Don't be like Brady!

You don't have to be a football fan to know that the New England Patriots are no longer contenders for the Super Bowl this year. News of their seven point, playoff loss to the New York Jets spread like wildfire. Not as widely known, however, is that Patriots quarter back Tom Brady was battling a stress fracture in his right foot all season. He played through the pain all year and only went in for surgery to repair the injury when Super Bowl XLV was out of the picture. In this way, Brady is so much like the rest of us whether we want to admit it or not. Love him or hate him, you're just like him because you probably postpone visiting the doctor until absolutely necessary.
So many of us either try to work through pain or diagnose and treat ourselves. I can't tell you how many times I've found one reason or another to put off seeing my doctor about a health issue. All too often I hear "I don't have time to go to the doctor" or "I'd have to leave work early to get this looked at." It's scary how common this phenomenon is because our health isn't something that we should gamble with. Untreated injuries or illnesses can often develop into something much more serious than the original problem. That pesky ingrown can lead to a dangerous infection. That painful foot injury might need surgery but then again it might not. The point is that you won't know until you get it looked by a professional.

Make time. Leave work early. Schedule an appointment to see Dr. Feeny or Dr. Yeaman. Your feet will thank you for it and you'll save yourself a lot of grief in the long run.

Fact or Fiction: There Is Nothing You Can Do For a Broken Toe?

Your alarm clock, conveniently located on the other side of your room, starts buzzing bright and early. No need to turn on the light…you know the way, BAM! You walk, barefoot, right into the dresser! Just like a cartoon character, you see stars. As your day continues, you can’t get past the throbbing pain. You know you have broken your toe.

Throughout the day your toe begins to bruise and swell. Wearing a shoe, or even walking, is excruciating, maybe even impossible. You know you need to call a doctor, but what did your mom always tell you? “There’s nothing you can do for a broken toe.” Will it be a waste of everyone’s time if you make an appointment with your podiatrist? Should you simply deal with the pain? But the pain is so bad…was your mom really right? Is the rumor true?

When people tell you nothing can be done for a broken toe they normally mean that a cast is not applied. A cast, made of plaster or fiberglass, is the most recognizable treatment for a broken bone. Does that mean if you don’t cast it, you’re not treating the broken bone? No!

The great toe has two bones in it, with all others having three. Although small, they are classified as long bones, just like an arm or leg. When any bone, especially a long bone, breaks, it is very important to make sure that it is not displaced; otherwise it will not heal properly.

During your appointment with us, we will take an X-ray and then be able to advise treatment. If the bone is not displaced, treatment can be as simple as applying a “buddy splint.” This is a splint that simply attaches the broken bone to an adjacent digit. This provides compression and stability.

If you have displaced the bone, most of the time we can realign the bone right here in the office. It involves numbing the toe and using traction to get the toe in a good position. In most severe cases, surgery may be necessary.

I know you may find it hard to believe but sometimes broken toes can become a medical emergency! Anyone who has poor circulation, such as a person with diabetes or peripheral artery disease, can end up with a spasm of the small arteries caused by the trauma, which can shut down the blood supply to the toes. If immediate care is sought, this can be reversed. If left untreated for even one day, however, amputation may be required.

So next time someone tries to argue that there is nothing you can do for a broken toe, let them know that the doctors at Shenandoah Podiatry informed you otherwise. The sooner you receive care, the quicker the pain and swelling will be reduced. Don’t be fooled by the popular rumor, call us right away!

Are your “ugly” toenails embarrassing you?

Do your thick, discolored, unsightly toenails cause you too much embarassment? Do you find yourself refusing to wear your sandals in the summer? Are you nervous that the infection will spread? Don’t worry, we are here to help!

Fungal toenails, or onychomycosis, are one of the most common conditions a podiatrist sees. Fungus is a naturally occurring component on the skin and nails, especially in the foot. If ignored, the fungus can cause an infection. Infection is especially prone when there has been a trauma to the toenail.

Are you unsure if your toenail is fungal? If your toenail appears thickened, yellowish, and crumble, chances are you have a fungal infection. People who have some immune compromise, such as diabetics, are more likely candidates for fungal infections. These people are also at risk for more severe infections if the fungal infection is ignored.

How do you treat fungal infections? There are many over-the-counter medications and preparations available, as well as many popular home remedies, which provide no cure. Fortunately, the podiatrists here at Shenandoah Valley Podiatry can evaluate and treat fungal infections with various medications that provide complete cures. No more “ugly” toenails for you!

Whether it be a prescription topical medication or an oral medication, a cure is possible. Remember, the nail is slow to clear so make your appointment today. We will cure you of your infection AND your embarrassment!

Winter Tips for Cold Feet

Brrr! Winter is in full force here in the valley and that means it’s COLD. During this time of the year we often pile on layers to protect our core but tend to forget about our extremities. If you’re looking for tips on how to keep your feet warm this winter, Shenandoah Podiatry can help.
Socks made from natural fibers – like wool – should be worn because they have moisture-wicking properties. This helps to prevent fungus which grows best in warm, damp places. Leather shoes can also keep your feet warm because leather has natural insulating properties. If you choose to wear insulated boots, be sure that they aren’t too tight as this can cause ingrown toenails. Avoid electric socks and other heated inserts because they can be dangerous especially if there’s an underlying reason for your cold feet.

Aside from winter weather, cold feet can be caused by a number of serious ailments that should be addressed right away. If our feet are cold year-round, we might be especially quick to write it off as normal during the winter. Unfortunately, cold feet can be indicative of a more serious problem and should never be ignored.

Peripheral vascular disease (PVD) or poor circulation is a common culprit. Blood helps to keep us warm and without proper circulation our bodies direct heat to our core and away from out feet. If you smoke or have diabetes, you have an increased risk of developing PVD which can make it harder for small cuts and ulcers to heal properly. This is why it’s so important to see a podiatrist right away if one of these sores develops.
Diabetes can also put you at risk for chilbains or ulcers of the toes and feet after cold exposure. If you experience redness and swelling in your toes after being outside and it doesn’t go away once they’ve warmed, make an appointment to see us right away.
We hope that you’ll follow these tips and be on the lookout for these possible conditions. If you do, you’ll find it easier to keep your feet warm this winter which is important because warm, dry, pain free feet are healthy feet.

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.

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/.

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)

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.

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