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!

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.

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.

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)

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

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

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.

Common Symptoms for Foot Ailments

Do you suffer from itching or scaling between your toes? Have you experienced this sensation in the past but now your feet are painful, inflamed, and possibly have blisters?

You might have Athlete’s Foot. Athlete’s foot is a fungus that enjoys the dark dampness between your toes. This is usually taken care of with an anti fungal cream or powder.

Does your big toe point towards the rest of your toes? Does your big toe look like its overlapping or invading the space of your second toe? Does the portion of bone that connects your big toe to your foot look like its protruding from your body?

You might have bunions. A bunion occurs when the bone starts pointing outward. This puts extra pressure on the toe joints which can cause inflammation and pain. Different splints and spacers can help slow this process or relieve pain but surgery is the only way to correct it.

Do you have sections on the skin of your foot that seem thicker than the rest of the skin?

You might have corns or calluses. These can be red flags for more serious foot ailments because they are caused by constant rubbing. These should only be removed by a professional.

Are your toe nails discolored, misshapen or smell? Is it painful to walk?

You might have toe nail fungus. The fungus can be gotten rid of by topical or oral medication. In extreme cases the toe nail will be completely removed so a healthy nail can have the freedom to grow.

Do you have severe and sudden attacks of pain, redness, or tenderness in your joints?

You might have gout, a form of arthritis that is caused by a build up of urate crystals in your body. These crystals are formed by uric acid, a by-product of breaking down of proteins. Different forms of therapy are now available to help cope with Gout.

Like any medical condition, the key to getting healthy faster is by listening the symptoms you have and treating the problem right away instead of just ignoring them and hoping they will go away. The sooner you see a podiatrist for your feet ailments the sooner your life doesn’t have to be run by them.

Pain In The Ball Of Your Foot

Metatarsalgia is a foot condition involving pain and inflammation in the ball of the foot just behind the toes. Pain may range between sharp, aching, or burning. Other symptoms may include pain that worsens with standing, walking, foot flexing, or running and improves with rest; sharp or shooting pain, numbness, or tingling in the toes; or increased pain when walking barefoot. Some patients describe a sensation similar to walking on pebbles. The primary cause of metatarsalgia is due to excessive pressure on the metatarsals, the bones that connect to the toes. Runners and others who participate in high-impact sports are most susceptible to metatarsalgia. Certain foot structures may also make a person more vulnerable to the condition.

Correcting foot problems has greatly improved over the past few years. Today’s newer treatments and techniques include special foot care products, custom orthotics, innovative, less invasive surgeries, even joint replacement. Your feet are not supposed to hurt. When they do, we are available at SHENANDOAH PODIATRY to ease your pain and get you walking in comfort.

For more information visit our website www.roanokefoot.com

Living With Gout

Gout is a form of arthritis that primarily attacks the big toe and causes redness, inflammation, and pain in the area. An initial attack of gout tends to last several days and may even disappear without treatment, but future attacks are typically more severe. To prevent repeated attacks of gout, several lifestyle choices should be made. Because gout is typically caused by an impaired ability to process uric acid, avoiding purine-rich foods like meat can help prevent episodes. Drinking enough decaffeinated, non-alcoholic beverages (water, juices) and losing weight, if necessary, can help patients manage gout. Reducing alcohol consumption and taking medications as prescribed are also recommended. Following your doctor’s recommendations and treatment plan for gout is important to reduce painful attacks.
While our specialty at SHENANDOAH PODIATRY is feet, our work in podiatry can affect all parts of the body. And as podiatrists, we have a unique opportunity to get an insight into how other systems of the body are working. With our knowledge and experience, your cooperation, teamwork with other medical caregivers, and the wonderful power of podiatry, we’ll have you once again walking with a smile. When gout or other foot aches and pains have you wincing with every step, it’s time to call our complete foot care facility, where same day appointments are often accommodated.

Dedicated To Your Healthy Feet,
Dr. Jennifer Feeny

P.S. Ninety-five percent of gout patients are men

What Is A Pedorthist?

You know that you make an appointment with a podiatrist for any foot ailments or injuries. But have you heard of a pedorthist? Many podiatric practices now engage the services of pedorthists to extend the value they provide patients. The field of pedorthics encompasses the design, manufacture, modification, and fit of footwear, orthotics, and devices to alleviate foot problems caused by disease, overuse, or injury. Pedorthists are certified by the Board for Certification in Pedorthics and must fulfill and maintain specific educational requirements to practice. Some of the more common disorders that pedorthists address with footwear treatment include heel pain, flat feet, high arches, hammer toes, pain or calluses in the balls of the feet, fallen arches, diabetes and arthritis.

At SHENANDOAH PODIATRY, we use today's high-tech diagnostic tools to fit orthotics and to detect foot imbalances, problems, and disorders, and to help determine the most appropriate treatment with more accuracy than ever possible before. We also use the most up-to-date materials for orthotics and other treatment modalities, always with the comfort of our patients in mind. Find out the many ways available today to keep your feet in the best of shape. Call us for comprehensive, family foot care.

Dedicated To Your Healthy Feet,

Dr. Jennifer Feeny

P.S. Improperly fitting footwear is one of the leading causes of foot pain.