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)