Summertime Foot Care IN SW Florida

Anyone who has lived through a Florida summer certainly recognizes that the cars seem to move faster on roads, the electric bill go up and the lines at restaurants have shortened. Access to golf courses, tennis courts, bowling alleys and all recreation facilities become more available to year-round residents and those who visit during the summer months.

What does all this mean to foot health during the summer? People in general tend to be more active in all phases of recreational activities. The increase in physical activities includes many outdoor hobbies and pastimes that were otherwise unavailable or too much of a nuisance to wait for in line. This does not go without some type of negative impact on the fee and ankles.

Many of the foot problems seen during the summer months are simply the result of over use syndromes. Inactivity or relative inactivity during the busy tourist season frequently leads to over-indulgence of ones penchant for things such as long walks on the beaches, 18 holes of golf, softball and baseball, to name just a few of the many things available in this part of our country in the summer.

Among these so-called over use problems often seen in our offices are heel pain, tendonitis, simple bursitis and stress fractures. A simple walk on the beach can often lead to significant arch pain, ankle pain, Achilles tendonitis and in general, a miserable time for you the rest of the summer months . Here is where the old adage when your feet hurt, you hurt all over comes into play.

Tennis and golf can often lead to pain in the big toe, either due to improper or worn out she gear, aggravation from an ingrown toe nail problem, or pressure on a thickened and deformed fungal nail problem.. Also, it is commonly seen that tennis players, even playing doubles , which is significantly less strenuous than singles, can lead to the so-called tennis toe. This is a painful condition that develops with hemorrhaging beneath the nail. Unless given appropriate attention, this can lead to loss of the nail and or infection.

As noted, stress fractures of any bone can occur from sudden over-use of our body's skeleton, but it is most commonly seen in our 2nd and 3rd metatarsal bones. These typically are genetically over stressed from every day walking, but are able to withstand these activities by adapting through a normal physiologic process that causes thickening of theses bones. However, with geometrically increased activity the tolerance to stress is often exceeded and the bone will develop a microscopic crack that can cause pain and swelling and an inability to bear weight normally. Initially, x-rays for these types of injuries are often not visualized. However, with follow up x-rays , weeks later or by performing a bone scan at the time of the onset of the problem, one can certainly recognize and thus appropriately treat these fractures. Left untreated, a small crack can often progress to a complete fracture and even displacement of the fragments.

A simple walk on the beach can also cause other problems. Very often, punctures and lacerations can occur on our sandy beaches which can hide: shells, fish barbs, broken glass, bottle caps and splintered wood, as well as other foreign objects that can wash up on shore or be the result of careless trashing of our beaches. Some of the worst infections encountered in our emergency rooms and in our offices are often a result of punctures and lacerations encountered either in the Gulf or other inland waterways and which initially appear to heal uneventfully. On many occasions 2 or 3 weeks later, one sees a massive infection develop, which requires surgical intervention to open and drain the wound and most of the time hospitalization. A truly crummy way to spend a summer.

People who live in these parts know the stingray shuffle. To the uninitiated, this is the safest way to move along the shorelines shallow waters and hopefully the thousands of stingrays who share our beaches will recognize the incoming feet and gracefully move on to deeper waters. In the event that we inadvertently step on one of these harmless sea creatures, one of our worst nightmares will have begun. In response the stingray's reflexive action is to instantaneously lash its tail upward and into you, leaving behind its spiny barb, which has a toxin as well as bacteria. Emergency room or office treatment for this most often will save a painful summer experience from becoming a prolonged nightmare.

Among some of the other commonly seen foot and ankle problems are fungal infections of the skin, commonly called Athletes Foot, a direct result of exposure, improper drying, recontamination of the skin and inadequate care. Warts are also frequently seen due to increased exposure to the viruses that are ever present. Blisters are often due to improperly fitted shoes, not wearing protective hosiery or socks and most often from friction against the skin. Common sense would dictate that good shoe gear, well aerated , fresh socks to absorb moisture and amply powdering the feet will prevent a multitude of problems.

There are many other problems that can result during the summer months, and this article was certainly not intended to discourage anyone from enjoying the good life. It was simply intended to remind people to use common sense good supportive shoe gear with adequate room and try a gradual increase in recreational activities.

Burning Feet or Nerve Pain in The Foot
Can now be Treated Painlessly

by Dr. Howard M. Imanuel
The Podiatry Center

It feels like your feet are burning or tingling like pins and needles and youve been suffering pain for years but dont know what to do about it.

What you are probably experiencing is something called Mortons Neuroma or Intermetatarsal Neuroma. The above complaints relative to these conditions are commonly presented to a podiatrist. In addition patients speak about an intense pain either in the ball of the foot or into the toes or both areas. The patient also can complain in some instances of a numbness or a "fuzzy" sensation in the toes. Along with these descriptions patients also mention a sense of fullness or cramping in the toes especially with activity. Some relate that the pain moves from the sole of the ball of the foot into the toes or even radiating into the arch or up the leg.

Dress shoes or running in athletic shoes tends to increase the severity of these symptoms. In most instances, patients do report that removal of the shoes and massaging the ball of the foot and the toes gives immediate relief of symptoms. However, in some instances, walking barefoot on hard surfaces can also cause extreme discomfort and duplicate the symptoms.

Morton's neuroma or intermetatarsal neuroma is a frequent finding most commonly accepted as caused by an entrapment or pinching of the nerves, or repeated micro-traumas which results in a degeneration of the nerve branches. The condition most commonly found between the 3rd & 4th toes and is much more common in women than in men. These neuromas can most often be found in flattened foot types, but also in the normal as well as the high arched foot.

The Doctors at the Podiatry Center now successfully treat these conditions using a series of vitually painless injections eliminating the need for surgery in most cases which for decades was the prescribed treatment for this condition. . The results have been dramatic and very well received by patients.

In an 8 year study, more than 150 patients who underwent the same treatment being used at The Podiatry Center between 80% and 90% experienced complete resolution of their symptoms after 3-7 weekly treatments. These results mirrored a much later study that documented 89% of the patients reported between 85% and 100% improvement. This resulted in an overall patient satisfaction of excellent or good of 89%.

For further information regarding this treatment, consult with your local podiatrist, or call for an appointment at The Podiatry Center which has four convenient locations in Fort Myers, Cape Coral and Labelle. Our central phone number is, (239) 768-2323.

Podiatry Center Offers Shock-Wave Therapy

One of the most common ailments of the foot is 'Heel Spurs'. This ailment creates a long term inflammation of the plantar fascia under the heel and converts the tissue into a bloodless, non-reactive inflammation. After a while the tissue has the consistency of cork material. The ailment results in a constant, dull ache, and the sufferer feels crippled when getting out of bed or getting up after sitting at a desk for a long period of time. It is due to overt stretching of the plantar fascia. The problem can happen at any age, from children to elderly people. Those who have a very tight Achilles tendon are more likely to suffer from it.
In about 90 percent of the cases plantar fascitis can be treated by simply changing shoes, custom foot supports, stretching exercises, physical therapy or ice massages. However, the other 10 percent of sufferers require surgery.

The Ossatron, now being used by The Podiatry Center's Dr. Imanuel and Grillo, is a new device which converts chronic inflammation into acute inflammation allowing the body to heal itself. Basically, some injuries go unattended by the bodies repair capabilities because they are not sending out the proper signals to the brain. By changing the status of the injury in this manner, the brain gets a new message and sends signals to the body to heal itself properly.

"This phenomenon is how we heal from ordinary bruises, cuts and breaks in tissue, such as skin and bone tissue" explains Dr. Imanuel.

"Shock waves have been known and used for more than a half-century but only recently have shock waves been used to treat people" Dr. Joe Grillo added.

The first use of shock waves was the "Litho-tripsy" which was for kidney stones. In this case a patient sits in a bath and shock waves are sent through the water into and through the patient. The frequency of the waves have been calibrated to only effect the stones and not effect the patients. These stones are reduced in size, so that they pass through more easily with urination.

The latest application of shock waves if for the foot. Studies are also being conducted on the use of similar treatments for elbows. Many feel shock waves will eventually be used in many areas of the body as an alternative to invasive surgery. There are no injections used in the procedure. The patient is given a mild sedative while they receive a painless 4,000 steady shock waves during a period of eight minutes. The procedure has been used in Europe for ten to fifteen years, very successfully.

Following the procedure, that patient must not use anti-inflammatory medication, since the early stage of acute inflammation, since the early stage of acute inflammation, which the shock waves have brought back, must be allowed to continue for the tissues to heal themselves. If there is any pain, over the counter pain relievers may be taken.

Studies show that 90 percent of patients who receive the shock-wave treatment experience either complete or partial relief. The technique can also be used on patients who have had other surgical procedures for heel spurs which have failed.

The shock-wave therapy is performed at Summerlin Bend Surgery Center, where Dr. Imanuel is one of the partner/owners.

The Podiatry Center's shock wave treatment generally requires a follow-up visit four weeks later. Invasive surgical treatment for heel spurs require the patient to return to see the doctor two or three days after the procedure.

"We are proud to be among the first in the area to have the Osatron and look forward to treating many of our patients in this most modern fashion." Said Dr. Imanuel.

Neuropathy

Peripheral neuropathy is a common disorder that results from damage to the peripheral nerves that branch out from the spinal cord to parts of the body creating the peripheral nervous systemIt can be caused by a variety of nerves diseases or be the result of systemic illnesses. While causes include vascular or collagen disorders, exposure to cold or radiation, some medicines, toxic substances,systemic lupus erythematosus, scleroderma and rheumatoid arthritis, Diabetes is, by far, one of the most common.

Symptoms:

The peripheral nervous system consists of motor nerves which aid movement and sensory nerves involving the sense of touch. Either or both can be affected in neuropathy.

When there is damage to the sensory nerve, the predominant symptoms which frequently start gradually are experiencing pain, numbness, tingling, burning or a loss of feeling. Sometimes one experiences a tingling sensation or numbness that starts in the toes and/or the balls of the feet and spreads upward. The skin can become ultra sensitive making the a light touch agonizing. Numbness, or a complete lack of feeling in the feet may also occur. Sometimes symptoms may be barely noticeable while at other times most frequently at night, they can be almost unbearable. The numbness symptom can make you feel like you're wearing a glove on your hands or a sock on your feet when they are actually bare. You can feel a burning sensation or freezing pain and/or have ultra sensitivity to a touch.

There may be muscle weakness or paralysis caused by damaged motor nerves. Foot muscles can atrophy.

Diabetic neuropathy is the most common type of Peripheral neuropathy, and it can lead to serious complications. It means damage of nerve fibers in diabetics most likely due to high blood glucose changes that affect a nerve cell's metabolism. The symptoms are:

Loss of sensations of pain, heat, and cold, which puts the foot at risk of being damaged without the person realizing it.

Pain and/or burning

Loss of strength to control motor skills and movement.

And loss of the body's ability to regulate autonomic functions such as digestion and heart rate

The treatment for peripheral neuropathy depends upon the cause. If it is caused by a vitamin deficiency taking supplements and controlling diet will help. When caused by diabetes the treatment is to control that disease. In most cases pain reliever and anti-depressants can be used.

Generally, the treatment for peripheral neuropathy offers only symptomatic relief through trans-cutaneous electrical nerve stimulation, acupuncture and biofeedback.

Foot Care and awareness is Essential in peripheral neuropathy Since there is often a loss of sensation in the foot, damage to it can go undetected and lead to serious complications especially in diabetics. See a Podiatrist if you experience numbness, or for treatment of corns and calluses. Have the doctor recommend good fitting shoes which should be inspected daily for damage.

Peripheral vascular disease:

Diabetes is the most common cause of peripheral vascular disease. It creates poor circulation to the feet and legs, and ultimately can result in a number of problems, including Artherosclerosis. This is referred to as 'hardening of the arteries because there is a gradual thickening and hardening of the walls of the arteries, the blood vessels that carry blood to the extremities from the heart.

Symptoms

The symptoms which depend on how much the blood flow is reduced and which artery or arteries are affected include: Some of the symptoms include:

• Numbness or tingling in the foot and or toes.

• Skin color changes

• Experiencing 'cold' or cool feet.

• Breakdown of skin, infections and or sores which do not heal well.

• A dull cramping of the calf muscle during or after walking (Claudication).

Treatment of poor circulation due to diabetes:

• Controlling blood glucose level is very important if diabetes is present.

• Blood clotting (antiplatelet agents and anticoagulants) can sometimes be treated by drugs.

• Angioplasty can be used to enlarge the narrowed peripheral arteries.

• Vein bypass surgery can be done.

See your Podiatrist for Foot care advice

• Get a complete examination and assessment regularly

• Prevent accidents which can cause damage to the feet and legs.

• Wearing well fitted or specialized footwear recommended by your Podiatrist.

• See you podiatrist to cut toe nails and to treat Corns and Calluses

Diabetes Mellitus

Diabetes mellitus, most commonly called 'Diabetes' is a chronic disease in which the body is unable to produce the proper amount of the hormone 'insulin' which helps us deal with glucose (sugar) in our diets. There are two types of Diabetes. When someone's body produces too little or no insulin, the patient has Type 1. Or the body tissues are resistant to the effects of diabetes which is Type 2. In each cse the results are that the body produces high levels of glucose in the blood, which can damage a variety of body tissues and organs.

Patient Foot-Care for Diabetics

Diabetes affects' approximately 6% of the general populations and a larger percentage in the upper age brackets.

* Wash your feet daily in lukewarm water using a mild soap. Dry carefully, especially between the toes. Put a light dusting of talcum powder on to reduce moisture, but be sure to wipe it so there is no residue between the toes. Dry skin may be treated with a quality emollient being careful not to get any between the toes.

* Inspect your foot daily, top and bottom, for sores, cuts, bruises and toenail issues file sharp corners of toe-nails, which should be cut flat to the toe.

* Don't try to remove any corns or calluses yourself. This includes not using any non prescribed corn or callus cures which can damage the skin of diabetics very easily.

* Protect your feet with footwear, don't go barefoot. Always get properly fitted shoes to prevent damage to the foot which can result in amputation.

Many podiatrists can recommend shoes appropriate for diabetics. Call one.

Make certain that the store offers an experienced shoe fitter. And avoid fancy shoes, i.e. pointed , or with high heals or tightly fitted.

Charcot's Foot

Causes:
Diabetics with nerve damage (neuropathy) always experience the complication of Charcot's Foot. Because of neuropathy, supporting muscles become weaker and bones in the foot are more fragile, making it more likely to sustain damage such as fractures. Yet, because of the lack of sensitivity, the sprains and minor stress fractures go unnoticed by the patient who will continue to walk on the foot, creating far more damage and possible deformities.

Symptoms and Early Signs of Charcot's Foot:

• The foot affected will feel warmer than the other foot, though both can be effected.

• Swelling & Redness which happens quickly.Slacking of muscles creating joint slippage.

• Arch may collapse when left untreated.

• Aching type pain may develop but it will not feel as severe as it should as damage occurs.

• Calluses and foot ulcers may occur due bone protrusions. This can lead to serious infections which can spread to the bones and joints.

• Weariness and tiring easily will occur

Treatment:

• Frequent reviews of foot-health by a Podiatrist.

• Rest and Stabilizing the damaged areas.

• A protective, pressure relieving bandages for the affected areas such as casts which should be replaced periodically (may take up to 9 months to heal).

• Protective care of other foot to prevent from potential problems

• The pharmaceutical category of bisphosphonates are useful in the management of Charcot's foot.

After Healing:

Specialized footwear and foot orthotics prescribed by your Podiatrist may prevent recurrence Surgical reshaping of the deformity.

Damage Prevention for Charcot's Foot patients:

• Avoid gaining excess weight

• Don't lift or carry heavy items

• Avoid any traumas to the feet

• Wear properly fitted shoes

• Check your feet frequently for telltale signs on bearing as much as possible.

• See your Podiatrist regularly