How to Tell If You Have Flat Foot and What to Do About It | Robyn Adams, CPed

Flat feet, do you have them, or do you have feet that flatten?  There are a few ways to tell the difference.  I will discuss a couple of them.  When seated (non weight bearing), put one leg across the other with the outside of your ankle on top of your knee and keep the foot relaxed.  Can you see the curve of your arch on the foot that is crossed over the knee?  If so, then I say that foot is not flat because you can see the curve.  If you cannot not see the curve in your arch then your arch may be low or the foot may be flat. While standing (weight bearing), look at your wet footprint on the floor/pavement.

You should see your toes, the balls of your foot, the heel, and a line that is also wet that connects the heel to the balls of your foot.  If the connecting line between the heel and ball of the foot is as wide as the front of the foot then your foot either flattens or is flat. The lower the arch, the wider the line between the heel and ball of the foot.  The higher the arch, the thinner the line between the heel and ball of foot will be.  Flat or flatten, neither conditions have to be painful. None of these techniques are a definitive diagnostic tool for flat feet.
If you have foot pain and suspect that you may have flat feet or feet that flatten, you should visit a podiatrist or go to a shoe store that specializes in foot function and that performs gait analysis. Either way, flat or flattened feet don’t have to be painful but they can be. There are several things that can be done to care for flat feet or feet that flatten.  Through a store that specializes is proper foot function and gait analysis, getting a proper fitting shoe alone or one that is modified can help.  Over the counter inserts combined with the shoe may also help. Wearing custom arch supports inside the shoes will help to give you foot the support where you specifically need it.  Ask your doctor or podiatrist, pedorthist and or store staff about the benefits of using these devices for flat feet or feet that flatten.


How Does Advanced Imaging Help Diagnose and Treat Foot and Ankle Ailments | Kevin Ray, DPM

Sherlock Homes was one of the world’s most famous detectives.  He was known for his observational ability, logical reasoning, and extremely high index of suspicion.  In the 1800s, investigations required a nose for the unusual and a foothold in the case.  This made Holmes the most sought after investigators of his time.

Today, physicians are world renowned medical detectives.  We must attempt to capture some of Sherlock’s natural abilities in observation and reasoning.  Everyday a new case presents itself for investigation and some of these cases have lifelong or deadly consequences.  Fortunately, we are not limited by the natural abilities of physicians. We have advance technology that can assist us during our investigation.

Magnetic Resonance Imaging(MRI) and Computed Topography(CT) are two of those advance imaging devices that will assist the physician in diagnosing and treating many medical conditions including foot and ankle ailments.  These two devices are very unique in that MRI is best for soft tissue concerns and CT is best for bony concerns, simply.  Often times they can be used in combination, in order to facilitate a more specific or accurate treatment plan.

Picture this, Dr. Achilles is evaluating Mrs. Foot for pain and swelling in her ankle.  Pain and swelling has been present for several months.  Mrs. Foot reports that she fell off of her step some time ago but did not seek medical care.  She applied ice and wrapped it up; though pain and swell is better it’s still present.  Dr. Achilles suspects that Mrs. Foot has broken her ankle or has a tendon or ligament rupture.  He sends Mrs. Foot for a CT and MRI to evaluate her bones and soft tissues.  With the utilizations of these advance images, Dr. Achilles concludes that Mrs.  Foot has fractured her ankle, torn several ankle ligaments and has devised a treatment plan that will get Mrs. Foot back to activity quicker.

The use of advance imaging has several practical benefits to today’s foot and ankle patient.  These benefits include better diagnosis, safe and effective, and decreased healthcare cost.  The devices aid the physician in making better decisions and understanding the complexity of the human foot and ankle.   The National Institute of Health reports that radiation has great benefit to humanity and carries a lower risk than driving to work.  Advance imaging makes healthcare more affordable because it reduces the need for invasive or exploratory procedures allowing physicians to drastically reduce your treatment cost.

Physicians Footcare, South Carolina’s largest provider of foot and ankle care, employs each of these advance imaging devices in order to provide our patients with high level, affordable foot and ankle care.  We are extremely proud to be the first in the United States to offer mobile CT imaging allowing us to improve care in rural communities.  As your leading foot and ankle detective, Physicians Footcare believes in the importance of advance imaging aiding in the evaluation, management, and treatment of your medical concerns. “Elementary, my dear Watson.”


Physicians Footcare welcomes Paul Shromoff, DPM

Physicians Footcare is pleased to announce the addition of Paul Shromoff, DPM to our team.

Dr. Shromoff will be seeing patients in May at our Summerville location, located at 515 Carnes Crossing Boulevard.

Call today to schedule your appointment.


Debunking Myths: Podiatrists are Only for People With Foot Pain | Gregory Santamaria, DPM

A podiatrist is a doctor of podiatric medicine (DPM), a physician and surgeon who treats the foot, ankle, and related structures of the leg. All too commonly, there is a misconception that podiatrist only treat foot related pathology. However, foot pathology only makes up a portion of what podiatrists actually treat on a day-to-day basis.

Podiatrists also provide treatment for ankle and related soft tissue pathology of the lower leg. The ankle is made up of three bones—tibia, fibula, and talus. The talus sits above your heel bone and supports the tibia (your shin bone) and the fibula (thinner bone found next to the tibia). These three bones are held together by multiple ligaments that surround the ankle joint.

Some of the more commonly encountered ankle conditions podiatrists treat include: ankle sprains and strains, ankle instability (recurrent giving way of the outer (lateral) side of the ankle), ankle fractures, peroneal tendonitis, achilles tendonitis and achilles tendon ruptures. But that’s not all – podiatrists also treat soft tissue pathologies on the lower leg such as lipomas, ganglion cysts and wounds.

The most common causes of ankle pain are ankle sprains, both acute and chronic. An ankle sprain usually occurs because the foot twists beyond its intended range. This overstretches, or even tears, ligaments that hold the ankle together. Some people may think an ankle sprain is something that only happens to athletes, but anyone who walks could, and most likely will, suffer from this injury at some point in their lives. All it takes is misstep down a curb or stepping on uneven terrain.

Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely. When you sprain your ankle, the connective tissues (ligaments) are stretched or torn. The ability to balance is often affected. Proper rehabilitation is needed to strengthen the muscles around the ankle and retrain the tissues within the ankle that affect balance. Failure to do so may result in repeated ankle sprains.

Repeated ankle sprains often cause—and perpetuate—chronic ankle instability. Each subsequent sprain leads to further weakening (or stretching) of the ligaments, resulting in greater instability and the likelihood of developing additional problems in the ankle. Without proper rest and rehab, an ankle sprain can lead to chronic ankle instability. People who suffer from ankle instability usually complain of persistent discomfort, pain and swelling, additionally described is an ankle feeling wobbly or unstable.

Therefore, it is important to rest, ice, compress and elevate the ankle following an injury. As the swelling and pain improve, proper rehab should take place. Failure to do so can lead to long-term issues. Likely on account of how common they are, most people think a sprained ankle isn’t really a big deal. With proper care and attention, they might be right. So next time you injure your ankle, don’t forget that the podiatrists at Physicians Footcare are here to help get you back on your feet.


The Do's and Don'ts of Open Toed Shoes and Sandals | Bridget Moore, DPM

As spring approaches, those of us living in warmer geographical regions are itching to pull out our open toed shoes and sandals. But before you slip on a pair of warm weather friendly shoes, make sure you are mindful of these criteria:

  1. Toebox: Only wear open toes shoes with a wide toebox that applies as little pressure on the toes as possible. Beware of peep toe shoes and sandals that are too narrow.
  2. Arch Support: Get sandals and open toed shoes that have an arch support already built in. There are several shoe companies that make orthotic based shoes, slides, thongs, and various strapped sandals.
  3. Non-flexible, thicker sole: Shoes that are too flexible create too much stress on your foot muscles, tendons, and joints making them more prone to injury. Thicker, more rigid soles create intrinsic stability and decreases motion, thus minimizing inflammation and pain.
  4. Motion/Rearfoot Control: The back of your foot needs control and this can be accomplished by wearing sling backs and sandals with a heel strap. Backless shoes force the front part of your foot to strain, making your toes work hard to grip the ground in order to stabilize you. This can promote the formation of bunions and hammertoes.

When in doubt, check with your podiatrist for the best shoe recommendations. While one shoe type may be recommended for those with a particular foot type, they may be dangerous or uncomfortable for you. Professional advice is always best.


How Foot Care Effects Your Overall Health | Aaron Haire, DPM

Hey, you. When is the last time you had your feet checked or paid them any attention? Your feet are vital parts of your body that, when properly taken care of, can help with holistic health.

Your feet are essential for walking, it’s the way us bipedal creatures get from one place to the next. The feet and lower extremities are the basis for all human locomotion. When our smooth motion is inhibited by deformity, disease or injury it takes a toll on our general health. Maybe you remember a time you might have been injured and had to be on rest, immobilized or bed bound in order to heal. Well, during that time of incapacitation you also might have noticed you general well being declined. You physically deconditioned, you might have gained a few extra unwanted pounds and your mood may have not been as rosy as it usually is. This is because with motion being such a huge part of human life, we depend on healthy free functioning lower extremity to help us to burn calories and to keep our muscles toned. Some of the largest muscle groups found in the human body are contained within the lower extremity, namely our glutes, hamstrings, and calfs. With muscle being so metabolically active, the more toned you get with exercise the easier it is for muscle burn calories that otherwise would be stored as fat.

Secondly, the alignment of the joints in your feet matter and affect the alignment of the other joints in your knees, hips, and spine. Having feet that are misaligned from deformities such a flat feet or high arch feet is analogous to driving your car around with unbalanced and unrotated tires. In a car if you continue to drive for thousands of miles with tires that either toe in or toe out too much, it will eventually cause problems with the rest of the car. You may find yourself spending money on brand new tires much sooner due to uneven wear, the shocks and alignment of the chasis will become damaged, and your fuel/oil economy will suffer. Analogous to feet if you continue to run or walk around on feet that or flat or feet that have high arches or other deformities you may find yourself dealing with constant repetitive injuries such as tendonitis, tendon ruptures ankle or foot sprains, and stress fractures. If these issues go on unchecked for long enough the joints in your feet, ankles, knees, hips, and spine will take a beating ending in the painful contention called arthritis. Treatment of arthritis pain most commonly results in surgical procedures to fuse together painful joint or replace the joint with artificial implants in attempt to retain normal or near normal motion.

Lastly, your feet are essential to your mood and mental health. If you have you ever gone for a run or enjoyed a nice walk on a perfect spring day, you know that your feet are essential for you to be able to enjoy such things. When the human body performs exercise or exposed to fresh air and sun light our bodies release endorphins, or feel good hormones. Feet that suffer from deformity or neglect are subject to cause chronic pain or disability which takes you away from the simple activities that give life meaning and bring you enjoyment. It’s hard to be happy and keep a positive outlook on life with chronic pain.

In closing, cherish and care for your feet as you would the rest of your body and they will see you through a life time of amazing moments.


How to Prevent Ingrown Toenails | Pat Nunan, DPM

Ingrown toenails can be very painful, lead to infection, limit shoe styles and even cause people to miss work. While not always successful there are steps you can take to help prevent ingrown toenails.

DO NOT CUT THE NAILS TOO SHORT OR DOWN IN TO THE CORNERS. 

AVOID SHOES THAT ARE TOO NARROW OR TOO SHALLOW IN THE TOE AREA.

CUT THE TOENAILS STRAIGHT ACROSS. 

PLACE A SMALL AMOUNT OF COTTON BETWEEN THE NAIL AND THE SKIN.

APPLY ANTIBIOTIC AND BAND-AID AROUND THE NAIL

SOAK FEET IN WHITE VINEGAR AND LUKEWARM WATER.

If you see pus, feel extreme pain or the toe turns red, see your podiatrist right away.  In some cases you may need oral antibiotics along with cream or ointments.  Do not attempt bathroom surgery on yourself.  At Physicians Footcare, we have the knowledge and experience to help you with ingrown toenails and many other foot problems.


Choosing Running Shoes for New Runners | Demond Thompson, C.Ped

New year, New resolutions…. For those of us that has chosen running as one of those resolutions, we are pretty excited to get out and put in some miles, but before you start pounding the pavement and chasing those miles, lets make sure you have the proper running shoes. Running is a simple beauty, and the benefits of a well fitted running shoe can make all the difference in the world.

When trying on running shoes they will often feel comfortable while you’re standing in the shoe store, but the true test comes after several miles into your run. Understanding your running style and foot type will benefit you in choosing the right running shoes. When it comes to running shoes, how they  fit is one of the most important factors to consider. An ill-fitting running shoe will not only make your running experience painful, it may also cause you to change your stride, leading to potential injury. Your feet tend to spread as you run. They also tend to swell a bit throughout the day, so trying on your shoes in the afternoon or evening may provide a more accurate fit. To accommodate foot spread, there should be roughly one thumb width between the end of your longest toe and the end of the shoe. Your shoes should wrap comfortable around your feet, they should not pinch or feel sloppy, and your feet should be centered on the platform of the shoes. Some shoes may better accommodate a narrow or wide foot, additionally, some shoe models are available in either wider or narrower size options. Standard shoe widths are Wide for men and Medium for women.

When choosing a running shoe, consider your style of running: trail running, cross training or road running.

  • Road running shoes are designed for pavement, they’re usually light and made to cushion and stabilize your feet on hard surfaces.
  • Trail running shoes are designed with aggressive treads that provides solid traction, stability, and protection while running off road on uneven terrain, such as rocks, mud, roots or other obstacles.
  • Cross trainers are designed more so for gym type workouts. These shoes are designed to give you more contact with the ground more so then the previous mentioned shoes, due to their thicker platform.

How do you run? Knowing how you run is very important when choosing the right running shoes. If you have an old pair of running shoes check the wear pattern to help you determine your running mechanics.

  • Neutral Foot: The wear pattern you will see in for this foot type is a wear pattern centralized to the ball of the forefoot and a small portion of the out side heel (The right side of the heel if you’re looking at the right shoe from the back, and the left side of the heel if you’re looking the left shoe from the back). This pattern shows  the foot’s natural heel strike, to mid stance to toe off (your gait). The neutral foot type helps absorb impact, by relieving pressure on the knees, hips and lower back. It is the normal trait of biomechanically efficient runners.
  • Overpronation (Flattening of the arch) The wear pattern you will see in this foot type  is a wear pattern along the inside edge of your shoes. The wear pattern will be medially located to the forefoot and rear foot (this will be the right side of the left shoe under the big toe and the heel, and the left side of the forefoot and heel of the right shoe if you’re looking at the shoes from the back). Overpronation is one of the most common foot types that affects runners, this foot type can leave runners risk of knee pain/ injury, heel pain, Achilles tendon pain/ injury ect. This foot type need stability or motion control shoes.
  • Supination (High arch): The wear pattern you will see in this foot type is a wear pattern along the outside edge of your shoes. Very few runners supinate, but those who do will benefit from a shoe with plenty of cushioning and flexibility.

Running can be rewarding, fun, and relaxing, but it also can cause a lot of harm if you’re not in properly fitted shoes. For more information, contact us for a free gait and foot evaluation today.


On a New Year’s diet? That may have an effect on your feet | Sabina Abbasova, DPM

It is the beginning of a new year and gyms are once again packed with enthusiasm. Space is becoming limited in and yoga and barre studios. The sales of books preaching paleo, vegan and ketogenic eating diets spike and you find yourself trying to figure out which direction to take your fitness and health goals.

 

While every nutrition program may come with its benefits, most people rarely take a moment to evaluate the effects that diet may have on our legs and feet. A Western diet, with which most of us are familiar, is rich in carbohydrates such as bread, rice, pasta and potatoes. In order to maintain a steady blood glucose level for healthy function, the pancreas works restlessly to pump out insulin, which is critical in shuttling the glucose out of the blood and either to our muscles and brain to be utilized or to be converted into energy reserves as glycogen or fat. A high carbohydrate diet is essentially a high glucose diet at the metabolic level and has your body—more specifically your pancreas—working very hard to keep the balance. The pancreas, like any other organ, is at risk to wear out if overworked. Another serious consequence of constantly elevated glucose and insulin levels is resistance to insulin, which occurs as the insulin sensitivity in the muscles decreases. We see a steady rise in diabetes as a direct consequence of the Western diet with devastating effects on the neurovascular system leading to thinning brittle skin, peripheral vascular disease and neuropathy.

 

Choosing a diet high in protein and increasing intake of meat and fish may help with controlling insulin spikes, blood glucose and appetite. However, the high protein diet may not be best for everyone due to the increase in uric acid level that would be added to the diet. Most animal derived protein has high levels of uric acid and people with decreased ability to excrete the acid or people who are natural overproducers of uric acid may develop a painful condition of Gouty Arthritis, better known as “Gout”. The common symptom of a Gout attack is a red, hot and swollen joint. The condition is commonly isolated to one joint at a time as the uric acid condenses into crystals, which leads to pain and joint erosion. In the foot, it is commonly the first metatarsophalangeal joint proximal to the great toe.

 

Some people may consider adopting a vegan or a vegetarian diet for ethical, environmental or the health benefits. It is important to keep in mind that Vitamins B6, B12 and folic acid are essential for healthy functioning blood cell and myelination, the covering of nerve cells. A strict vegetarian diet would promote a B12 deficiency as animal based foods such as red meat, dairy products, fish, poultry and eggs are the only recognized source of dietary B12. Without proper oral or injectable supplementation, eliminating animal derived food products may put one at risk for anemia and serious nerve damage leading to neuropathy. One of the first symptoms of neuropathy is the tingling and numb sensation of the feet.

 

Most Americans cite lack of time as the reason to have neglected making healthier choices. The savvy entrepreneurs noticed a need and there are now many options for delivery companies that will help you with your dinner plans. Walking down the aisle of your local grocery store frozen foods section, you notice that there is no lack of options for convenience foods. The controversial topic of preservatives aside, we need to be cautious of the sodium in conveniently packaged foods. While prepackaged meals advertised as healthy can help us with controlling the calorie intake, the increase in sodium may contribute to swelling and aches of the legs and feet that some people feel at the end of a long day.

 

It is possible that the change in your diet is the reason for an inflamed joint, swelling of the legs and feet or the tingling sensation of your toes, but taking your health to online research is never enough. It is essential that you speak with your medical and foot care provider about these symptoms. Your provider will help with narrowing down the differential diagnoses for the symptoms of the neuropathy and you may need follow-up testing or imaging for appropriate treatment. Of course, it is recommended to consult your provider before making significant changes to your diet and/or level of physical activity.


Prevention of Achilles Tendon Ruptures | Christopher Tyree, DPM

Achilles tendon rupture is not only a condition that has to be worried about for the high end athlete but also the weekend warrior, and aging athlete. The peak age for achilles tendon rupture is 30 to 40 years old. This is due to a variety of factors however top risk factors as we age are an increase in weight accompanied with a decrease in elasticity, and blood flow to the achilles tendon.

However there are additional risk factors that one should consider at any age. These include activities that involve running, jumping, or sudden starts and stops. This often happens during certain sports such as jumping to catch a pass in football, accelerating quickly in basketball, and jumping to block a hit in volleyball. Obesity also can play a role in achilles ruptures as the additional weight will put more strain on the achilles while performing certain exercises.

Steroid injections also weaken tendons, for this reason if you have a cortisone injection into the foot and ankle if near the achilles even if not directly into the tendon, there is an increased risk of rupture. Finally certain antibiotics under the fluoroquinolone family can increase risk of rupture. The key with these general risk factors is to separate the out. If a person is on a fluoroquinolone antibiotic or has recently had a cortisone injection it would be advised to stop exercise that strains the achilles tendon for a period of time. In addition if one is obese it would be advised that they start with low intensity exercises to lose the weight before directly jumping into high impact activities.

If you are participating in an activity in a competitive environment, and you are taking precautions as described above there are still additional steps that should be taken. First it is important to stretch and strengthen calf muscles regularly.

When strengthening or exercising using the calf muscle start off slowly and slowly increase the intensity of the exercise rather than jumping directly into very strenuous exercises. Choose proper shoe gear for the proper environment in order to prevent slipping or falling that may increase strain on the achilles, avoid running in ice and snow if possible. Finally try to alternate between high impact and low impact activities.

Achilles tendon rupture is indicated when you hear and or feel a pop in the back of your calf. Often accompanied with a feeling of being kicked in the calf. Followed by an inability to raise one’s body weight with the calf. However you may also partially rupture or tear the achilles, as well as my have an injury to the heel bone or surrounding structures. This can often be delineated by a visit with a podiatrist. In addition achilles ruptures can be prevented by preventing a podiatrist. If you are feeling pain in the back of your calf, or at the heel imaging can be performed looking for calcification of the tendon, which may increase your chance of rupture.

Hopefully after reading this article you understand that achilles tendon ruptures like many other injuries can often be prevented. Rather that be from stretching, weight loss, or by visiting a podiatrist. This is vital to understand as prevention is allot easier than treating a ruptured tendon.