Happy New Year!

Wanna break out those sassy high heels for your New Year's celebrations? Ring in the New Year the healthy way with some tips (an quick fixes, so you don't have to miss the fun!) for happy feet, courtesy of the APMA:

http://www.apma.org/new-years-foot-fixes

Happy New Year from all of us at Shenandoah Podiatry!

Corns

For more information visit our website http://www.roanokefoot.com/


Corns are hyperkeratotic papules of the skin. They are also known as clavi. These lesions can be painful.

They develop due to excess pressure on the bony prominences of the feet and toes.


Factors that contribute to the formation of corns include:

Abnormal foot mechanics

Foot Deformities

High Activity Levels

Peripheral Neuropathy


Corns are often seen in:

Athletes

Elderly Patients

Diabetic Patients


Types of Corns:

Hard Corn (Helloma Durum)- Commonly found over the joints of toes.

Soft Corn (Helloma Molle)- Found in interdigital locations and has a macerated texture.

Periungual Corn- Found near the edge of a nail.


Presentation:

Corns present with a growth on the foot or toes. Pain is associated with walking or wearing shoes.

Direct pressure generally cause pain to the affected area.

After debridement a corn may have a central plug of skin.



Intrinsic causes:

Foot deformities such as a bunion or a hammertoe

Extrinsic causes:

Activity

Poor fitting shoe gear


Work Up:

X-rays of the feet while weight-bearing can help identifying bony prominences.

Pressure studies- Can help locate the exact location of pressure.

After trimming the lesion the examiner can attempt to determine if the lesion is a corn, callus, or wart.


Treatment:

Hard corns- Pare or debulk the lesion utilizing a small blade. Removal of the centralized plug.

This should be performed regularly in high risked patients such as diabetics.

Regular debridement might decrease the risk of ulceration.


Soft corns- Hygiene is important to decrease the chance of infection. The patient should wear a pair of properly fitting shoes.

The use of an antifungal or antibacterial powder may be helpful.

Toe spacers can also be beneficial.


Other treatment:

Keratolytics such as salicylic acid, urea cream, or lactic acid cream may be prescribed by your doctor.

Good fitting shoe that match the length and width of the patient's feet.

The use of a pumice stone for careful debridement.

The use of good foot hygiene.

The use of a silicone sleeve.

Orthotics


Surgical care:

If conservative treatment fails surgery may be indicated to remove bony prominences.

How is the Metrodome like a bunion pad?

An analogy from Dr. Andrew Schneider, a friend and colleague of Dr. Feeny's

This past Sunday, football fans everywhere marveled when a blizzard caused the roof of the Metrodome, home of the Minnesota Vikings, to collapse. It was the fourth time in the stadium's 28 year history that the roof collapsed. As I was searching for the video on YouTube to show a friend of mine, I came across an article that compared the roof to a bunion pad.

An interesting comparison, don't you think? At first glance, you'd think they were made of similar materials. I learned that the roof was made of a fiberglass cloth that's 1/16" in thickness. Surprisingly a bunion pad is thicker than that!

What the article was referring to was both an air supported, inflatable roof and a bunion pad are cheap and unsophisticated methods of treating a complex problem. Let's face it...it's Minnesota...it really snows there...you really need a proper dome on your stadium!

Similarly, using a bunion pad to control the pain associated with a hallux valgus deformity is the easy way out. It is simply addressing the pressure on the bump on the side of the foot against the shoe. Nothing more. It doesn't address the function of the foot that caused the bunion to form in the first place and will cause it to continue to grow. It does not address the rotation of the metatarsal bone that is causing the bump to form. It's merely helping to cushion the bone today, to allow you to wear shoes today, hoping that it will feel better tomorrow, but it won't.

Treating the bunion requires, at the very least, good mechanical control to return stability and efficiency to the foot. This will stop the foot from deforming further and prevent the bunion from getting bigger. If a bunion is already painful in shoes, then surgery to correct the bunion may be the best option. It's better to address that sooner than later since the complexity of the procedure and recovery will change depending on how bad the bunion is.

It's not worth wasting time on a bandaid solution. In Minnesota, they'll patch the flimsy roof and reinflate it. But when it comes time to treat your painful bunion, take a smarter approach. If you haven't seen the collapse of the roof yet, watch it here!

Dr. Andrew Schneider is a podiatrist with Tanglewood Foot Specialists in Houston, TX.

What is Athlete's Foot?

No, it's not just something athletes get. Athlete's foot is a skin disease caused by a fungus that can occur on the feet and between the toes. The term "athlete's foot" became popular because athletes who used these facilities would develop the fungal infection. Some symptoms of Athlete's foot are dry skin, itching, burning, scaling, inflammation, blisters, and pain.

Athlete's foot can happen to anyone, and the fungi grow abundantly in many common places. Shoes create a warm, dark, and humid environment, the ideal environment for the growth of a fungus, which is why a the feet are a common spot for a fungus to attack. Breeding grounds for fungi can also be found around swimming pools, showers, and locker rooms.

You can prevent Athlete's foot by practicing good foot hygiene and washing your feet daily with soap and water. Be sure to dry your feet well, especially between the toes, and try to change your shoes and socks often to decrease the moist environment. You can also decrease excess perspiration by using a talcum powder. If you are in an environment where a fungus can be found - such as a pool, locker room, public shower, or dressing room - avoid walking barefoot and wear shower shoes when rinsing off.

If treatment does not respond to good hygiene or self treatment, make an appointment with a podiatrist. The podiatrist will determine if the condition is a fungus or some other problem and determine a plan of treatment, which may involve topical and oral antifungals.

A Shoe For Every Sport

Shoes, shoes, and more shoes. There seems to be a shoe designed for every sport out there. But
there’s a method to the madness. Sport-specific shoes really can change your game. See the tips
from the APMA below to learn why the shoe you choose could make or break your day on the court or field.

Basketball

Whether you’re making the perfect pass or finishing off the high-flying dunk, basketball shoes have several features that will help you prevent injury.

• A thick, stiff sole gives support while running and landing from jumps.

• High ankle construction supports the ankle during quick changes in direction. A basketball shoe should have the strongest support on either side of the ankle.

Racquetball/Tennis

On the surface, court shoes for tennis and racquetball may look like any other athletic sneaker, but it’s what’s on the inside that makes the difference.

• A court shoe supports both sides of the foot because of all
the quick lateral movements and weight shifts in court sports.

• It provides a flexible sole for fast changes of direction.

• It has less shock absorption than a running or basketball shoe.

Running

The running shoe is perhaps the most personal and intricate
of all athletic shoes. Every runner has different needs and there
are a multitude of choices out there.

• A running shoe must provide maximum shock absorption to help
runners avoid ailments such as shin splints and knee pain.

• The shoe should control the way your heel strikes the ground, so
the rest of your foot can fall correctly.

• Know your foot type (high, medium, low arch) so you can get the
shoe with the right support for your foot.

“Generally, you want to go with the sport-specific shoe if you are participating
in a sport on a regular basis (2-3 times a week). Make sure the shoe fits correctly. Fit is just as important as the right type of shoe,” says APMA Director of Scientific Affairs Dr. Jim Christina.

To read more articles about shoes and your feet, check out the Footnotes link on our website at http://www.roanokefoot.com/.

Running for Women: An Uphill Trend

According to Running USA, over 10 million people finished a race last year. Running has taken on a huge growth in general over the past couple of years. Research shows that running as a form of exercise tends to increase in a bad economy, and with our economic situation running can be an appealing alternative to paying large sums of money for gym memberships.

However, money isn't the only reason for this increase. Many women run for the social aspect. "There's about 10 of us that will travel somewhere in the US. We'll say, 'This is where we're gonna go,' and we all pitch in and we get hotel rooms for all of us," says runner Hillary Mancuso.

Running is an excellent, inexpensive, effective form of exercise. So grab a pair of well-fitted and supportive running shoes, fill up a water bottle, stretch and warm up your muscles, and most of all have fun!

To read more, visit the article from WRCBtv Chattanooga News at http://www.wrcbtv.com/Global/story.asp?S=13628789.

Your Feet...Out on the Town

According to a survey in British newspaper The Telegraph, it only takes an average of 34 minutes for a woman wearing high heels to start feeling pain in their feet from high-heeled shoes. Four out of ten women surveyed stated that they carry a spare pair of pumps in case their first pair starts to rub throughout the night. More than fifty percent admitted to walking home barefoot after a night out on the town. The survey also showed that the average British woman owns 18 pairs of high heels.

The survey included 4,000 women between the ages of 18 and 65. Click here to read more.

Just remember that while your high heels may look fabulous, it's wise to listen to your feet when they hurt! Change into more comfortable shoes (not another pair of stilettos!) or take a seat and let your tootsies rest. And we don't recommend walking home barefoot - broken glass and rocks are just a few of the possible hazards you could stumble upon.

And if your feet keep hurting, please come see us - we can help! Visit our website or give us a call at (540) 904-1458 to have all your questions answered.

Diabetic Ulcers

Contributing Factors :

- Mechanical changes in conformation of the bony architecture of the foot

- Peripheral Neuropathy

- Peripheral Arterial Disease

- Glycosilation - Predisposes ligaments to stiffness

Diabetic Facts:

- 12-24% of individuals with ulceration require amputation

- Half of all non-traumatic amputations are the result of diabetic foot complications

- The 5-year risk of needing an amputation on the other extremity is 50%


Diabetic Peripheral Neuropathy results in:

- Loss of sensation in the foot

- Injuries and fractures

- Structural foot deformities

- Hammertoes

- Bunions

- Metatarsal Deformities

- Charcot Foot

- Tissue Breakdown


Peripheral Arterial Insufficiency Results In:

- Intermittent claudication

- Pain at rest

- Non-healing ulceration of the foot

- Ischemia of the foot - Inadequate blood supply

Examination:

Diabetic Ulcers tend to occur in the following areas:

- Heel

- Metatarsal Heads

- The tops and ends of hammertoes


Lab Studies:

- A complete blood count may signal an abscess or infection

- Non invasive vascular studies to assess circulation deficiencies

- Infection markers such as the sedimentation rate


Imaging (to evaluate the presence of osteomyelitis):

- Plain Radiographs

- CT

- MRI

- Bone Scans


Treatments:

- Treat infections with appropriate antibiotics

- Offloading the area of the ulcer

- Wound care

- Application of a Wound Vac - Negative pressure under an occlusive wound dressing for deep cavity wounds

- Surgical Debridement - Surgical management is indicated for debridement of non viable and infected tissue from the ulceration

- Debridement of infected bone

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic systemic inflammatory disease of unknown cause that primarily affects the peripheral joints in a symmetric pattern.

RA causes joint destruction and thus often leads to considerable morbidity and mortality.

Why do people Get RA ?

- An infectious etiology has been speculated
- Associated with a number of autoimmune responses
- Whether autoimmunity is a secondary or primary event is still unknown
- RA has a significant genetic component

Frequency :

The worldwide incidence of RA is approximately 3 cases per 10,000 population

Mortality/Morbidity:

- Daily living activities are impaired in most patients
- Life expectancy for patients with RA is shortened by 5-10 years

Signs and Symptoms:

- Morning stiffness
- Arthritis of 3 or more joint areas
- Arthritis of hand joints - At least one swollen area
- Symmetric arthritis with simultaneous involvement
- Rheumatoid nodules

Progression of RA :

Stage 1 (early RA)

- No destructive changes observed on x-ray
- Radiographic evidence of osteoporosis possible

Stage II (moderate progression)

- Radiographic evidence of periarticular osteoporosis with or without slight subchondral bone destruction
- Slight cartilage destruction possible
- Joint mobility possibly limited; no joint deformities observed
- Adjacent muscle atrophy
- Extra-articular soft tissue lesions (eg, nodules, tenosynovitis)

Stage III (severe progression)

- Radiographic evidence of cartilage and bone destruction in addition to periarticular osteoporosis
- Joint deformity
- Extensive muscle atrophy

Stage IV (terminal progression)

- Criteria of stage III
- Fibrous or bony ankylosis - stiffness of a joint due to abnormal adhesion and rigidity of the bones of the joint

Remission:

Remission of RA - Five or more of the following conditions present for at least 2 consecutive months:

- Duration of morning stiffness not exceeding 15 minutes
- No fatigue
- No joint pan
- No joint tenderness or pain with motion
- No soft tissue swelling in joints or tendon sheaths
- ESR of less than 30 mm/h for a female or less than 20 mm/h for a male

Lab Studies:

No pathognomonic test is available to help confirm the diagnosis of RA. The diagnosis is made using clinical, laboratory, and imaging features. Clinicians will analyze the following:

- Markers of inflammation, such as ESR and CRP
- Synovial fluid analysis
- Rheumatoid factor - Present in approximately 60-80% of patients with RA over the course
- Antinuclear antibodies - These are present in approximately 40% of patients with RA

Treatments:

Disease-modifying antirheumatic drugs:
- Leflunomide (Arava)
- Methotrexate
- Sulfasalazine
- Etanercept (Enbrel)
- Infliximab (Remicade)

Nonsteroidal anti-inflammatory drugs

Analgesics

Glucocorticoids

Immunomodulators:

- Anakinra (Kineret)
- Abatacept (Orencia)

Shoe Advice from the APMA

A Shoe for Every Sport

Shoes, shoes, and more shoes. There seems to be a shoe designed for every sport out there. But there’s a method to the madness. Sport-specific shoes really can change your game. See the tips below to learn why the shoe you choose could make or break your day on the court or field.

Basketball — Whether you’re making the perfect pass or
finishing off the high-flying dunk, basketball shoes have
several features that will help you prevent injury.
• A thick, stiff sole gives support while running and landing
from jumps.
• High ankle construction supports the ankle during
quick changes in direction. A basketball shoe should
have the strongest support on either side of the ankle.

Racquetball/Tennis — On the surface, court shoes for tennis and
racquetball may look like any other athletic sneaker, but it’s
what’s on the inside that makes the difference.
• A court shoe supports both sides of the foot because of all
the quick lateral movements and weight shifts in court sports.
• It provides a flexible sole for fast changes of direction.
• It has less shock absorption than a running or basketball
shoe.

Running — The running shoe is perhaps the most personal and intricate of all athletic shoes. Every runner has different needs and there
are a multitude of choices out there.
• A running shoe must provide maximum shock absorption to help
runners avoid ailments such as shin splints and knee pain.
• The shoe should control the way your heel strikes the ground, so
the rest of your foot can fall correctly.
• Know your foot type (high, medium, low arch) so you can get the
shoe with the right support for your foot.

Free Foot Care for Poor and Homeless in Syracuse

Photo by David Lassman / The Post-Standard

This Wednesday in Syracuse, NY, over 50 poor and homeless patients left with happy feet from the annual foot care clinic by Amaus Health Services at the Cathedral of the Immaculate Conception.  This is the third year that this team of about 30 medical and nursing students offered free foot exams and cleaning to needy people in the area.  In addition to foot care, patients were also given socks, shoes, clothing, toiletries, and other items that were collected by students from surrounding universities.  “There are so many health issues that can result from exposure and the feet being injured and damaged," said Barbara Carranti, a LeMoyne nursing professor who organizes the foot care clinic.  "There are infections people would never know about unless they get a good foot inspection."

Your feet mirror your general health - everyone needs to take care of their feet, regardless of income level.

To read more about this past week's Amaus free foot care clinic, click here.

For more information about how we can help you take care of your feet, visit our website www.roanokefoot.com.

Give your feet a little TLC this fall

No matter how much you may hate it that the weather is moving into the lower temperatures, we need to always be sensible about taking care of our precious feet. Cold feet are not happy feet!

Here are a few tips to keep your feet warm and happy through the cold months:

1. Give your toes some shelter.

Open-toed shoes in cold weather may seem fun and rebellious, but your feet certainly won't appreciate the sentiment. Your feet tend to be one of the first areas of your body to lose heat in cold temperatures.

2. Keep your feet dry in inclement weather.

Wearing shoes with rubber, PVC, or Gore-Tex-treated components will help to keep the water out. Frostbite and trench foot are just a couple of dangerous conditions that can be caused by having wet feet for an extended period of time. However…

3. You need to keep your feet hydrated, too.

Lots of people suffer from dry skin in the cold months because of low humidity in and high winds. If your feet tend to dry out, use some moisturizer immediately after you shower, while your skin is still a little damp. You can also use a pumice stone to soften dry skin and calluses - just make sure to not use lots of pressure. Keep your feet warm by wearing clean cotton socks around the house; this will help them retain their moisture as well. And make sure to hydrate your whole body by drinking plenty of water!

For more info about taking care of your feet in cold climates, look at these articles:

http://preventdisease.com/home/weeklywellness143.shtml
http://beauty.about.com/od/skinflaws/a/skinsavers.htm
http://www.ehow.com/how_4689079_dry-feet-through-winter-months.html

New Blog Location!

We just wanted to let you know that we're in the midst of combining all of our blogs (Roanoke Foot Doctor, Blacksburg Foot Doctor, and Botetourt Foot Doctor) into a bigger, better one - if you'd like to keep following us and stay updated on all the fun foot facts and articles, please update your bookmarks to http://shenandoahpodiatry.blogspot.com.

Thanks for reading, commenting, and of course visiting our offices!

Dedicated to your happy feet,

Nancy Ann Ballhagen
Administrative Assistant, Blacksburg Office

Cross Country Barefoot Encounter

Did you hear about the guy walking across the country barefoot?? Yes, you heard me correctly. Ron Zaleski is trudging across the US - BAREFOOT - to raise awareness about the need for mental counseling for all military personnel.

As a former military man himself, he is attempting to collect 1 million signatures for his petition along his back roads route to the west coast. The petition calls on Congress to mandate mental counseling for all military personnel.

Tuesday August 10 (just last week!) he passed through good ole' Buchanan, VA. Such a huge cause trampling right through our back yards. Our very own Roanoke Times had a chance to catch up with Mr. Zaleski and get an update on his journey.

Ron is giving everything he has to this cause including the health of his poor tootsies! Rex Bowman from the Roanoke Times reported that his feet were a "mess of broken skin and calluses." Not exactly the prettiest of mental pictures. He should definitely have stopped by to see us while he was in town. ;-)

Well, I just wanted to share with you a little about the barefoot walker's journey. If you'd like to follow him on his cross country trek, check out his website www.thelongwalkhome.org.

For more information visit our website www.roanokefoot.com

Lady Gaga Takes A Nose Dive

Lady Gaga - these boots were NOT made for walking!!!

On Tuesday, Lady Gaga hit the floor at London's Heathrow airport while wearing ridiculous looking thigh high black leather boots with over the top platform heels.

Current fashion trends, like the Armadillo shoes designed by Alexander McQueen, leave models and celebrities at risk for falls and injury.

I thought that I had seen everything at the Bata Shoe Museum in Toronto, Canada last year. But, it is one thing to see a crazy shoe on a shelf and a completely other experience to watch someone try to walk in unsafe shoes.

Women -please do not try this one at home!!!

Shoes that are creating their own path in our world Part 3

Vibram Five Fingers


These are the shoes to wear if you don’t like wearing shoes! Vibram Five Fingers were made to protect our feet while giving them the freedom to biomechanically perform as they were naturally designed to. Before Five Fingers were introduced Vibram was known for their rubber soles introduced in 1935. Vitale Bramani, the grandson of the founder of Vibram, came up with the idea of inventing a shoe that simulates being barefoot. With a team of researchers and engineers, this grandson and grandfather duo, created Five Fingers and their popularity spread all over the world! These shoes promote muscle development and range of motion in feet and ankles as well as body awareness to our surroundings and the function of our feet. They come in several different styles for different activities as well as different colors for different personalities. Check them out at www.vibramfivefingers.com.

Shoes that are creating their own path in our world Part 2

Simple Shoes

This shoe company has come along way since opening in 1991. The Simple shoes that we know and love today are not at all the same shoes from the 90’s. For about 13 years Simple was just like every other shoe company out there. But in 2004 Simple Shoes had an epiphany and decided to take on the challenge of providing eco friendly shoes to the public. They started small with 2 different styles in 2005 called their ‘Green Toe’ collection. These shoes where a hit and as soon as the ball was rolling for Simple there was no stopping it. Over the past few years Simple has produced with even more shoes that incorporate natural and sustainable materials into their products. In 2006, Simple set a new goal to become a 100% sustainable company. This was a huge step for any company, and a very exciting one at that. In 2007, they took it one step further (we didn’t think it was possible!). Simple shoes started to use recycled materials as well as products found naturally in our world. So now, old tires can gather dirt on people’s feet instead of in a dump. To learn more about Simple Shoes visit www.simpleshoes.com.

Shoes that are creating their own path in our world Part 1

Tom’s

Tom’s are extremely colorful with many different patterns, but this is just a bonus. The best thing about these shoes is that you get two for the price of one! Deals are great aren’t they!! What is even better about this deal is that one pair of shoes goes to you and one pair of shoes goes to a child who doesn’t have any shoes to call their own. Tom’s was started in 2006 by Blake Mycoskie. His inspiration came from seeing children without shoes on his visit to Argentina. A little known fact is that many diseases can be picked up from the ground by being absorbed through the skin on the feet. Another concern is puncture wounds especially when medical treatment is not readily available. These things are not acceptable when there is something we can do about them. So, when Blake came back to the states he got very busy. During his first year in business he gave 10,000 shoes to children all around the world. Tom’s have become increasingly popular over the years. Their expansion has been exciting and inspiring. As of April 2010, Tom’s have given approximately 600,000 shoes to children all over the world! To check out Tom’s shoes online please visit www.toms.com.

5 warning signs of foot problems in children

Foot pain in children is not something to be taken lightly or ignore. Sometimes it is hard for children to tell their parents when they are having foot troubles. Perhaps the child was born with a foot abnormality so their gait, though abnormal, seems normal to them. Or, a child may feel embarrassed about how their feet appear so they don’t want to bring it up. So, it is very important for parents to keep an eye on children's feet to keep them just as healthy as the rest of their body. Remember these feet have lots of miles ahead of them!!

Here are five things to look out for that might indicate your child is having foot pain or problems.

1. If your child is having trouble keeping up with other children~ If your child frequently lags behind other children in sports or other physical activities this could be due to flat feet causing the leg muscles to tire more easily. The muscles and feet become tired easier because the feet are not functioning as efficiently as they could be.

2. If your child suddenly stops wanting to participate in activities they enjoy~ If your child is suddenly not participating in their favorite activities this could be due to heel pain that is common in children ages 8-14. Heel pain can be caused by repetitive stress that occurs while playing sports. Too much strain can lead to pain and inflammation in the growth plate at the back of your child’s heel.

3. If your child is reluctant to show you their feet~ If a child notices a change in their feet they might be embarrassed or nervous that the change could lead to a trip to the doctors office. Start making it a habit early to check your children's feet for discoloration of the skin or nails, growths, calluses, redness, swelling or ingrown nails. Seek podiatric help for any of these signs of a problem.

4. If your child trips or falls often~ Although children are often clumsy while they are getting used to their body, repeated clumsiness can be a sign of in-toeing, balance problems or neuromuscular conditions.

5. If your child tells you they have foot pain~ Sometimes we get lucky and our children will tell us that their feet hurt. If this happens be thankful and take them to see a podiatrist right away. It is never normal for children to have foot pain and since they are growing all the time foot pain should not go overlooked. If injuries cause pain or swelling for more than a few days see a podiatrist asap.

Even if no symptoms are present and your children don’t complain of foot pain it is a good idea to get a yearly check up to make sure that the feet are growing properly.

A Hiking We Will Go

I saw my first through hikers off the AT last weekend at Kroger-Daleville while doing my weekly grocery shopping. It got me thinking about all of the people that have limped into my office off the trail over the years.

Walking up and down steep hillsides and tramping through wet, slippery fields and wooded areas puts stress on the muscles and tendons in the feet and ankles, especially if you haven't conditioned properly before hitting the trail. Also, many don't realize that sneakers aren't the best choice for extended hiking and hunting. Had some of my patients worn sturdy, well-constructed hiking boots, they wouldn't have suffered sprained ankles or strained Achilles tendons.

Make the investment in top-quality hiking boots. Strong, well insulated and moisture-proof boots with steel or graphite shanks offer excellent ankle and foot support that helps lessen stress and muscle fatigue to reduce injury risk. The supportive shank decreases strain on the arch by allowing the boot to distribute impact as the foot moves forward. So if a boot bends in the middle, don't buy it.

In wet and cold weather, wearing the right socks can help prevent blisters, fungal infections. Synthetic socks should be the first layer to keep the feet dry and reduce blister-causing friction. For the second layer, wool socks add warmth, absorb moisture away from the skin, and help make the hiking boot more comfortable.

Don't ignore pain and hope that it will go away. If you are out on the trail, try and take a break to see if the pain subsides. As soon as you are able, make a visit to your podiatrist to determine the cause of your pain. Remember, pain is your body letting you know there is something wrong.

Dedicated To Your Health Feet,

Dr. Jennifer Feeny

For more information visit our website www.roanokefoot.com

Hammertoes

Digital contraction deformities include hammertoes, clawtoes, and mallet toes.



There are three main causes of digital contracture deformity:

Flexor Stabilization- occurs about >70%. The muscles in the back of the foot and leg fire earlier and longer to stabilize the hypermobile fore foot. This results in overpowering the little muscles in the foot causing the hammertoe. It is possible to see rotation of the 4th and 5th digits with this type of deformity.

Extensor Substitution – is associated with a high arch foot, foot drop, and a weakness of the muscles in the front of the leg.

Flexor Substitution – is the least common cause of digital contracture, and occurs due to weakness of the muscles in the back of the leg.

A mallet toe involves bending of the far toe joint downward and may be associated with a long digit.

Hammertoes involve upward bending of the the first bone in the digit and downward bending of the middle bone in the digit.

The clawtoe involves downward bending of both the middle bone and the far bone of the digit.

Symptoms associated with advanced digital contracture deformity include painful motion, painful hyperkeratotic lesion (Thickened Skin), inability to wear regular shoes, contracted painful toe which is short.

Treatment for claw toes and hammertoes depends on the severity of the deformity.

Goals are to keep the foot comfortable:

If biomechanics is the reason for the hammertoe deformity tan the patient can be fitted for custom-molded orthotics.

Changing to a wider pair of shoes, with more depth in the toe box.

Hammertoe pads or Hammertoe cushions can also be used on hammertoes.

Padding placed under the toes, with a strap that is placed over the toes which helps to straighten the toes.

Pads and cushions can help to alleviate pain and irritation of the toes, these pads however will not change the deformity.

It is possible that the soft tissue structures can begin to tighten. A rigid deformity can develop in such a case.


When conservative care fails and there is considerable pain at the hammertoes, surgery is then considered.

Hammertoe surgery involves straightening the toe through either an arthroplasty by removing a small piece of bone of the digit, or arthrodesis (fusing the joint) using a wire or implant.

Arthroplasty is a minor surgical procedure that may be used to treat hammertoes. In this procedure, the head of the first bone in the digit is removed, allowing the toe to straighten. If the affected toe does not straighten sufficiently after arthroplasty, a number of progressive stepwise soft tissue procedures can be used to attempt to straighten the toe.

In some cases an arthrodesis is necessary. Arthrodesis involves fusing two bones together, typically the first and second bones of the digit. The articular cartilage is removed from each bone. They are then held together with either a pin or an implant.

Following surgery, the patient is placed in a surgical shoe or boot and the patients has limited activity for several weeks.

Introducing Dr. Daniel Yeaman

I am pleased to announce that Daniel Yeaman, DPM has joined our team at Shenandoah Podiatry. A native Virginian, Dr. Yeaman recently completed an extensive fellowship in diabetic wounds and limb salvage following a three-year residency, specializing in reconstructive foot and ankle surgery.

His specialties are management and reconstruction of the diabetic foot and ankle. He also treats ingrown nails, skin conditions of the foot such as plantar warts, fungal nails and painful foot conditions such as heel spurs.

He has traveled to Honduras to assist in surgery for children born with foot deformities such as clubfeet and has volunteered locally throughout his education.

In his free time, Dr. Yeaman enjoys hunting, fishing and spending time with his family.

We strive to provide the best care possible for our patients and feel his addition will contribute greatly to our efforts. Please welcome Dr. Yeaman as we all work towards your good health.

Dedicated To Your Healthy Feet,

Dr. Jennifer Feeny

King Tut's Club Feet

When we think about world rulers, the ones who changed history, we usually concentrate on the changes they’ve done rather than think about the human aspects of their lives. Recent CT scans and DNA tests reveal a lot about the great Boy-King of Egypt’s very human life. They found out that he had club feet, Kohler’s disease, and a cleft lip just to name a few, yet he went on to rule the empire of Egypt for 10 years from 1333 B.C. until his death at the age of 19.

It is amazing to see that he was able to rule such a great empire with these ailments despite the physical pain that they cause and also though they caused visual changes in him as well. Club foot is a congenital deformity in which the foot turns inward and downward at birth causing that outer side of the foot to become the area that is walked on. Kohler's disease is a condition, where the navicular bone in the foot undergoes avascular necrosis. Avascular necrosis is a disease resulting from the temporary or permanent loss of the blood supply to the bones. Without blood, the bone tissue dies and causes the bone to collapse. Both of these ailments are very painful and make it extremely difficult to walk.

Often people have a hard time following leaders if they seem physically weak but King Tut was able to pull it off despite being in pain everyday and having to use a cane to walk. It is inspiring to know the lives that people have lead even with foot pain but makes me so thankful that we now have podiatrists and don’t have to live it foot pain!!

Fun fact: Over 130 walking sticks where found in King Tut’s tomb.

Olympic Feet

With the winter Olympics going on right now, it makes me think of all the different sports we are able to participate in. Sports that ask us to run, jump, kick, twist, turn, and glide. Sports that ask for speed and agility that, without the versatility of our feet, would not be possible or at least would look quite a bit different!

The 26 bones and 33 joints in each foot allow us to effortlessly become mobile in many different ways. When I see someone skate their heart out down the length of the ice and stop on a dime, my breath is taken away. Though it may seem like the boot is doing the work, anyone who has ice skated before and had sore feet the next day will tell you otherwise. The complexity of the foot is amazing. And even more amazing than that are the mechanics that make a human foot work properly, the podiatrist.

Though feet are not visible during the winter Olympics, they are still a very important part of the games. A ski or a skate is merely an extension of the foot. Bobsledding wouldn’t be possible without the help of our feet mustering up enough momentum to make the sled go. Even changing the balance and placement of your feet in curling can change your game.

During the 2010 winter Olympics root for team feet! And keep in mind all the amazing things your feet do for you everyday.

Though we are all about feet, we want to recognize those who haven’t given up the games they love because their mode of movement is different than the movement of the original game. We want to recognize how these sports have been modified to work for all kinds of people. For more information about wheelchair and ambulatory sports check out http://www.wsusa.org/.

American Podiatric Medical Association Podiatrists Perform Life-Saving Amputations in Haiti

Above: A team of doctors works to perform foot surgery on a victim of the January 12 earthquake in Haiti.


Bethesda, MD – When a devastating earthquake rocked a vulnerable Haiti on January 12, lives of numerous American podiatrists with ties to the country and its people were rocked, too. For years, American Podiatric Medical Association (APMA) doctors have traveled to the diabetes-plagued nation on a mission to save lower limbs from amputation as a result of the disease. In fact, nearly seven percent of the estimated nine million Haitians have diabetes, and far too many don’t even know they have it. Ironically, APMA doctors, such as Patrick DeHeer, DPM, of Carmel, IN, who set up a diabetes wound care center in Port-au-Prince with the intent of preventing people’s legs, feet, and toes from being amputated, this month found himself back in the devastated city to perform the surgery he tried so hard to avoid—amputations. He did it not because of diabetes, but in order to save lives.

"It is chaos here—terrible injuries, people crushed, compartment syndromes—many of which are ending up in amputations," reported Dr. DeHeer, who served as a wound care director for a field hospital at a United Nations (UN) compound overseen by Project Medishare in Haiti’s capital city. "I just assisted on a below-the-knee amputation with an orthopedic surgeon on a 12-year-old girl. It is overwhelming."

This type of limb removal surgery, such as the one Dr. DeHeer described, has become all too common since the disaster hit. Infections such as gangrene have made amputations imminent without enough antibiotics and proper sterilization. The Pan American Health Organization reports there will be thousands of amputations in Haiti—and nearly half of the people impacted may lose more than one limb. Haiti’s high prevalence of diabetes and lack medicine to properly regulate the disease may only compound the amputation demand, as well as the need for expert podiatric care.

“It’s a tragedy that such an already fragile nation has to deal with such devastation and loss,” said APMA President Ronald D. Jensen, DPM. “As a podiatrist, I know firsthand how tragic it can be for a patient to lose a limb. There is a tremendous amount of help and support that the patient and their family require that is a challenge to provide in the best of circumstances. The people in Haiti will need help for a very long time.”

APMA podiatrists across the country continue to deploy to the shaken country to offer medical assistance. Only time will tell what toll the surge in amputations will have on the plight of the Haitian people.

To read more about APMA podiatrists’ missions to Haiti, visit www.apma.org.

Helping Hatian Feet

It is about three weeks after the 7.0 earthquake hit Haiti. Sadly, the news of this devastating event is fading out of the spot light of our media and out of the minds of those in our country though the effects of this earthquake have hardly vanished from the eyes of the Haitians. Some of us have not forgotten, others of us just need a little reminder to bring us out of our own routine. Perhaps you have been keeping up with the news in your own way; checking blogs, talking to friends, watching videos, doing what you can to not let the Haitians vanish into the rubble that is now their country. Perhaps you have given your time, informed others, or given monetarily to show the Haitians your support. Every little bit helps and giving can be fun especially when you can find ways to give that resonate with things you are passionate about.

Since we are all about feet, we wanted to share some ways with you that will help the feet of the people in Haiti. Through these websites there are several ways that you can find to help protect the Haitians from the debris left by the earthquake.

http://www.soles4souls.org/

http://www.shoes2share.com/

Check them out today!

The Strength of Feet: A Remembrance of Martin Luther King Jr.

Today we remember a man who called on the feet of our country to bring about the changes that we needed. We remember those who marched for freedom and stood strong on their beliefs. We look back into history and take into account the miles traveled towards a more equal future for all Americans in our country.

From the beginning to the end of Martin Luther King Jr’s days as one of the most influential people in the civil rights movement, walking was an extremely important part of the campaign to bring about change. From the Montgomery Bus Boycott to the march supporting sanitary waste workers in Memphis, activists used there feet to get their voices heard and heard they were.

One momentous march, the ‘March on Washington for Jobs and Freedom’ has inspired people everywhere to get off the couch and get moving towards the things they believe in. It inspired local marches throughout cities all over the U.S. during the civil rights movements and beyond. Even today we see different groups of people taking to the streets to stand for what they are passionate about and to bring light to inequalities that unfortunately are still present in our world.

Today, take a few steps and remember those who rallied together and used their feet to peacefully make a difference in our world. Take a few steps for those in our history who have fallen fighting for the freedom we enjoy. Today, take a few steps for Martin Luther King Jr. and everything he stood for.

Common Symptoms for Foot Ailments Part 2

Do any of your toenails curl into the fleshy part of your toe causing pain?

You could have an ingrown toenail. This can occur from cutting your toenails rounded at the corners instead of straight across, tight shoes, injuries, toenail fungus, or infections. Do not attempt to cut the toenail out yourself. If you notice your toenail curling even before it is painful call a podiatrist to get this nail removed.

Do you have stinky feet? Do your feet sweat profusely?

You might have Hyperhidrosis or trench foot. This is caused by sweat glands on the bottom of your foot creating more sweat than necessary. What may start off as just an annoyance or unpleasant smell can cause skin to become thick, macerated or painful.

Do you experience a feeling of sharp pain, cramping, or burning in your feet?

You might have a neuroma. A neuroma is when the nerves are pinched by your toe bones. This pinching commonly occurs between the third and forth toes. Tight shoes irritate the symptoms.

Do you have wounds on your feet that do not seem to be healing in a normal amount of time?

You might have chronic wounds or ulcers due to poor circulation or increased pressure on the wound site. These can be very dangerous if they are continuously left untreated. They can become seriously infected or even gangrenous and in severe cases can lead to amputation. Treatment plans can be offered by podiatrists to help the healing process and in most cases can heal in a few months.

Do you have painful growths on the underside of your heel bone? Do the arches of your feet hurt when you get up in the morning?

You might have heel spurs also known as Plantar Fasciitis. This is caused by a strain on the ligaments and muscles attached to your heel bone that lead to the membrane covering the bone to tear. This leaves the ligaments becoming inflamed and the heel bone lacking its natural protective barrier.

If you are experiencing any of these symptoms please call our office and make an appointment today. Don’t live with foot pain any longer! The sooner you get into an office and get your foot pain diagnosed the sooner something can be done about it.

New Year's Resolutions

New Year’s resolutions are exciting and can be a great way to motivate us to achieve life goals that we have. Resolutions can range anywhere from breaking old habits to creating new lifestyles. One resolution that many Americans hold is to lose weight. After the holidays we are not pleased with how the scale reads, so we decided to exercise more and eat right. This is a great change that more Americans should try but there is only one problem. Excessive exercise after you have not been active can be very dangerous for your… FEET!! Feet take quite a beating with new strenuous workout routines. Plantar Fasciitis, Neuromas, and Achilles Tendonitis are a few ailments that can occur due to over exercise and shoes that are too tight. Not only do these ailments lead to sever foot pain, they also make these great resolutions extremely hard to reach. To decrease your chances of foot pain or injury and increase your chances for success, take things slow. Set up a routine that will ease you into the healthy lifestyle you want to achieve. This will help your body adjust and provide a strong foundation to keep building on. If you are investing in new shoes, shop at night when your feet are swollen from the day and make sure to get your feet measured first. This will help you get the correct size shoe. Make sure to stretch your feet before your routine. This sounds silly to most people but it is so important! Lots of injuries could be avoided if you stretch before and after your work out. It’s wise to speak with a podiatrist or physician to make sure your work out plan will not cause more harm to your body than good. Finally, if you want to make New Year’s resolutions but can’t because foot pain is keeping you bound to your chair, don’t worry, there is hope and there are people waiting to help you. Call your podiatrist today and start a new year pain free!!