you want to give your children’s feet! There are parents who walk around the yard barefoot and those who wouldn’t dare.

Bare feet come with risks any way you look at it. Yes, there is an increased risk for athlete’s foot keeping protective shoe gear on, but athlete’s foot is a lot easier to get rid of than the other options!

Always make sure you are prepared with the essentials for healthy foot care before summer. Doing so will allow you and your children to enjoy the summer knowing their feet can too!

More on Diabetic Foot Problems

Sock It To You!

Date: 03/19/2009

The Perfect Sock

We use them almost every day. They come in all different forms and sizes and some even come with bells and bows. What am I talking about? Your socks! Do you ever wonder if your socks are feet friendly? Believe it or not but socks made out of the wrong fabric or that are poorly made may worsen some common foot conditions.

The American Podiatric Medical Association (APMA) recommends the following when shopping for socks:

Purchase a sock made of a polysynthetic blend. This material will best wick away moisture from the foot, which can prevent blister formation and irritation.

Avoid socks with large seams at the toe or in other areas. Those with diabetes or decreased circulation, who have an increased chance of developing irritation and blistering of the foot skin, should seek out seamless socks whenever possible.

Choose thickness of sock material based on personal preference and comfort.

Evaluate each sock’s fit, making sure that there is no loose fabric around toes or heels.

Conversely, socks that are too tight can decrease circulation and comfort.

If you suffer from sweaty feet also known as hyperhydrosis, it is especially important to buy the correct socks. You may think 100% cotton is the best way to go but a blend of cotton with other natural materials will do a better job of wicking away moisture. Choosing the right sock will keep your feet dryer and less stinky. Maybe you will think again when buying your husband’s socks!
Noticing the importance of choosing the right socks, the APMA recently recognized and gave the seal of acceptance to two new sock products. Injinji Footwear Performance Series Tetratsok has a patented anatomical, five toe-design that separates toes with an anti-friction seamless membrane. The sock is made out of a combination of coolmax wicking fiber, and a durable shell cover of nylon and lycra. This helps protect the foot from slipping and sliding in your shoe.
The Takeda Legwear Big Toe R x L socks are designed specifically for the right and left feet. This allows for a snug and comfortable fit. BigToe R x L socks is also made from Coolmax fabric to keep moisture away from your skin.

They next time you buy socks, take a closer look at the materials. Slip them on and see how they fit. Are they snug? Can you feel the seams? Are there any knobs of fabric that are rubbing against your feet? Just as importantly are your shoes. If your shoes are too tight, it will exacerbate the effects of poor quality socks. Make sure your shoes are the right size and gives you room to wiggle your toes.




Diabetes and Foot Ulcers

Date: 02/11/2009

There are over 23 million American with diabetes, and another 57 million with pre-diabetes. Many argue that diabetes is becoming an epidemic. As technology continues to advance the efficiency of our world, it also takes away the need for physical exertion. In order to get the exercise necessary to stay healthy, we have to “go work out.” Most of us are dropping the ball on this; and thus, America is gaining weight. This combined with fast food and fat filled diets are causing diabetes to be on a continual rise. Unfortunately, many underestimate the severity of the disease. Diabetes is a very serious condition that has many complications which includes blindness, cardiovascular disease, kidney failure, and foot ulcerations. These complications are acquired over time and greatly increase mortality rates. A person diagnosed with diabetes before the age of 40 will lose 15-20 years of their life!
Out of all of the complications linked to diabetes, the complication that causes the most hospitalizations is foot ulceration. Many of these ulcers may lead to amputations and this greatly increases the mortality rate. A person has a better chance of survival with colon or breast cancer than they do having a diabetic amputation. There are several reasons why diabetes has such strong effects on the feet; all of these complications combine into a formula for disaster if one does take proper measures to protect their feet and their health.
Causes foot ulcers 1o1
1) Macrovascular/Microvascular complications. Diabetes is the inability of the body to control blood glucose levels. The rise in blood glucose, or hyperglycemia, is when there is excess sugar in your blood stream. This can facilitate clot formation and increase your chance of heart attack and stroke, but more commonly leads to micro vascular complication that decreases your blood flow in small vessels and in your extremities. A decrease in blood supply in an area, such as the foot, makes it difficult for your body to keep those tissues healthy.
2) Foot deformities. The excess sugar in circulation can deposit in tissues and joints and lead to foot deformation. Diabetics may see changes in their foot structure or feel pain with motion. In very serious cases, the foot develops Charcot’s foot. In this instance, the bones in the foot are actually being destroyed. The deformity is often described as the foot becoming a” bag of bones.” These deformations change how forces are applied across the foot. Normally, when walking, weight is nearly evenly distributed across your foot, deformations cause increases in pressure at certain areas. This facilitates tissue break down
3) Peripheral Neuropathy. Neuropathy is the loss of nerve function. The nerves most commonly affected are sensory nerves. Over time, diabetics experience nerve damage due to the increased levels of sugar. Initially, this damage presents as tingling and burning but eventually leads to loss of feeling. Thus, diabetics lose the ability to feel pain, the body’s natural warning sign. It is very dangerous for diabetics to be unable to perceive a problem in the foot. For an example: If one steps on a piece of glass, they would be unaware and walk around on the glass all day.
Preventing Ulcers 101?
1) Controlling your blood sugar levels with diet and exercise is the best way to prevent all diabetic complications. When diet and exercise is not enough, there are medications that can assist your body in maintaining appropriate amounts of sugar in your blood.
2) Inspect your feet regularly. Look in-between your toes under and all around. Watch your feet for any changes in appearance, temperature, and feeling. Before or when changes are noted, contact a podiatric physician. A podiatric physician can help prevent and accommodate changes in your feet due to diabetes.
3) Avoid walking around barefoot, in sandals, or any other open shoes. This leaves your feet vulnerable to getting cuts, bruises, bumps, and infections.
Diabetes is a multisystem disease that can cause many complications. Foot ulcers are highly prevalent, but also highly preventable. It is important to consult your physician to help you control your blood sugar levels. Podiatric Physicians are foot specialist that have extensive training in diabetic feet and wound care. They will provide you with the best care to prevent foot ulcers and amputations, the leading cause of diabetic hospitalizations.

More on Keeping Your Feet Feeling Young

Can a Can a Medical Food Help Control the Symptoms of Peripheral Neuropathy?

Date: 09/03/2010

Peripheral Neuropathy is becoming a more-frequently diagnosed condition. In fact, in Houston, TX podiatry practice, I see neuropathy as becoming an overused diagnosis…one that is used when the doctor can’t figure out what is causing a numbness or pain. Peripheral neuropathy is a common effect of diabetes. The blood sugar can cause the nerves to [...]


Family Dog Chews off an Infected Diabetic Toe and Saves Owner’s Life

Date: 08/04/2010

Yes, that title says what you think it says. I must begin with a warning…this post is not for the faint of heart or stomach! So a friend of mine on Facebook posted this and I just had to write about it. Check out the link to this article about how a man found out [...]

More on Heel Pain

Does Your Pump Bump Have One or Two Humps?

Date: 10/28/2009

It sounds like a catchy lyric from the Black Eye Peas or Beyonce, but “Pump Bump” is a common term used among podiatric physicians. Do you have pain behind your heel? Do shoes irritate areas behind your heel and cause pain? Do you feel an abnormal bump behind your heel? It may be a bump that is irritated by your pump and thus a pump bump!

Pump Bump may also be referred to as a Haglund’s deformity as well as a retrocalcaneal bursitis. Typically, women most commonly complain of the irritation due to their selected shoes designed for fashion rather than comfort. The pain is sharp and along the side of the Achilles tendon insertion into the heel. Many of my patients find significant relief when they wear athletic shoes or backless shoes, but additional treatment is often needed to be completely pain free.

Typically a pump bump is caused by some abnormality in the heel bone. It may be that the heel bone tilts slightly out or pronates. Or, the heel bone may be tilted upward in a high arch. The Achilles tendon is only attached to the middle one-third of the heel bone. The upper one-third of the heel normally allows a nice gliding motion of the tendon like a pulley. When the heel bone is mal-positioned, the gliding motion is less smooth. Eventually, the unusual rubbing of the Achilles tendon causes irritation and the body develops a bursa. The bursa then becomes inflamed and causes pain in the heel.

On examination, the back of the heel will appear red, slightly swollen and painful to the touch. X-rays or ultrasound will often reveal some degree of boney deformity or mechanical disruption.

When changing shoes does not resolve the painful symptoms, it is necessary to see a podiatric physician to begin a treatment regimen that will hopefully keep you out of surgery. A heel lift can be put in the shoe. This will elevate the heel and reduce the area of friction on the shoe. NSAIDs are also used to decrease the inflammation, but it should be noted that if the shoe is still rubbing hard up against the bump the drugs will not be of great effect. Some of my patients have seen great relief by stretching their Achilles tendon 2-3 times a day. In addition, cryosurgery, which is a minimally invasive procedure helps relieve the inflammation along the heel. In most cases, the pain at the back of the heel is due to the constant pulling of the Achilles tendon along a sack of tissue in this area. This is called bursitis. Cryosurgery requires a very small incision along the area and then a probe that sends liquid nitrous oxide at a temperature of (-) 72 degrees is placed into the inflamed area. This reduces the inflammation, thus relieving the pain permanently. One can walk right away after the procedure with their regular sneakers.

Depending on the cause of your bump, orthoses may be necessary to correct the mechanical problem of your heel. Sometimes, the bump is unable to be resolved by the treatments and surgical excision of the bone bump is necessary.




Children Get Heel Pain Too and They are Not Faking IT!

Date: 10/28/2009

Many of us think that foot problems are one of the aches and pains of aging. But heel pain is not normal nor is it isolated to only adults. I have seen my share fair of children and teens that are having difficulty playing sports or participating in gym classes because of heel pain!

Sever’s disease is the most common cause of childhood heel pain and usually affects children 8-14 years of age. Traditionally, the disease was thought to affect males much more predominately, but now that we are seeing more young women athletes, the incidence is nearing the same between genders. Sever’s disease is medically described as osteochondritis of the calcaneal apophysis. This is an injury to the growth plate in the back of your heal. During development, all bones in the body start as cartilage and fill in with calcium and other minerals to create a strong skeleton. This process is referred to as ossification. The calcaneus, or heel bone, has two separate areas of ossification that are connected by the cartilaginous growth plate.

Because of overuse or tight muscles, these two ossification centers are pulled away from each other causing strain on the growth plate. Overtime simple activities such as running, jumping or even standing can cause severe heel pain. I will often see children limping into my office when they have this condition.

Luckily, this is a self limiting condition meaning it will eventually go away. Unfortunately, children will have to tone down their activity schedule to reduce the pain. It is important to make the children as comfortable as possible and keep them active in their favorite’s sports, but we also have to be reasonable in the treatment options. Physical therapy will help the child stretch the muscles to decrease the pull on the developing calcaneus and Thera-band exercises can be used to strengthen the area. Ice massages will also help decrease the inflammation which is the culprit of pain. Heel lifts placed in the shoes, to decrease the pressure of the Achilles tendon on the calcaneus , and orthoses can also bring relief. Occasionally, there is need for a cast to immobilize the area to ensure proper healing. Though NSAIDS can bring relief to pain, large does are not always recommended for children. Thus, I prefer to have children to try topical pain relievers first.

Since Sever’s Disease can last up to 18 months, it is important to treat it aggressively soon as possible. Thus the child is not stuck on the bench, disappointed in their inability to perform. It may be necessary to take a short break from vigorous sports or exercise to allow proper healing time, but that is much better than sitting on the bench for an entire year!

More on Foot Care Product Options

The Journey to a Texas Ironman

Date: 08/30/2010

Hey Everybody! Trusting you had a good week and restful weekend. Here is a little something I took on for fun:

Saturday was the Hotter N Hell 100 in Wichita Falls, Texas. For the second year in a row, the weather was hot but not like one would imagine in the place opposite of heaven...okay, around mile 85 things began to get a little toasty.

This event is a great ride for all levels of athlete. Thing is, you have to train or you might end up joining the ranks in the SAG wagon or worse, the ambulance wagon. If you ever have the chance, try out the event. It is traditionally held nine days before Labor Day every year. Hotels sell out months in advance for the four day event. There are different mileage options so you don’t have to ride 100 miles but if you can, it is one event with some serious bragging rights!

After working the week away, I packed up Celeste (now you better know who she is by now) and an overnight bag and drove off to Wichita Falls. Arriving at the hotel I had to snicker as directly across the parking lot was a bike shop. This was definitely a good sign.

The expo was a cyclists dream. Anything you needed, the expo had it and if you were looking for mark downs on cycling gear, this was the place to be. Of course the important stuff such as picking up the packet was the first thing off my list then on to pick up the coveted HHH100 jersey. This year’s jersey was without a doubt the coolest one yet. I can’t wait to wear it at next year’s ride as tradition is to wear a previous years jersey the day of the ride.

After seeing many familiar faces, I decided to get a good night’s sleep in preparation for the ride. Unfortunately, that did not happen for unknown reasons so I did the best I could until the alarm went off at 5:00am.

Finding parking the morning of the ride is easy, as long as you get there early. I arrived to the start around 6:15am. Shortly thereafter, about 14,000+ cyclists jammed the street ready to take on the days event. Just after 7am, a beautiful live version of the National Anthem was sung followed by the Air Force fly over and a cannon start. I can’t help but to get choked up with the anthem and fly over. It gets me every single time.

The rest stops were awesome with plenty of hydration, snacks and of course the favored pickles and pickle juice. Last year, at the start of the ride I thought drinking pickle juice was ridiculous however by the end of the ride, I was ready to take stock in the product. It’s a great salt replenishment and with the heat and long distance miles, I along with many others were searching out the pickle juice volunteers the minute we rolled to a rest stop.

One of the many perks is the Mile 98 unofficial stop. This lovely stop however it is not part of the organized ride. I won’t go into too much detail but let’s just say, it was a welcomed beverage for the adult riders of the HHH100. You can even obtain a T-shirt signifying you were there. Of course, I am now a proud owner of the mile 98 stop t-shirt. ;)

Driving home after the 100 mile ride pretty much zapped out my energy until I arrived home checking FaceBook updates. K2 – you know who you are, reminded me of the push up and sit up challenge. As if the 100 mile ride with little sleep then a 1.5 hour drive home wasn’t enough, I had to complete the ongoing push up and sit up challenge. So, after 240 push ups then 240 sit ups(you add a push up each day beginning on January 1st then finish on December 31st with 365), I collapsed into bed and slept a good sleep.

The next morning, I was pleasantly surprised with no soreness, refreshed from a great night of sleep and filled with a feeling of excitement for those who finished. Oh and of course, I now have one cool cycling jersey to remember the day.

Talk to you next week!
Janet
Healthy Steps was created for you with the proper fitting shoe and orthotic in mind. Whether you wear orthotics and need properly fitting shoes or are looking for shoes that are comfortable with style, let the staff at Healthy Steps be of service to you. Healthy Steps is a division of Foot and Ankle Associates of North Texas (FAANT). For more information or foot health tips visit our website at www.faant.com



The Journey to a Texas Ironman

Date: 08/20/2010

Another week of training, another week of heat. I would suppose eventually there will be a blog from me not mentioning the weather however it’s August, I have to train and darn it…it’s hot outside!

This week was a lot of cycling and running. I decided to sign up pretty much last minute for the Hotter N Hell 100 miler to be held on Saturday, August 28th in Wichita Falls Texas. Yep, I guess if I have to train in this heat, why not pay to ride in an unshaded oven for six or so hours.

So I turn once again to the greatest running club around for some friendship during the long training ride before the 100 miler. I belong to the Lake Grapevine Runners and Walkers and consider myself pretty lucky to be a member as we have it all from walkers to runners to cyclists to swimmers and at all levels. So a few emails exchanged and viola – a group forms to ride last Sunday for a lovely 62 mile jaunt of beautiful roads, annoying hills and of course, 100+ degree temperature.

I invited a friend along to join in on the ride. It was not his day. I am sure everyone has had an off day, and his was a picture perfect off day. First, we ride for 4 or so minutes from the start and his chain falls off. Chain back on and off we go. Next, we encounter hills…he rides flat roads and has not dealt with too many hills during his current training. The heat and hills zapped him for a bit. The cool part was watching him fight through the hills and do it! To top things off, he fell last week and this week, he fell again the course. Unfortunately he falls on the same scar and the blood was a flowing.

Brushing off all the days challenges, he finishes and I am glad to see him finish because you know what? He could have easily quit, turned around never to be seen again, but he didn’t. That’s my friend and I am proud of him. He is training to one day also be an IronMan and when he crosses the finish line, we will all smile that much more ‘cause we watched and knew he has what it takes. Good job Scott!
Healthy Steps was created for you with the proper fitting shoe and orthotic in mind. Whether you wear orthotics and need properly fitting shoes or are looking for shoes that are comfortable with style, let the staff at Healthy Steps be of service to you. Healthy Steps is a division of Foot and Ankle Associates of North Texas (FAANT). For more information or foot health tips visit our website at www.faant.com

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