What Questions Do You Have?
- Why Do My Feet or Ankles Hurt?
- My Feet Are Numb or Tingling
- Tell Me About My Diabetes
- I Want To Keep Playing Sports
- What About My Child's Feet?
- Do I Have An Ingrown Toenail?
- Do I Have An Infection?
- Do I Have A Bunion?
- Why Do My Heels Hurt?
- Why Are My Toes Curling?
- Am I Walking/Running Correctly?
- What Is This On My Skin?
- Do I Need Orthotics?
- What Shoes Should I Buy?
- Should I See/Call The Doctor?
- Do I Need Surgery?
- Tell Me About My Foot
- What Is Podiatry?
- Who Do You Treat?
- Where Can I Get Registration Forms?
- How Do I Request An Appointment?
- Page 2
Should I Break in my Cleats Before Training in Them?
Just like stretching or warming up before a workout, breaking in your cleats before wearing them for an extended period of time can help to prevent injury.
Ways to Prevent Injury as You Break in Your Cleats:
It is important to make sure that the shoes you wear during athletic activity gives you the comfort and support that you need. Since cleats are most often made with leather, they are easily able to stretch and mold to your feet. Here are a few guidelines to keep in mind as you start breaking in your cleats:
- Get them fitted. Cleats are often supposed to have a tight fit to offer extra support during athletic activity, but it is crucial to make sure you are getting the right size for your foot. It is easier to make sure this is the case when you wear the same althletic socks that you would wear in a game to the fitting.
- Bending. Moving the toe of the shoe up and down will help stretch the leather and will make the shoe more pliable when you are on the go. You can do this several times a day and may even consider applying a thin layer of leather protector to keep them flexible and to avoid cracking.
- Slow and Steady. Day by day, gradually increase the amount of time you spend in your cleats as you work up to training in them. You should only wear your cleats on grass and dirt and you may want to wear an extra pair of socks with them the first time worn, to prevent blisters.
- Pain is never normal. Just like any new shoes, cleats can cause blisters, corns or pains in the arches. If you are experiencing pain wear other shoes to practice for a few days. If your pain continues after returning to your cleats be sure to see a podiatrist.
How do Bones Heal?
Bone healing is a carefully orchestrated process within the body to both stabilize and heal bone as quickly as possible. The ultimate goal of bone healing is to return to previous anatomy and appearance. This whole process is done in three distinct steps-
Immediately following a fracture, the area forms a hematoma (or blood clot) to the area from bleeding bone and blood vessels. The vessels then constrict limiting further bleeding to the area. These extravascular blood cells then die and degenerate leaving a web or matrix of fibroblasts to support the healing process. Swelling during this stage is often utilized by the body to further immobilize the fractured area to facilitate healing.
Once the area is stabilized, the bone cells transform into chondroblasts (cartilage forming cells) that start replacing the matrix with hyaline cartilage. Similarly other bone cells are transformed into osteoblasts (woven bone forming cells) that replace the matrix and ultimately the hyaline cartilage with woven bone. This restores most of the bones original strength.
Additional cells transform into osteoclasts and the woven bone is resorbed and replaced with compact bone with similar appearance and strength to original bone in this area.
What is the difference between custom, semi-custom and drugstore orthotics?
We offer two types of orthotics in our office. Custom orthotics, and Quadrasteps semi-custom orthotics. These shoe inserts change the way you walk, stand, and distribute weight through your entire body. They have a many things in common, but they also have a few key differences. Sometimes patients ask a follow up question, which is, "are Quadrasteps any better than drugstore shoe inserts?" In a word, YES. The chart below shows the differences between these three types of shoe inserts.
Custom Orthotics Quadrasteps
Drugstore Shoe Inserts
Gives support to specific areas that your foot needs Exact support based on your exact way each of your feet are individually shaped. Specialized support based on the way your feet are shaped
Minimal support, mostly cushion
Feels soft to the touch by giving your feet cushion
More support than cushion More support than cushion Primarily cushion.
Relieves stress points on feet
Yes,with exactness Relieves stress points caused by foot shape No
Fixes alignment in feet and body
Yes Yes No
Improves gait and body pains
Recommended and evaluated by a doctor
Yes Yes No Inexpensive Usually, depending on insurance Very affordable Cheap
As you can see, custom orthotics are highly advantageous, followed by semi-custom orthotics. Unfortunately, drugstore orthotics do not offer many advantages at all. Their cheap cost and cushy feel convince many customers to buy, but they do not function as an orthotic should, and are essentially a waste of money. They do not change the way the foot is aligned or striking the ground. Custom orthotics are obviously the best choice, but if a patient is uninsured or under-insured, semi-custom Quadrastep orthotics offer most of the benefits at a more affordable cost. Call our office for help deciding which is the best route for you.
How Will I Know if Neuropathy Treatment is Working?
When patients come in for Neuropathy treatment, we do careful initial evaluation and careful tracking of their progress. We want to make sure the treatment is actually working effectively for them. Since there are many causes of neuropathy, some treatments we offer may work better than others, depending on the individual. We will want to hear from you about the signs and symptoms of improvement you've been experiencing and ask you to rate your symptoms on a scale of 1-10, but that's not all we track. Because of something called the Placebo effect, we also track more concrete numbers. Basically, a placebo effect occurs when a patient starts a new medicine or treatment and they start feeling better...even if the treatment isn't working! There are a lot of psychological reasons for this. To make sure what you're experiencing is real change, we track numbers that you don't have control over. The doctor will administer several tests, to see if you can detect the feeling of hot and cold, feel the presence or absence of a foot poke, and feel the number of pokes. This way, the responses are purely physical. By using these methods, we are able to determine what is working best for our patients and try other treatments as needed.
Do You Offer Closed-Toed Boots?
When you're healing from a fracture, time seems to pass very slowly, especially in the winter. Aside from all the regular annoyances, you're faced with constantly going without a shoe on the broken foot. We now offer options for closed-toed boots, which may be the best option for many patients.
Find out more by giving us a call or visiting our office. Fractures are difficult enough, let us make them easier on you.
Could Vitamin D Deficiency Be Worsening My Neuropathy?
In a word, yes. Nerve function is influenced by many factors, but numerous and recent studies have shown that those with neurological disorders often have a vitamin D deficiency. What does this mean? It means that although there is no proven causation, there is at least a proven link between the two. You can be tested in our office for vitamin D deficiency, and recieve nutrition coaching. There are many foods and supplements out there, but there are some in which the vitamin D is more "bioavailable," or more easily absorbed and used by the body. Our doctor and staff can guide you towards which treatments will be most beneficial for you.
What is Neurogenx?
Neurogenx is an advanced electroanalgesic medical device. It is used in a treatment for peripheral neuropathy. The therapy is called Combination Electroanalgesia Therapy, or CET for short. CET consists of two combined procedures. First, a local anesthetic will be applied to local nerves that are involved. This is so you will not feel any pain during the treatment. After the anesthetic is applied, Electronic Signal Treatment will be used. This is administered through pads that are attached to the affected areas of your feet. You may have had treatment similar to this before to increase medicine absorption or treat muscles. The difference is is in what type of electronic signal is used. The signal used in peripheral neuropathy treatment is much stronger than what is used during other treatments. The reason for the difference in signal is that to treat peripheral neuropathy, the signal needs to penetrate all the way through to affected nerves. The electronic signal is picked up by nerves, and as nerves begin sending and receiving signals again, nerve functioning is improved.
Is It a Bone Spur or Plantar Fasciitis?
We have a lot of patients coming into our office that think their pain caused by bone spurs, what they are experiencing is actually plantar fasciitis from another cause. They may have even been told by a primary care physician that they have bone spurs that are causing them problems. However, the fact is that many people have osteophytes, or, "bone spurs," which are slightly raised bony projections that are usually the effect of osteoarthritis. The spurs themselves cause no pain, but if they are large enough or projecting in the right way, it's possible for them to irritate the tendons nearby and cause tendonitis.
Many people that experience plantar fasciitis (inflamed plantar tendon) think the cause may be a bone spur. It makes sense, because usually heel pain is only felt when you step on your foot a certain way. The pain is usually most intense on your first few steps after being at rest. The name plantar fasciitis simply means having an inflamed plantar fascia, which is the casing of the muscle that runs from your heel to your toes. A bone spur may be the cause, but that is actually pretty rare. Usually the source of plantar fasciitis is a tight Achilles tendon or plantar fascia. The increased pressure and rubbing from this condition can actually cause bone spurs. So, certainly, bone spurs may be present, but removing them may not remove the pain. We do remove a number of calcaneal bone spurs, however only along with treatment for the plantar fascia as well.
Usually treatment for the plantar fasciitis is enough to resolve the pain. Treatment options vary in intensity from things as simple as stretches to more invasive treatments like surgery. One procedure we commonly do in our office is a very effective and only slightly invasive Topaz Radiocoblation treatment.
The best option if you are experiencing heel pain, is to get a podiatric examination. With the help of X-Rays and other diagnostic measures, we can determine how to best resolve your pain.
How do I get my fungus filled toenail healthy again?
Although there will be numerous answers passed around by your friends and neighbors, here is what we know can work:
- If you want to go the "natural" route, melaleuca (or tea tree) oil is a strong antifungal and antibiotic as is oregano. Both work really well for athlete's foot in 2-4 weeks if applied twice a day. They are notoriously less effective on toenails because of the thickness of the keratin (ie it usually doesn't penetrate the nail and get to the root of the problem because nail fungus usually lives under the nail). This may be an option for you because you have no nail. Note: Lavender will work really well for an injured nail bed, but has no proven anti-bacterial or anti-fungal effectiveness.
- Oral medications are also valuable. Most nail fungus are the form Trichophytum Rubrum and Diflucan is often not a good option for this. Terbenifine (or Lamisil) has a longstanding track record against most fungi that can infect nails, even yeast. This medication is taken once a day for three (3) months, with the biggest concerning side effect being it injuring the liver. This is so uncommon now that a liver function test is not required anymore (I still recommend the lab test before starting and six weeks in). A nail biopsy can be utilized to show exactly what bug (if any) infects the nail.
- The one piece of the story not discussed is the possibility of no infection. A thick nail can also be traumatic. If the nailbed is injured, it will grow thick and medications don't fix it. Nail biopsy will prove infection or not.
Please note that when you have diabetes, yeast infections and bacterial infections can become more common because of the inability of the body to fight of infections as well.
What Do You Do If Your Baby Breaks A Foot?
Children's bones are less brittle than the bones of adults. This is helpful because children fall much more frequently than adults. Usually they aren’t seriously injured, but occasionally even infants can break bones. When a small child breaks a bone, it’s important to go to an expert. If the break is near a growth plate, more treatment may be needed. We offer very small boots so babies can heal while it’s much easier for parents to bathe and dress the child. If the child is older, there are even modifications we can employ to ensure the child will not remove the boot. If you suspect your child has a fractured foot/ankle, we can provide the expert care you need.
What Type of Orthotics Should I Get for Flat Feet?
People with flat feet have a variety of symptoms, such as neuromas, seasmoiditis, and hip pain among other things. We diagnose this type of foot as either a mild pes planus (mild flat foot) "Type B," moderate pes planus (moderate flat feet) "Type D," or severe pes planus (severe flat foot) "Type F."
There are three different types because treatments vary depending on the severity of the case. For example, giving someone with severely flat feet an orthotic meant for mild flat feet will not be effective. Giving someone a with a mildly flat foot an orthotic for severe flat feet would cause pain and incorrect gait. A podiatrist can determine the exact degree of your flatfootedness.
Flat feet may be painful, but they usually aren't. The problem with flat feet is primarily what they do to your gait and posture. If your feet are pronating (rolling inward) there will be unusual stress points on all of your joints the rest of the way up: ankles, knees, hips, spine and neck. If you have unresolved, chronic joint pain in particular areas, orthoics are an important option to consider. We carry several different types of orthotics in our office, stop by to get checked by Dr. Gibson if you have questions about what's right for you.
What Type of Orthotics Should I Get for High Arches?
People with high arches have several problems with their feet. They often have poor shock absorption, which can lead to lots of conditions, including things like heel pain, lower back pain, poor ankle stability among others. We refer to this as the Type A foot. People with Type A feet are referred to as "tightrope walkers," or "chandelier shakers," because of their gait pattern, very narrow with poor shock absorption. For this foot type, you'll need an orthotic that will correct the inverted heel alignment and take the pressure off of pressure points created by the unusually high arch. Your true foot type is best evaluated by a podiatrist.
We have several options for orthotics in our office. We have some prefabricated semi-custom orthotics that are adequate for some cases, while others require a full on custom orthotic. Dr. Gibson can discuss the pros and cons of these choices for your particular case.
Do You Offer Any Treatments to Make Fungal Nails Look Better?
We see a lot of patients in our office for fungal nails. We offer several treatments in our office to manage and resolve fungal nails. We usually send a sample of the affected toenail to a lab so we know exactly what antifungals will work best in your particular case. However, even if fungal nails are getting treated, many patients have two concerns:
1) Will it spread to my other toenails/family's toenails?
2) How long will they look so bad?
For most people with fungal nails, yes, it can be spread, and they will look bad for about a year. These are major concerns for patients. So, we've introduced the Keryflex system into our office. These are prosthetic nails. We will grind down the affected toenail(s) and apply the prostetic nail for immediate toe protection and increased aesthetic appeal. They aren't the same as acrylic nails. They are flexible, so they won't hurt or break off when wearing them in shoes. They aren't affected by acetone so patients can paint them like regular nails and apply nail polish remover with no weakening of the nail. And we can apply them with either a shiny or matt finish depending on your preference. If you have fungal nails, nail salons are supposed to refuse you service. However, we use a new set and new application tools for each patient, that way there is no fear of cross infecting patients with different types of fungus. Call our office to find out more about our Karyflex prosthetic nail options.
When Do I Need to See the Doctor?
The general rule of thumb (er, big toe...) is to come in if you are in severe pain.
Severe pain or swelling
Does Mountain West Foot & Ankle Institute Provide Emergency Services?
Yes. We are equipped in our office to treat emergency situations. We have a digital X-Ray machine in our office; allowing us to take instant read X-rays of patients who come in with broken bones. We do boots and casting, write prescriptions for necessary medications, perform ingrown toenail removals, and many other treatments. If you have an emergency, call our office right away and we'll be ready to treat you when you arrive.
Is there anything you can't treat at your office?
Dr. Gibson does perform limited surgical proceedures in-office, but if you need more serious surgery, you'll have to make an appointment with him at the hospital; just like other surgeons.
Why Are High Arches Painful?
Most people know that flat feet can be a problem, but are less aware of the less common condition of high arches. It may be a good thing to have a well-developed arch, but an arch that is too high can cause pain and problems.
When the arch is too high, it means there are structural abnormalities in the foot. Bone positions may be off and bunions, hammer toes and corns are much more likely to occur. One of the biggest problems with high arches is shock absorbtion. The high arch poorly distributes the shock of the foot hitting the ground and causes increased stress to the ball of the foot and the heel. This can lead to pain, bone and tendon injury. This becomes even more of a problem when barefoot, in flip flops or other flat shoes. Even common running shoes usually fail to provide necessary support to a high arch (they are usually designed for the average foot). That's why specialized orthotics are so important for someone with high arches. As you recieve better support, much of the pain to the arch will improve or even resolve.
Why Can't a Corn/Callus Be Permanently Removed?
Many patients come in to our office with corns and calluses that become troubling. It can be annoying to have to have them treated over and over, and patients wonder if corns and calluses can be permanently removed.
What you need to understand is that corns and calluses aren't necessarily deformities; they are the skin's natural response to pressure. If pressure or rubbing occurs, the skin gets worn and blisters. In a less severe case, a callus is formed. It protects the underlying skin from being damaged.
-Wear more supportive shoes. The pressure points created by improper shoes can create corns and calluses.
-Remove the pressure points through padding. Wearing padding on affected areas can decrease pressure points.
-Have the underlying conditions treated. If you have a structural foot problem, you will likely experience abnormal pressure points that lead to the creation of corns and calluses. Getting those conditions treated will stop the chain reaction of corn and callus formation.
Why Are Infected Areas Hot?
Doctors call this calor, which means heat in Latin. Infected areas are hot partially for the same reason infected areas have Erythema: increased blood flow. The other reason is immune factors react to increase body temperature to fight of infection, sometimes over the whole body (fever) and sometimes just at the area of the infection (local).
What is Erythema?
Erythema is when skin gets red. This could be due to lots of things: rash, inflammation, injury or infection. Skin looks red because the capillaries in the skin are increasing blood flow in response to a stimulus. Increase in blood flow can bring more nutrients to the area, clear away debris, and bring extra immune factors to an infection.
What is Edema?
Edema is a term to describe tissue swollen with fluid. Since the feet are at the bottom of the body, they are the most common place people experience edema. Normal tissue and blood fluids get into extracellular areas and cause swelling. Swollen edemic feet can be helped by elastic socks, compression, and elevation.
Is swelling due to a buildup of extracellular fluid. It can be caused by a change in tissue or blood pressure, like when you’ve been putting pressure on your feet all day. It can be caused by a change in blood makeup, like when you swell after ingesting too much salt. It can be caused by a block of the lymphatic system, which usually clears lymphatic fluid from the region, like when you wear too tight clothing and the surrounding area is swollen, even when you take off the item. It can also be caused by infection, when blood vessels are extra permeable to aid in healing.
If you are experiencing edema, come in to see us and have it diagnosed and treated.