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.

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.