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Ask a Doctor: Podiatric care

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Posted: Friday, June 7, 2013 11:00 am | Updated: 8:02 am, Fri Jun 14, 2013.

What is a podiatrist?

A podiatrist, or doctor of podiatric medicine (DPM), treats conditions that affect the foot and ankle. Podiatrists treat patients of all ages for problems such as stress fractures, arthritis, toe and joint deformities, toenail problems, and flat or fallen arches using either therapeutic or surgical treatments.

Does the type of shoe I wear matter?

It is very important that your shoes fit properly. Many foot problems can be attributed to ill-fitting shoes. First, in order to get a proper fit, keep in mind that no two feet are alike. One foot can be as much as one size larger than the other. Both feet should therefore always be measured and, if necessary, you should settle for the fit of the larger shoe. Measurements should be done toward the end of your day’s activities to allow for the natural swelling your foot undergoes during the day. Also keep in mind that the foot changes with age, even beyond adolescence, usually becoming longer and slightly wider.

A thumb’s width should be present between the longest toe and end of the shoe and the overall fit should be immediately comfortable (no breaking-in period). Room for all toes to move freely without irritation or restriction should be present. Width size is essential and should not be either too loose or too tight. Women should avoid heels greater than two inches in height and shoes should match the activity for which they are intended.

Is there anything a person can do about hammer toes?

Hammer toes are a common foot problem, usually caused by a muscle/tendon imbalance. Flexor tendons on the bottom of the toe overpower the extensor tendons on the top. This results in a buckling of the toe which, combined with shoe irritation, creates a build up of thickened, dead, callous tissue commonly referred to as a corn. Pressure sores on the top of the knuckle joint or tip of the toe may also develop.

Treatment for hammer toes can be as simple as accommodating the toes with a roomier toe box in the shoe to avoid irritation. In some cases, surgery may be necessary to realign the toe. The most common surgery for hammer toe is called arthroplasty. This procedure involves removing a small portion of the knuckle joint and straightening the toe. The gap created by the removal of this portion of bone is then filled in by fibrinous tissue. Patients are able to bear weight right after surgery and are usually able to return to their normal shoes in two to three weeks.

Why do I have pain in my heel? What can I do about it?

Heel pain syndrome is one of the most common problems seen by foot doctors. It is safe to say 95 percent of all heel pain is caused by mechanical trauma. Factors that contribute to this include rapid increase in activity level, inadequate and improperly-fitting shoes, hard surfaces, obesity, and very high or low arches. In essence, anything that is creating unusual stress patterns for a prolonged period will result in fatigue and inflammation to the heel.

With weight bearing, the foot lengthens and stretches the soft tissue attachments to the heel. This fulcrum effect results in compression and traction forces around the heel. In some cases, a bony spur develops as a reaction to such forces. Bursitis is also common and results in a fluctuant swelling around the heel. In severe cases, a stress fracture can occur.

Treatment is usually twofold. First, the inflammation and pain cycle must be controlled. Your podiatrist will advise the best course of therapy for your situation. Ice/heat contrast therapy and anti-inflammatories such as ibuprofen, aspirin or stronger prescription medications are helpful. In severe cases, cortisone injections followed by deep heating ultrasound are of tremendous value in stopping the pain/inflammation cycle.

Second, and most importantly, constant biomechanical control of the stress occurring around the heel and instep are essential. This includes modifying improper activity levels, padding and strapping the heel and instep to provide support, and accommodating insole liners to the shoes. Supportive shoes, such as walking or jogging shoes, are essential and should be worn at all times. In some cases, specific custom made orthotics to control the abnormal motions of the foot will be needed if the above treatments are not working. With the above protocol, dramatic improvement is usually seen within two weeks.

Why does my big toe nail always become ingrown?

Causes for ingrown toenails include injury to the toe or foot, heredity, tight shoegear or hosiery, and/or improper trimming, any of which can result in damage or injury to the root of the nail, called the matrix.

As the damaged nail grows outward, it also tends to grow down into the skin. Once the skin is punctured, infection occurs. The symptoms then include severe pain, swelling and drainage. Many times, the patient will try to perform “bathroom surgery,” which will usually only provide temporary relief. To permanently cure this painful problem, the defective nail root must be removed.

First the toe is numbed using a local anesthetic and the damaged section of nail is removed. A chemical is then applied to the nail root area to destroy the nail cells and to insure that the offending portion of nail does not grow back. Postoperative care includes foot soaks, application of topical medicine to the wound and a band-aid covering on a daily basis. Patients are usually seen at weekly intervals initially and then return two to three months afterwards for a final check to make sure that portion of the nail has not grown back.

Steve C. Jensen, DPM, is the founder of Foot Care of Sonora and has been practicing podiatry in Sonora for more than 30 years.

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